Effects of 0.15% ropivacaine alone and combination with sufentanil on epidural labor analgesia and adverse reactions.

Objective: The aim of this study was to compare the impacts of 0.15% ropivacaine alone and 0.15% ropivacaine combined with sufentanil on epidural labor analgesia. Methods: A total of 297 eligible primiparae were randomly divided into group A (n=149, 0.15% ropivacaine + sufentanil) and group B (n=148, 0.15% ropivacaine). Visual analogue scale (VAS) scores prior to analgesia and 20 min following epidural medication, the maximum VAS score during labor, dosage of analgesic drugs, modified Bromage score, satisfaction degree, labor duration, delivery mode, 1-min and 5-min Apgar scores of newborns, adverse reactions during analgesia, and fever during labor were recorded. Results: Group A and B had similar VAS scores 20 min following epidural medication and maximum score during labor (P>0.05), which significantly fell compared with those before labor analgesia (P<0.05). The occurrence rates of nausea and vomiting were of significant difference (P<0.05). Conclusion: 0.15% ropivacaine alone achieves a comparable epidural labor analgesia effect to that of 0.15% ropivacaine + 0.05 µg/mL sufentanil on primiparae.

Influence of Dexmedetomidine on Diaphragm Function and Postoperative Outcomes in ICU Patients with Mechanical Ventilation.

OBJECTIVE: To probe into the influence of dexmedetomidine (DEX) on diaphragm function and postoperative outcomes of mechanically ventilated patients in the intensive care unit (ICU). METHODS: 84 patients with mechanical ventilation (MV) in the ICU of our hospital were selected as the research participants, including 38 patients in the control group (CG) sedated with midazolam (MZ) and 46 patients in the research group (RG) with DEX sedation. Ramsay sedation score, visual analogue scale (VAS), and restlessness score (RS) were used to evaluate their state before sedation (T0), as well as 2 h (T1), 6 h (T2), and 24 h (T3) after sedation, and the alterations of mean arterial pressure (MAP) and heart rate (HR) were recorded. Serum cortisol (Cor), adrenocorticotropic hormone (ACTH), superoxide dismutase (SOD), malondialdehyde (MDA), interleukin- (IL-) 1ß, IL-6, and tumor necrosis factor-α (TNF-α) were measured before and 24 h after sedation. The end-inspiratory diaphragm thickness (DTei) and end-expiratory diaphragm thickness (DTee) were measured within 2 h after the initiation of MV and 5 min after the spontaneous breathing test (SBT), and the diaphragm thickening fraction (DTF) was calculated. Finally, the ventilator weaning, MV time, and the incidence of adverse reactions (ADs) of the two groups were counted. RESULTS: T0 and T3 witnessed no distinct difference in Ramsay, VAS, and RS scores between the two arms (P > 0.05), but at T1 and T2, RG had better sedation state and lower VAS and RS scores than CG (P < 0.05), with more stable vital signs (P < 0.05). After sedation, the contents of oxidative stress and inflammatory factors in RG were lower, while DTee, DTei, and DTF were higher, versus CG (P < 0.05). Moreover, RG presented higher success rate of first ventilator weaning, less MV time, and lower incidence of ADs than CG (P < 0.05). CONCLUSIONS: DEX is effective in mechanically ventilated patients in the ICU, which can protect patients against diaphragm function damage, improve the success rate of ventilator weaning, and benefit the postoperative outcome, with excellent and rapid sedation effect and less stress damage to patients.

Study on the Effect of Different Doses of Hydromorphone on the Time Response and Postoperative Analgesia of Ropivacaine in Ultrasound-Guided Suprailiac Fascia Inguinal Block.

OBJECTIVE: To investigate the effects of different doses of hydromorphone under the guidance of ultrasound on ropivacaine blocking the superior inguinal iliac fascia and postoperative analgesia. METHODS: From January 2020 to June 2021, 90 American Society of Anesthesiologists (ASA) I-II patients undergoing elective total hip arthroplasty (THA) were selected and randomly divided into 3 groups, 30 patients in each one. Ultrasound-guided superior inguinal iliac fascia block was performed in the patients of the 3 groups before operation. The L group: 0.3% ropivacaine 30 ml; the H1 group: 0.3% ropivacaine + 25 µg/kg hydromorphone 30 ml; the H2 group: 0.3% ropivacaine + 50 µg/kg hydromorphone 30 ml. The time until the occurrence of pain, pain intensity, sufentanil remedial dose, the number of PCIA presses, and effective times were compared among the 3 groups. The VAS and Ramsay scores of 3 groups were recorded at 12 h, 24 h, 36 h, and 48 h after operation. RESULTS: The time from the end of surgery to the appearance of pain in the H2 group was higher than that in the H1 group and the L group, and the time in the H1 group was higher than that in the L group (P < 0.05). The VAS score in the H2 group was lower than that in the H1 group and the L group, and the VAS score in the H1 group was lower than that in the L group (P < 0.05). The VAS scores of 12 h, 24 h, 36 h, and 48 h after operation in the H2 group were lower than those of the H1 group and the L group, and the H1 group was lower than the L group (P < 0.05). The Ramsay scores at 12 h, 24 h, 36 h, and 48 h after operation in the H2 group and the H1 group were higher than those in the L group (P < 0.05), and the difference was not statistically significant in the H2 group and the H1 group (P > 0.05). The remedial dosage of sufentanil, times of PCIA compression, and effective times in the H2 group were lower than those in the H1 group and the L group, and the level in the H1 group was lower than that in the L group (P < 0.05). The incidence rates of adverse reactions in the L group, the H1 group, and the H2 group were 13.33%, 23.33%, and 30.00%, respectively. There was no significant difference in the incidence rate of adverse reactions among the 3 groups (P > 0.05). CONCLUSION: 25 µg/kg and 50 µg/kg hydromorphone used in the ultrasound-guided superior inguinal iliac fascia block can enhance the time effect of ropivacaine and improve analgesic effects, with good safety. In addition, time effect and analgesic effect of 50 µg/kg hydromorphone in enhancing ropivacaine were more obvious.

Comparison of the effect and clinical value in general anesthesia and combined spinal-epidural anesthesia in elderly patients undergoing hip arthroplasty.

Effect and clinical value in general anesthesia and combined spinal-epidural anesthesia in elderly patients undergoing hip arthroplasty were compared. One hundred and six patients with hip arthroplasty in the Affiliated Nanhua Hospital, University of South China from May 2013 to July 2015 were selected as the research subjects, including 50 patients in the study group who received combined spinal-epidural anesthesia by ondansetron hydrochloride tablets combined with spinal-epidural puncture kit, and 56 patients in the control group who received general anesthesia by fast-induced endotracheal intubation. Retrospective analysis was performed in terms of anesthesia effect, complete block time, anesthesia onset time, hemodynamic parameters at different time points before and after the surgery, and adverse reactions after the surgery. The study group had a statistically shorter onset time and a statistically shorter complete block time than the control group (P<0.05). No significant difference in the heart rate, systolic blood pressure or diastolic blood pressure before the surgery in the two groups was shown (P>0.05); the heart rate, systolic blood pressure, and diastolic blood pressure in the study group 20 min after the start of the operation and 15 min before the end of the operation were significantly higher those in the control group (P<0.05); the adverse reactions such as venous thrombosis, pulmonary infection, and nausea and vomiting in the study group were fewer than those in the control group (P<0.05). For elderly patients with fracture surgery, both the general anesthesia and the combined spinal-epidural anesthesia can maintain a good anesthesia effect, but the combined spinal-epidural anesthesia can shorten the onset time and has less impact on the patient's hemodynamic parameters and less incidence of complications, thus worthy of clinical promotion.