Study on the application value of combined spinal-epidural anesthesia under the assistant of ultrasound localization on patients with lower limb fracture / 中国医学装备

Objective:To explore application value of combined spinal-epidural anesthesia under the assistant of ultrasound location on lower limb fractures.Methods:A total of 80 patients with lower limb fractures who underwent surgical treatment at the 901th Hospital of the PLA Joint Service Support Force from July 2020 to July 2022 were selected,and they were divided into a control group and an observation group according to the random number table method,with 40 cases in each group.The control group received epidural anesthesia under ultrasound,and the observation group received the combined lumbar-epidural anesthesia under ultrasound.The lidocaine dosage,anesthetic block time,anesthesia onset time and dosage of additional analgesic,as well as the changes in vital signs such as diastolic blood pressure(DBP),systolic blood pressure(SBP)and heart rate(HR),between the two groups of patients were compared.In addition,the thrombelastogram,anesthetic effects and occurrence of adverse reactions also were compared between two groups.Results:The lidocaine dosage,anesthetic block time,anesthesia onset time and dosage of additional analgesic of the observation group were significantly higher than those in the control group,and the differences were statistically significant(t=8.657,23.483,12.785,16.600,P<0.05),respectively.There were no statistically significant differences in DBP,SBP,HR,comprehensive coagulation index(CI),reaction time(R),formation time of blood cell agglutination(K)and incidence of adverse reactions between two groups before anesthesia,at the 30th minute after anesthesia and after the end of anesthesia(P>0.05).Compared with α angle before anesthesia and at the 30th minute after anesthesia,the α angles of the two groups increased significantly after anesthesia(t=6.564,5.783,P<0.05),respectively.The mechanical strength(G)of the blood clot and the maximum amplitude(MA)of chromatogram of the observation group were significantly reduced after completed anesthesia,and the differences of them were statistically significant(t=8.480,4.236,P<0.05),respectively.There were no significant differences between G and MA in the control group(P>0.05).The total effective rate of the observation group was 97.50%,which was significantly higher than 80.00% of the control group,and the difference was statistically significant(x2=4.507,P<0.05).Conclusion:The combined spinal-epidural anesthesia under the assistant of ultrasound location can effectively reduce the amount of anesthetics in patients with lower limb fracture,which has fast block and effect.In addition,it has little influence on circulatory function,and it is less likely to form a hypercoagulable state.It has better clinical anesthesia effect.

Effects of remimazolam on early postoperative cognitive function in elderly patients with hip fracture / 中国临床药理学与治疗学

AIM: To evaluate the effect of remimazolam on early postoperative cognitive function in elderly patients with hip fracture based on a randomized controlled trial. METHODS: A total of 106 elderly patients, aged 65-90 years, ASA grade Ⅱ or III, who underwent hip fracture surgery under combined spinal-epidural anesthesia in the Sixth Affiliated Hospital of Wenzhou Medical University from December 2022 to June 2023 and met the inclusion criteria, were selected and randomized into remimazolam group (group R) and propofol group (group P) according to the random number table, with 53 cases in each group. Patients in group P received a slow intravenous injection of propofol at a dose of 0.3-0.5 mg / kg (injection time of 1min), followed by a pump infusion at 0.5-3 mg · kg

Acupoint Injection Decreases Anesthetic Cosumption during Combined Spinal-Epidural and Patient-Controlled Epidural Labor Analgesia / 中国结合医学杂志

OBJECTIVE@#To explore if acupoint injection can improve analgesic effects or delivery outcomes in parturients who received combined spinal-epidural analgesia (CSEA) and patient-controlled epidural analgesia (PCEA) for labor analgesia.@*METHODS@#A total of 307 participants were prospectively collected from July 2017 to December 2019. The participants were randomized into the combined acupoint injection with CSEA plus PCEA group (AICP group, n=168) and CSEA plus PCEA group (CP group, n=139) for labor analgesia using a random number table. Both groups received CSEA plus PCEA at cervical dilation 3 cm during labor process, and parturients of the AICP group were implemented acupoint injection for which bilateral acupoint of Zusanli (ST 36) and Sanyinjiao (SP 6) were selected in addition. The primary outcome was Visual Analogue Scale (VAS) score, and the secondary outcomes were obstetric outcomes and requirement of anesthetics doses. Safety evaluations were performed after intervention.@*RESULTS@#The VAS scores were significantly lower in the AICP group than in the CP group at 10, 30, 60, and 120 min after labor analgesia (all P<0.05). The latent phase of the AICP group was shorter than that of the CP group (P<0.05). There were less additional anesthetics consumption, lower incidences of uterine atony, fever, pruritus and urinary retention in the AICP group than those in the CP group (all P<0.05).@*CONCLUSION@#Acupoint injection combined CSEA plus PCEA for labor analgesia can decrease the anesthetic consumption, improve analgesic quality, and reduce adverse reactions in the parturients. (Registration No. ChiMCTR-2000003120).

Anesthetic considerations and postoperative pain management in radical penectomy: Case report / Penectomía radical, consideraciones anestésicas y manejo del dolor postoperatorio: Reporte de un caso

Abstract Radical penectomy (RP) is infrequently performed as it is reserved for specific cases of penile cancer, hence the paucity of reports regarding surgical and anesthetic considerations. Acute postoperative pain, chronic post-surgical pain, concomitant mood disorders as well as a profound impact on the patient's quality of life have been documented. This case is of a patient with diabetes and coronary heart disease, who presented with advanced, over infected penile cancer, depressive disorder and a history of pain of neuropathic characteristics. The patient underwent radical penectomy using a combined spinal-epidural technique for anesthesia. Preoperatively, the patient was treated with pregabalin and magnesium sulphate, and later received a blood transfusion due to intraoperative blood loss. Adequate intra and postoperative analgesia was achieved with L-bupivacaine given through a peridural catheter during one week. Recovery was good, pain was stabilized to preoperative levels and the patient received pharmacological support and follow-up by psychiatry and the pain team.

Resumen La penectomía radical (PR) es una cirugía infrecuente, reservada para casos específicos de cáncer de pene, por lo que hay escasos informes sobre sus consideraciones quirúrgicas y anestésicas. Se ha documentado dolor agudo postoperatorio, dolor crónico posquirúrgico y alteraciones del estado de ánimo concomitantes, así como un profundo impacto en la calidad de vida posterior del paciente. Se presenta el caso de un paciente diabético y cardiópata coronario con cáncer de pene avanzado y sobreinfectado, trastorno depresivo y dolor previo de características neuropáticas, que recibe técnica combinada espinal-peridural para cirugía de penectomía radical. Se le trata también con pregabalina preoperatoria, sulfato de magnesio y transfusión por sangrado quirúrgico. Se otorgó una adecuada analgesia intra y postoperatoria, mediante catéter peridural con L-bupivacaína hasta por una semana. El paciente tuvo una buena recuperación, estabilización del dolor a niveles preoperatorios, controles y apoyo farmacológico por psiquiatría de enlace y equipo del dolor.

Anaesthesia for Fibroid Surgeries: Experience from A Nigerian Tertiary Institution

Introduction: Worldwide, uterine fibroid is the commonestgynaecological tumour in women. The standard treatment forsymptomatic uterine fibroid is surgery. This is facilitated usinganaesthesia, which could be general or Central neuraxial block(Regional anaesthesia, RA). In Nigeria, most women presentlate with huge fibroids which is a main determinant of themode of anaesthesia. While general anaesthesia (GA) is morecommonly used, it is not without challenges necessitating theincreasing use of Regional anaesthesia (RA) which is thoughtto be more beneficial for the patient. This study seeks to auditthe anaesthetic practice for fibroid surgeries over a five yearperiod in our Institution, assess the role of RA and to generateawareness with a view to increasing its utilization for fibroidsurgeries.Material and methods: The Nurses’ and Doctors ‘theatrerecords were reviewed for Socio demographics, type ofanaesthesia, type of surgery and uterine size.Result: Summary of statistics was done using percentages,means and standard deviation. Categorical variables werecompared using the Chi-square test. A P-value of <0.05 wasconsidered statistically significant. Five hundred and twentyfive (525) surgeries were performed for women with uterinefibroid with an age range of 20-65years.Two hundred andfifteen (215/41%) patients had GA, while 284 (54.1%) hadRA. Twenty six patients (26.4.9%) had spinal anaesthesia thatfailed and had to be converted to GA.Conclusion: There was a yearly increase in the use of RA,and a yearly decline in the use of GA. Regional Anaesthesiais the more commonly used mode of anaesthesia for fibroidsurgeries in our institution.

Comparison of Different Volumes of Normal Saline for Epidural Volume Extension in Combined Spinal Epidural Anesthesia for Lower Abdominal Surgeries

Context: Block augmentation by epidural volume extension has been adequately documented but therehave been not enough studies comparing different volumes of normal saline used in this technique toaugment the level of block achieved. The study compares different volumes of normal saline(5,10 and 20ml) for epidural volume extension in combined spinal epidural anaesthesia for lower abdominal surgeries.120 women, aged between 20-60 years belonging to ASA grade I-II undergoing elective lower abdominalsurgeries were included in this study. The patients were randomly allocated into 3 groups and each groupcomprised of 40 patients. GROUP 1(EVE 5) received 10 mg 0.5% bupivacaine heavy (H) intrathecallywith 5 ml normal saline through the epidural catheter as a part of Epidural volume extension. GROUP 2(EVE10) and GROUP 3 (EVE20) received 10 ml and 20 ml of normal saline as a part of Epidural volumeextension respectively in addition to the intrathecal drug. The patients were assessed for sensory blocklevel to loss of pain from pin prick and for motor block using Bromage scale. Peak sensory block height,highest Bromage score, time taken to achieve maximum sensory and motor block and the time to theirrecovery were recorded.Statstical Analysis. was done using statistical software SSPS version 16.0 andEpi- info version 6.0 .Outcome measures were presented as % for qualitative variables and mean±SD forquantitative variables.Demographic data and duration of surgery were similar in all the groups.Sensoryblock augmentation was found to be significantly higher in the EVE10 and EVE 20 groups. There was nodifference in the peak motor block score between the groups during the study. Time to achieve the blockswere significantly shorter for the 20 ml group than the 10 and 5 ml groups; the latter two being comparable.This was associated with a significantly faster motor recovery to Bromage 0 in groups EVE10 and EVE20.

​Comparative Evaluation Of 0.2% Ropivacaine Versus 0.125% Ropivacaine Under Combined Spinal-Epidural Technique For Labor Analgesia

Background: Both pharmacological and non-pharmacological strategies for pain relief in labor have been tried and tested sincelong. Combined spinal-epidural analgesia (CSEA) satisfies the basic requisites of labor analgesia. Various concentrations oflocal anesthetics along with the addition of opioids can be used. The objective of this study is to compare the quality of laboranalgesia with two different concentrations of ropivacaine (0.2% vs. 0.125%) and assess fetomaternal outcome.Materials and Methods: A total of 60 primipara women with a singleton pregnancy in active labor were given CSEA afterrandomly allocating them in two groups of 30 each. Both Group A and Group B received intrathecal injection of 4 mg (2 ml)0.2% ropivacaine + 25 µg (0.5 ml) fentanyl: Group A - epidural dose of 15 ml of 0.2% ropivacaine solution + 2 µg/ml fentanyland Group B - epidural dose of 15 ml of 0.125% ropivacaine + 2 µg/ml fentanyl. Then, continuous epidural infusion was startedat the rate of 10 ml/h which was continued until the end of delivery.Results: GroupA showed better maintenance of analgesia and better maternal satisfaction while parturients in Group B neededrescue top-up analgesia due to breakthrough pain.Conclusions: It was concluded that ropivacaine in both concentrations (0.2% and 0.125%) with fentanyl is effective forinitiation of labor analgesia. However, quality of analgesia with 0.2% ropivacaine concentration is superior to 0.125%concentration.

Combined spinal-epidural block for labor analgesia. Comparative study with continuous epidural block / Bloqueio combinado raquiperidural para analgesia de parto. Estudo comparativo com bloqueio peridural contínuo

Abstract Introduction: Lumbar epidural block is an effective and routinely used technique for labor pain relief, and the combined spinal-epidural block has the benefit of using lower doses of local anesthetics and rapid onset of analgesia. The objective of this study was to evaluate the effectiveness and safety of two anesthetic techniques: combined spinal-epidural block and continuous epidural block in pregnant women for labor analgesia. Methods: Eighty patients, ASA II and III, with cephalic presentation and cervical dilation between 5 and 6 cm, undergoing labor analgesia, allocated in two groups according to the anesthetic technique: combined spinal-epidural (GI) and continuous epidural (GII). Pain severity before the blockade, time to complete analgesia, degree of motor blockade, time to full cervical dilation, duration of the second stage of labor, pain severity during the 1st and 2nd stage of labor, type of delivery, use of oxytocin during labor, maternal cardiocirculatory and respiratory parameters and adverse events, and neonatal repercussions were recorded. Results: At the time of anesthesia, pain severity was similar in both groups. Pain relief was faster in GI (4.5 ± 1.5 min) when compared to GII (11.6 ± 4.6 min) p = 0.01; pain scores in the first and second stages of delivery were lower in GI (0.9 ± 0.3 and 1.8 ± 0.7, respectively) when compared to GII (1.9 ± 0.6 and 2.2 ± 0.5, respectively), with p = 0.01 only in the first stage of labor; there was need for local anesthetics supplementation in GII; there were more frequent spontaneous deliveries in GI (80% of patients) than in GII (50%) (p = 0.045) and more frequent use of instrumental (p = 0.03) in GII (12 patients) compared to GI (4 patients); the frequency of cesarean deliveries was significantly higher (p = 0.02) in Group II than in Group I, with 4 cases in GI and 8 cases in GII; absence of maternal cardiocirculatory and respiratory changes and neonatal repercussions; more frequent pruritus in GI (10 patients) and (0 patients in GII) (p = 0.02). Conclusion: The combined blockade proved to be effective with better quality of analgesia and greater comfort for pregnant women, constituting a good option for the practice of obstetric analgesia.

Resumo Introdução: O bloqueio peridural lombar constitui técnica eficaz e rotineiramente empregada para alívio da dor do parto e o bloqueio combinado raquiperidural tem como benefícios o emprego de doses menores de anestésicos locais e rápido início de analgesia. O objetivo do estudo foi avaliar comparativamente a eficácia e a segurança de duas técnicas anestésicas: bloqueio combinado raquiperidural e peridural contínua em grávidas submetidas à analgesia de parto. Método: Oitenta gestantes, ASA 2 e 3, apresentação cefálica e dilatação cervical entre cinco e seis centímetros, submetidas à analgesia de parto, distribuídas em dois grupos de acordo com a técnica anestésica: técnica combinada raquiperidural (GI) e peridural contínua (GII). Avaliaram-se: intensidade de dor antes do bloqueio; tempo para completa analgesia; grau do bloqueio motor; tempo para dilatação cervical total; duração do 2° estágio do trabalho de parto; intensidade de dor durante o 1° e o 2° estágio do trabalho de parto; tipo de parto; uso de ocitocina durante trabalho de parto; parâmetros cardiocirculatórios, respiratórios e eventos adversos maternos; repercussões neonatais. Resultados: No momento da anestesia a intensidade de dor era semelhante em ambos os grupos. O alívio da dor foi mais rápido no GI (4,5 ± 1,5 min) quando comparado com o GII (11,6 ± 4,6 min) p = 0,01; os escores de dor no primeiro e segundo estágios de parto foram menores no GI (0,9 ± 0,3) e (1,8 ± 0,7) quando comparados com o GII (1,9 ± 0,6) e (2,2 ± 0,5) com p = 0,01 somente no primeiro estágio de trabalho de parto; houve necessidade de complementação com anestésicos locais no GII; partos espontâneos mais frequentes em GI (80% das pacientes) do que em GII (50%) p = 0,045 e instrumentais mais frequentes (p = 0,03) em GII (12 pacientes) quando comparadas com o GI (quatro pacientes); a frequência de partos cesáreos foi significativamente maior (p = 0,02) no Grupo II do que no Grupo I, quatro casos no GI e oito no GII; ausência de alterações cardiocirculatórias e respiratórias maternas e repercussões neonatais; prurido mais frequente no GI (10 pacientes) e (0 paciente no GII) p = 0,02. Conclusão: O bloqueio combinado mostrou-se eficaz com melhor qualidade de analgesia e maior conforto às gestantes, constitui boa opção para a prática de analgesia obstétrica.

A Comparative Study Of Combined Spinal Epidural Anaesthesia Versus Epidural Anaesthesia For Elective Caesarean Section

Background and aims This study was done to compare the efficacy of combined spinal epidural(CSEA) anaesthesia with epidural anaesthesia based on the parameters such as onset time,quality of intraoperative analgesia, quality of motor blockade,incidence of hypotension and total local anaesthetic dose requirement Materials and methods– 50 patients undergoing elective LSCS were divided into two groups of 25 each .One group received combined spinal epidural anaesthesia(CSE). The other group received epidural anaesthesia.The combined spinal epidural (CSE) group received 1 ml of 0.5% hyperbaric bupivacaine intrathecally followed by 10 ml of 0.5% plain bupivacaine with adrenaline 5mcg/ml (1 in 2,00,000) epidurally. The epidural group patients received 16 ml of 0.5% plain bupivacaine with adrenaline epidurally. Study parameters were noted. Observation and results In CSE group 72% achieved complete anaesthesia ,while in epidural group only 40% achieved complete anaesthesia which is statistically significant.(p<0.05)Complete motor blockade was achieved in 68% in CSE group and 36% in Epidural group.Incidence of hypotension was similar in both groups.Mean local anaesthetic dose was 55 mg in CSE group compared to 86mg in the epidural group which was statistically significant. Conclusion Combined spinal epidural anaesthesia offers rapid onset of intense neuraxial blockade, better muscle relaxation, better intraoperative analgesia and decrease in the total requirement of local anaesthetic dose when compared with epidural anaesthesia in elective caesarean section.

The observation on the clinical effect of CSEA by using orbital needle external needle in PCEA post cesarean delivery / 中国医学装备

Objective: To observe the clinical effect of combined spinal epidural anesthesia(CSEA)by using orbital needle in patient-controlled epidural analgesia(PCEA)post cesarean delivery.Methods: 94 puerperas who received cesarean were divided into observation group(47 cases)and control group(47 cases).The patients of two groups were narcotized by using CSEA combined with PCEA.And the observation group adopted a new type of lumbar vertebral combined puncture needle and the control group adopted the traditionally typical lumbar vertebral combined puncture needle.The score of visual analogue scale(VAS)and sedation score of Ramesay of two groups of postoperative 1h,4h,12h,24h and 48h were compared.And the number of times in 48h,the drug dosage and adverse reaction of using analgesia pump also were compared.Results: In postoperative 12 h,the VAS scores of the two groups showed an increasing trend.And the VAS scores of pain of two groups within postoperative 12-48 h decreased gradually.The differences of VAS scores of pain of two groups within postoperative 1-12h and 12-48h between observation group and control group were statistically significant(F=29.596,F=156.366,P＜0.05),respectively.And the VAS scores of pain post operative 4h and 12h of observation group [(2.01±0.51)and(3.49±0.74)]were significantly lower than that of control group [(2.32±0.47)and(3.85±0.69)](t=3.064,t=2.439,P＜0.05),respectively.Within postoperative 1-48h,there were no significant fluctuation in sedation score of Ramesay and the difference of sedation score between the two groups were no significant.And the number of times(11.35±3.04)and drug dosage(65.67± 7.98)mL of using analgesic pump of observation group were significantly lower than that of control group [(20.08±5.32)and(82.07 ± 9.05)mL],(t=9.768,t=9.318,P＜0.05),respectively.Besides,the incidences of postoperative nausea and skin pruritus of observation group(4.26％and 14.89％)were significantly lower than that of control group(17.02％and 34.04％)(x2=4.029,x2=4.663,P＜0.05),respectively.Conclusion: The analgesia effect of orbital needle external needle in implementing CSEA for cesarean delivery is better than that of traditional needle inner needle,and its adverse reactions are less and it is safety.

Clinical investigation of nalbuphine for treatment of post combined spinal-epidural anesthesia shivering in patients undergoing cesarean section / 临床麻醉学杂志

Objective To investigate the clinical efficacy and side effects of nalbuphine for treatment of post combined spinal epidural anesthesia shivering undergoing cesarean section.Methods Ninety puerpera underwent elective caesarean section under combined spinal-epidural anesthesia,who developed shivering Wrench grade 3 or 4,aged 20-35 years,ASA physical status Ⅰ or Ⅱ,were randomly and double-blindly divided into three groups with 30 puerpera each to receive either saline (group C) or nalbuphine (group N,0.07 mg/kg) or tramadol (group T,1 mg/kg) as a slow intravenous bolus for treatment of shivering.Onset of shivering,time interval from treatment to cessation of shivering,success rate,recurrence rate after successon treatment outcome of shivering,OAA/S sedation scores,nausea and vomiting,bradycardia and hypotension were recorded.Results There was no significant difference of the time interval from treatment to cessation of shivering between the three groups.Compared with group C,there was statistically significant shorter time interval from treatment to cessation of shiveringin group N [(3.6±1.3) min vs (14.3±7.3) min] and group T [(4.2± 2.2) min vs (14.3±7.3) min],higher success ratein group N (93.3％ vs 16.7％) and group T (90％ vs 16.7％) and lower recurrance ratein group N (7.1％ vs 80.0％) and group T (11.1％ vs 80.0％)(P＜ 0.05).Higher sedation scores in group N were observed (P＜0.05).The incidence of nausea and vomiting was 60.0％ in group T,which was significantly higher than those in group C (20.0％) and group N (13.3％) (P＜0.05).There was no significant difference in the incidence of bradycardia and hypotension in three groups.Conclusion Nalbuphine can control the shivering of post combined spinal epidural anesthesia undergoing cesarean section safely and effectively,which seems suitable for parturients cesarean delivery due to the lower incidence of nause and vomiting and a certain sedation effect.

A prospective study evaluating the effectiveness of epidural volume extension with normal saline in combined spinal epidural anesthesia for lower limb orthopedic surgeries using low dose intrathecal hyperbaric bupivacaine

Background: Combined spinal-epidural anesthesia technique for providing pain relief for orthopedic procedures has gained popularity. It combines the advantages of rapid onset and the reliability of blockade obtained spinally along with the flexibility given by epidural catheter avoiding the disadvantages of either technique used alone. Spinal anesthesia provides dense neural blockade of finite duration while epidural is more titratable producing less hemodynamic swings and postoperative analgesia. The epidural volume extension adds color to combined spinal-epidural anesthesia technique where the onset and the level of blockade obtained spinally are enhanced by administering saline or local anesthetic via the epidural catheter. The ideology behind this is the volume effect accomplished by injecting saline epidurally which would result in intrathecal compression and cephalad migration of spinal local anesthetic. S. Sudhakaran, S. Ashwini. A prospective study evaluating the effectiveness of epidural volume extension with normal saline in combined spinal epidural anesthesia for lower limb orthopedic surgeries using low dose intrathecal hyperbaric bupivacaine. IAIM, 2017; 4(11): 52-60. Page 53 Aim of the study: To identify the effectiveness of block profile provided by extending the epidural volume with normal saline for lower limb orthopedic surgeries using a low dose intrathecal hyperbaric bupivacaine without causing hemodynamic changes. Materials and methods: A prospective randomised controlled study involving 80 patients posted for elective lower limb orthopedic surgeries were divided into two groups of 40 each. Group A received combined spinal-epidural anesthesia with 10 mg of 0.5% bupivacaine with epidural volume extension of 10 ml normal saline. Group B received combined spinal-epidural anesthesia alone. The blood pressure and heart rate changes were observed at the 5th, 10th, 15th, 20th min and then every fifteen minutes. Results: Low dose of intrathecal hyperbaric bupivacaine (10 mg) with 25 micrograms of fentanyl with epidural volume extension (10ml normal saline) is associated with early onset of sensory and motor blockade, high level of sensory block, shorter time of two segment regression. Conclusion: In this study we can safely conclude that combination of spinal epidural with epidural volume extension with normal saline achieves an effective and shorter block time as evident by significantly lower maximum motor block time providing prolonged analgesia by requiring less topup dose of bupivacaine with higher level of sensory block at the tenth minute with shorter mean maximum sensory block time

Effects of general anesthesia and combined spinal epidural anesthesia on postoperative cognitive function in elderly patients with lower limb fracture / 中国生化药物杂志

Objective To observe the effects of general anesthesia and combined spinal epidural anesthesia in elderly patients with lower limb fracture surgery, and to evaluate the effect of postoperative cognitive function and pain score.Methods Retrospective analysis, screening of intraoperative anesthesia, postoperative change lost invalid cases, from November 2012 to October 2015 in our hospital accepted surgical treatment of 180 patients with lower limb fracture surgery were selected according to different patients with different anesthesia methods can be divided into treatment group and control group, 90 cases each group of patients.Patients in the treatment group were treated with combined spinal epidural anesthesia , while the control group received general anesthesia.The incidence of cognitive dysfunction and postoperative pain scores were compared between the two groups. Results the incidence of cognitive dysfunction after surgery in 90 cases of observation group was lower than that of the control group , and the difference was statistically significant (P<0.05).The evaluation of two groups of postoperative chronic pain for 3 days, 6 days, 10 days, 15 days, the incidence rate of VAS score and the character, whether the impact on the daily life and the rest, the patients in the treatment group pain scores were significantly lower than the control group, the difference was significant (P <0.05).Conclusion After lumbar epidural anesthesia in elderly lower limb fracture surgery effect on cognitive function in patients with small, and can reduce the pain of patients, in the actual work according to the actual situation of different specific problems in different specific analysis.

The application of dexmedetomidine in patients with combined spinal epidural anesthesia and its effects on hemodynamics and renin angiotensin aldosterone system / 中国生化药物杂志

Objective To study the application of dexmedetomidine in patients with combined spinal epidural anesthesia and its effects on hemodynamics and renin angiotensin aldosterone system (RAAS).Methods96 patients with open surgery under combined spinal epidural anesthesia from Oct.2013 to Oct.2016 in our hospital were selected.Divided into two groups by randomly, the dexmedetomidine group(46 cases) was given dexmedetomidine before anesthesia, the control group(46 cases) was given sodium chloride solution.The operation condition, and the changed of mean arterial pressure (MAP), heart rate, plasma renin activity (PRA), angiotensin II (ANG-II) and aldosterone (ALD) at before anesthesia (T1), post anesthesia 10min (T2), end of the operation (T3) and end of the operation 30 min (T4) were compared.ResultsThere was no significant difference in the operation time, blood loss, intraoperative transfusion, and wake up time between the two groups;there was no significant difference in MAP and heart rate between the two groups at T1, at T2, T3, T4 point, control group MAP, heart rate were significantly changed(P<0.05), and there was no significant change in dexmedetomidine group, at T2,T3,T4 point, the levels of MAP, heart rate in the dexmedetomidine group were lower than the control group(P<0.05);there was no significant difference between the two groups in PRA, ANG-Ⅱ and ALD at T1, at T2 and T3 point, the PRA, ANG-Ⅱ and ALD in the two groups were increased, at T4 point down, there were significant differences compared with the same group at T1(P<0.05);but at T2,T3,T4, the levels of PRA,ANG-Ⅱ,ALD were lower than the control group(P<0.05).ConclusionIn the combined spinal epidural anesthesia with dexmedetomidine before anesthesia, which can Maintain hemodynamic stability, And inhibit the activation of RAAS.

The Comparison of Ultra-sound Guided Thoracic Paravertebral Nerve Block and Combined Spinal-epidural Anesthesia in Percutaneous Nephrolithotomy / 临床外科杂志

Objective To compare the anesthetic effect of ultra-sound guided thoracic paravertebral nerve block and combined spinal-epidural anesthesia in percutaneous nephrolithotomy.Methods For 80 patients in our hospital scheduled for percutaneous nephrolithotomy were randomly divided into two groups with 40 cases each.The patients in group GT were given ultra-sound guided thoracic paravertebral nerve block.And the patients in group G were given combined spinal-epidural anesthesia.Observe and compare the aesthesia effects,the hemodynamic changes during body change in perioperative period,adverse reactions after surgery and complications of two groups.Results Anesthetic effects were not significantly different between two groups (P ＞ 0.05).During body change in perioperative period,the MAP and HR of G group were significantly lower than those of GT group.They had significantly difference (P ＜ 0.05).The adverse reactions after surgery and complications of two group were significantly different between two groups(P ＜0.05).The number of patients who have headache and urinary retention are apparently more group G than in group GT.Conclusion Ultra-sound guided thoracic paravertebral nerve block for percutaneous nephrolithotomy has significant anesthetic effect.Hemodynamics is stable during body change in perioperative period.And there is less complications after surgery.

Influence of combined spinal-epidural anesthesia on perioperative coagulation function,RAAS activity and postoperative analgesia effect in parturients with cesarean section / 国际检验医学杂志

Objective To study the influence of combined spinal-epidural anesthesia on perioperative coagulation function,RAAS activity and postoperative analgesia effect in parturients with cesarean section.Methods One hundred and eighteen parturients of cesarean section in our hospital from June 2013 to January 2016 were collected and divided into the observation group and control group according to the random number table method,59 cases in each group.The observation group received the combined spinal-epidural anesthesia and the control group received epidural anesthesia.The coagulation function indicators on preoperative 1 d (T0),at 10 min before operation end(T1) and postoperative 6 h (T2) were detected by adopting the automatic blood coagulation analyzer,the renin angiotensin aldosterone system (RAAS) function indices were detectd by radioimmunoassay.The pain indicators at postoperative 6 h(T2),12 h (T3) were detected by the pain threshold test instrument.Results The levels of prothrombin time(PT),activated partial thromboplastin time (APTT) and thrombin time (TT) at T1 and T2 in the observation group were significantly higher than those in the control group,while the PTA level was lower than that in the control group(P<0.05);serum RAAS indices such as (renin),angiotensin Ⅱ(ANG II) aldosterone(ALD) in the observation group were lower than those in the control group(P<0.05).The VAS score at T2,T3 in the observation group was lower than that in the control group,while the pain threshold and pain tolerance threshold levels in the observation group were higher than those in the control group(P<0.05).Conclusion Combined spinal-epidural anesthesia can reduce the blood coagulation and RAAS activation caused by cesarean section trauma,and the effect of postoperative analgesia is more significant.

Nicardipine′s Influence on Post Operation Cognitive Dysfunction in Senior Patient after Hip Joint Replacement Operation / 现代医院

Objective To discuss nicardipin′s influence on post operation cognitive dysfunction (POCD) in senior patient after hip joint replacement operation.Methods 180 senior patient, who received selective unilateral hip joint replacement operation between October 2015 and October 2016 under the condition of combined spinal-epidural anesthesia (CSEA) were randomly divided into Group A (with nicardipine) and Group B (without nicardipine).Nicardipine was only appropriately pumped into vein in time in Group A.MAP was observed and recorded 30 minutes after starting the operation and at the end of the operation.Mini-mental state examination (MMSE) was applied to score the patient one day before, one day, three days and five days after operation, and the number of POCD was recorded.Results Compared with Group B, Group A was obviously lower in MAP level (P<0.05) after 30 minutes.MMSE score of Group A was obviously higher (P<0.01) one day after operation.The number of POCD in Group A was 8 (8.89%) significantly lower than than that of Group B (19, 21.11%).Conclusion Nicardipine could maintain hemodynamic stability of senior patients receiving selective unilateral hip joint replacement operation under the CSEA and prevent POCD to a certain extent.

Clinical study on the effect of transvaginal total hysterectomy under combined spinal epidural anesthesia / 中国生化药物杂志

Objective To analyze the effect of transvaginal total hysterectomy under combined spinal epidural anesthesia. Methods From December 2015 to December 2016, in Longde people's hospital 80 cases underwent transvaginal total hysterectomywere randomly divided into two groups, he observation group and the control group. The control group was treated with continuous epidural anesthesia, the observation group were given combined spinal epidural anesthesia. The anesthesia effect and VAS scores were observed and compared. Results The excellent rate of anesthesia in the observation group was 95%, which was significantly higher than 75% in the control group(P<0.05). 1h after anesthesia, there was no statistically significant difference in the cough and static state VAS scores between the 2 groups; 6 and 12 hours after anesthesia, the cough and static state VAS scores was significantly better than those in the control group(P<0.05). Conclusion Compared with epidural anesthesia, combined spinal epidural anesthesia for vaginal total hysterectomy has a better anesthetic and analgesic effect, anesthesia safety is high, it is worthy of clinical application.

Observation on effect of different concentrations and small dose of lidocaine of CSEA in elderly patients with non-PPH anorectal surgery / 重庆医学

Objective To evaluate the efficacy of different concentrations and small dose of lidocaine of combined spinal epi-dural anesthesia(CSEA) in elderly patients with non-procedure for prolapse and haemorrhoids(PPH) anorectal surgery .Methods One hundred and twenty elderly patients undergoing non-PPH anorectal surgery were selected and randomly dividedin to 4 groups , the group A(1 .5% lidocaine) ,B(1 .0% lidocaine) ,C(0 .8% lidocaine) and D ,30cases in each group .The group A ,B and C adopted CSEA ,and the group D adopted the sacral anesthesia .The changes of mean arterial pressure(MAP) and heart rate(HR) at different time points ,stress reactions before and after operation ,anesthetic operating time ,effect onset time ,postoperative reactivating time , anesthetic grade ,success rate ,postoperative patient satisfaction ,postoperative surgeon satisfaction and urine retention were recor-ded .Results MAP and HR at different time points had no statistical difference among 4 groups(P>0 .05) .The anesthetic onset time and postoperative activity recovery time in the group A ,B and C were significantly less than those in the group D(P<0 .01) . The postoperative activity recovery time in the group A was longer than that in the group B and C .The urine retention time in the group A ,B and C was significantly less than that in the group D (P<0 .05) .The postoperative patient satisfaction and surgeon sat-isfaction in the group A and B were 100% .Conclusion 1% lidocaine CSEA is more suitable for the elderly patients with non-PPH anorectal operation .

Combined spinal-epidural analgesia in labour: its effects on delivery outcome / Analgesia combinada raquiperidural em trabalho de parto: seus efeitos sobre o desfecho do parto

ABSTRACT BACKGROUND AND OBJECTIVES: Combined spinal-epidural (CSE) has become an increasingly popular alternative to traditional labour epidural due to its rapid onset and reliable analgesia provided. This was a prospective, convenient sampling study to determine the effects of CSE analgesia on labour outcome. METHODS: One hundred and ten healthy primigravida parturients with a singleton pregnancy of ≥37 weeks gestation and in the active phase of labour were studied. They were enrolled to the CSE (n = 55) or Non-CSE (n = 55) group based on whether they consented to CSE analgesia. Non-CSE parturients were offered other methods of labour analgesia. The duration of the first and second stage of labour, rate of instrumental vaginal delivery and emergency cesarean section, and Apgar scores were compared. RESULTS: The mean duration of the first and second stage of labour was not significantly different between both groups. Instrumental delivery rates between the groups were not significantly different (CSE group, 11% versus Non-CSE group, 16%). The slightly higher incidence of cesarean section in the CSE group (16% versus 15% in the Non-CSE group) was not statistically significant. Neonatal outcome in terms of Apgar score of less than 7 at 1 and 5 min was similar in both groups. CONCLUSION: There were no significant differences in the duration of labour, rate of instrumental vaginal delivery and emergency cesarean section, and neonatal outcome in parturients who received compared to those who did not receive CSE for labour analgesia.

RESUMO JUSTIFICATIVA E OBJETIVOS: A analgesia combinada raquiperidural (RP) tornou-se uma opção cada vez mais popular para o trabalho de parto tradicional devido ao seu rápido início de ação e ao resultado confiável. Este foi um estudo prospectivo de amostragem conveniente para determinar os efeitos da RP sobre o desfecho do parto. MÉTODOS: Foram incluídas 110 parturientes primigestas saudáveis, com gestação única de ≥ 37 semanas e na fase ativa do trabalho de parto. As pacientes foram designadas para os grupos RP (n = 55) ou não RP (n = 55) com base em seus consentimentos para a analgesia combinada RP. As parturientes do grupo não RP receberam outros métodos de analgesia para o parto. As durações do primeiro e segundo estágio do trabalho de parto, as taxas de parto vaginal instrumental e cesariana de emergência e os escores de Apgar foram comparados. RESULTADOS: A média de duração do primeiro e segundo estágio do trabalho de parto não foi significativamente diferente entre os dois grupos. As taxas de parto instrumental não foram significativamente diferentes entre os grupos, RP (11%) versus não RP (16%). A incidência ligeiramente maior de cesariana no grupo RP (16% versus 15% no não RP) não foi estatisticamente significativa. O desfecho neonatal em termos de índice de Apgar foi inferior a 7. CONCLUSÃO: Não houve diferenças significativas em relação à duração do trabalho, às taxas de parto vaginal instrumental e cesariana de emergência e ao desfecho neonatal em parturientes que receberam RP para analgesia de parto em comparação com aquelas que não receberam.