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Objective:To investigate the effect of ultrasound-guided erector spine plane block(ESPB)on postoperative analgesia in elderly patients undergoing abdominal operation.Methods:This was a prospective study.A total of 50 patients undergoing cholecystectomy and choledochotomy under laparotomy and general anesthesia were divided into two groups(n=25, each)according to the random number table method.The patient-controlled intravenous analgesia was named as the group P, and a single ESPB(the group E)was conducted with 0.33% ropivacaine 30 ml before induction of anesthesia as add-on to the management of group P. The block rang of ESPB, visual analogue scale(VAS)at 4, 12, 24 h postoperatively, number of analgesia pump pressure, number of patients receiving parecoxib sodium medication, complications related to the ESPB including dyspnea and local anesthetic systemic toxicity and anal exhaust time were recorded in the two groups.Results:The range of pain block in group E included the spinal innervation area(T5~T12)(13 cases)and(T6~L1)(12 cases). Compared with the group P, the group E showed that EVAS scores at 4, 12, 24 h postoperatively were decreased(4.2±1.1 vs.1.4±0.6, 4.0±0.8 vs.1.8±1.2, 3.5±0.9 vs.2.0±1.1, P<0.01), the number of analgesia pump pressure and the number of patients receiving supplemental parecoxib sodium were decreased(2.5±0.9 vs.9.9±1.5, 20.0% or 5 cases vs.64.0% or 16 cases, t=10.566, χ2=9.934, P<0.01), and the anal exhaust time was shortened[(20.1±1.9)h vs.(24.5±2.1)h, t=7.388, P<0.01]. No patients had dyspnea or local anesthetic toxicity. Conclusions:Ultrasound-guided ESPB has less complications, lower dose of postoperative opioid analgesics, faster recovery of postoperative intestinal function.
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Objective:To investigate the effects of driving pressure(DP)-guided individualized positive end-expiratory pressure(PEEP)on intraoperative pulmonary function in elderly patients undergoing robot-assisted laparoscopic radical prostatectomy.Methods:This was a retrospective case-control study.A total of 40 elderly patients undergone robot-assisted radical resection of prostate cancer were enrolled and divided into the control group and the DP-guided group(n=20, each group)based on the random number table method.Data on the peak inspiratory pressure(PIP)at time points including 4 min after the first PEEP set(T1), 4 min, 1 hour, 2 hours(T2-4)after the second PEEP set, and 1 min after closing abdomen(T5), lung compliance(Crs), PEEP and the partial pressure of carbon dioxide in end expiratory gas(PetCO 2)were recorded and compared between the two groups.Blood gas analysis was conducted, and the oxygenation index(OI), alveolar-arterial oxygen tension difference(A-aDO 2)and the dead space volume/tidal volume(Vd/Vt)were calculated. Results:Compared with the control group, Crs, OI and PaO 2 were increased and DP, Vd/Vt, A-aDO 2 and PaCO 2 were decreased in the DP-guided group at each time point( P<0.05). PIP showed no significant difference between the two groups at each time point( P>0.05). Compared with T1, PIP and DP were increased and Crs was decreased( P<0.05)in both groups at T2-T4( P<0.05). At T5, PIP was increased in both groups( P<0.05), Crs was decreased and DP was increased in the control group( P<0.05), while Crs and DP had no significant difference in the DP group at T1( P>0.05). OI and PaO 2 showed no significant difference between the two groups at T2-T5( P>0.05). Vd/Vt and PaCO 2 were increased in both groups at T3-T5( P<0.05). Compared with T1 levels, A-aDO 2 was increased in the control group at T3-T5( P<0.05)and in the DP group at T4( P<0.05). Conclusions:DP-guided individualized PEEP can reduce the occurrence of intraoperative atelectasis, improve intraoperative respiratory mechanical state and gas exchange, reduce the risk of potential ventilator-related lung injury and has good lung-protective effects of PEEP in elderly patients undergoing robot-assisted laparoscopic prostatectomy.
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Objective To investigate the effect of general anesthesia combined with epidural block anesthesia on intestinal barrier function in patients with gastric cancer after radical resection.Methods 90 patients with gastric cancer undergoing laparoscopic radical resection were selected.They were randomly divided into observation group (epidural anesthesia plus general anesthesia) and control group (general anesthesia),45 cases in each group.The intraoperative blood loss,intraoperative infusion volume,postoperative exhaust time,postoperative complications and the function of intestinal barrier effects were compared between the two groups.Results The total incidence rate of postoperative complications in the observation group(8.89％) was significantly lower than that in the control group (28.89％) (x2 =4.83,P ＜ 0.05).The hospital stay in the observation group [(12.5 ± 4.23) d] was significantly shorter than that in the control group [(17.5 ± 5.26) d] (t =3.27,P ＜ 0.05).The two amine oxidase [(3.88 ± 0.98) U/L],D-lactic acid [(7.44 ± 5.23) mg/L],endotoxin [(13.44 ± 2.12) U/L] levels of the observation group were significantly lower than those of the control group [two amine oxidase (11.33 ± 1.25) U/L,D-lactic acid (15.34 ±3.21) mg/L,endotoxin (21.03 ± 0.82) U/L] (t =5.63,5.02,4.19,all P ＜ 0.05).Conclusion Compared with total intravenous anesthesia,total intravenous anesthesia combined with epidural anesthesia is beneficial to the recovery of intestinal barrier function after radical gastrectomy,and can shorten the postoperative hospital stay.It is worthy of clinical application and popularization.
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Objective To investigate the effect of sufentanil on norepinephrine (NE)-induced contraction of thoracic aorta isolated from rats with spontaneous hypertension (SH) .Methods Eight male rats with SH weighing 250-300 g were used in this study. The rats were decapitated and their thoracic aortas were isolated and cut into rings 2-3 mm in length. The aorta rings were suspended for isometric tension recording. The aortic rings obtained from SH rats were divided into 4 groups ( n = 8 each) : control group and 3 sufentanil groups. The contraction of aortic rings in response to NE in the absence (control) and presence of 3 concentrations of sufentanil 7 × 10-11 ,2 × 10-10 and 1 × 10-9 mol/L was recorded. Results The amplitude of NE-induced contraction of thoracic aorta was significantly greater in 3 sufentanil groups than in control group. Sufentanil significantly inhibited the NE-induced aortic contration in proportion to concentration. Conclusion Sufentanil can inhibit NE-induced contraction of thoracic aorta isolated from rats with SH in a concentration-dependent manner.