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Open Journal of Anesthesiology 2020年第4期10卷 134-143页

作者： Agnes Huang Prit Anand Singh kwee lian woon Department of Anesthesia and Surgical Intensive Care Changi General Hospital Singapore

This case series describes the use of Interspace between the Popliteal Artery and the Capsule of the Knee (IPACK) block to provide motor-sparing analgesia for two consecutive patients undergoing anterior cruciate ligament reconstruction (ACLR) by the same surgeon. Case 1 demonstrates the use of a proximal IPACK block as a post-operative rescue block for a patient who still experienced severe pain despite having received a femoral nerve block and parenteral opioids. Case 2 describes the use of a modified IPACK block as part of a multimodal approach with opioid and motor sparing effects. In both cases, the IPACK block provided satisfactory pain relief in the immediate postoperative period without motor weakness, making it an effective analgesic method for day surgery. With the IPACK block shown to be an effective nerve block for ACLR, we explore other advantages, limitations and further research required to better define the role of this block.

关键词： IPACK Anterior Cruciate Ligament Reconstruction

Erector Spinae Plane Block for Mastectomy and Breast Flap Reconstructive Surgery: A Three Case Series

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Open Journal of Anesthesiology 2020年第1期10卷 30-37页

作者： Wei Shyan Siow Jimmy Guan Cheng Lim kwee lian woon Department of Anaesthesia and Surgical Intensive Care Changi General Hospital Singapore Singapore

Uncontrolled pain after breast surgery can have early to chronic repercussions. The repertoire of pre-emptive opioid-sparing analgesic options includes regional blocks such as paravertebral blocks to myofascial blocks and more recently the Erector Spinae (ESP) block. Case 1 demonstrates the ESP block as an easy and conveniently performed post-operative rescue block for a patient who still experienced uncontrolled pain despite a combination of myofascial blocks and systemic analgesics. Case 2 and 3 demonstrate the advantage of providing an extensive coverage of surgical field in breast reconstruction surgery covering variable donor sites. It was due to the extent of coverage, that allowed the placement of ESP block catheter distantly without interrupting the surgical site. Post operative prolongation of pain relief was also successful by titrating analgesia via intermittent boluses. In our case series, the ESP block consistently and safely provided satisfactory pain relief for breast reconstruction surgery. It can be a viable option for peri-operative analgesia compared to other more invasive or less extensive alternatives.

关键词： Erector Spinae Block Analgesia Mastectomy Breast Reconstructive Surgery Flap

Erector Spinae Plane Block for Open and Laparoscopic Liver Surgery: Two Case Reports

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Open Journal of Anesthesiology 2020年第4期10卷 113-119页

作者： Jimmy Guan Cheng Lim Agnes Wanwei Huang kwee lian woon Prit Anand Singh Department of Anaesthesia and Surgical Intensive Care Changi General Hospital Singapore

Epidural analgesia has long been regarded as the gold standard in abdominal surgery. However, concerns regarding risks associated with central neuraxial blockade, catheter placement and the presence of coagulopathy in patients undergoing liver resection have limited its use. Bilateral erector spinae plane blocks and catheter placement may mimic the effects of epidural analgesia by blocking both somatic and visceral pain while concomitantly avoiding central neuraxial blockade and catheter placement. We describe our experience in using the erector spinae plane block and catheter placement as part of a multimodal analgesia approach in a patient undergoing laparoscopic and another patient undergoing open liver resection. Our findings concur with previous reports which suggest that erector spinae plane blocks may be more efficacious as somatic rather than visceral analgesia. However, we conclude that further studies on factors affecting its efficacy should be conducted in view of the present lack of researched evidence.

关键词： Erector Spinae Plane Block Bilateral Erector Spinae Plane Block Laparoscopic Liver Resection Open Liver Resection ESP Block

A Comparison of Local Infiltration Analgesia and PECS II Block for Analgesia in Mastectomy with Axillary Dissection—A Randomised Equivalence Study

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Open Journal of Anesthesiology 2021年第8期11卷 229-242页

作者： Louis Xiang Long Ng Marilyn Hui Xin Ng Chi Wei Mok Wai Peng Lee Su-Ming Tan kwee lian woon Department of Anaesthesia and Surgical Intensive Care Changi General Hospital Singapore Department of Anaesthesiology and Surgical Intensive Care Changi General Hospital Singapore Department of Surgery Changi General Hospital Singapore Department of Anaesthesia and Surgical Intensive Care Changi General Hospital Singapore

Objective: Various analgesic techniques can be used for a mastectomy with axillary dissection with varying degrees of efficacy. In our institution, local anaesthesia infiltration (LIA) is commonly performed by surgeons. In this study, we hypothesise that the relatively novel PECS II block is equivalent to the analgesic profile of LIA. Methodology: In this single center, prospective, randomised control trial, 40 patients undergoing unilateral mastectomy with axillary dissection were randomly assigned to receive either 30 ml 0.5% ropivacaine before skin via LIA by a specialist breast surgeon during surgery or 30 ml 0.5% ropivacaine via PECS II block, before skin incision. Fentanyl was used as rescue analgesia intraoperatively, and all patients received morphine via patient-controlled analgesia (PCA) device postoperatively. The primary outcome was the difference in total morphine consumption in 24 hours between the 2 groups after surgery with equivalency set at ±1 mg. Secondary outcomes included time to rescue analgesia after block administration, post-operative pain score over 24 hours, adverse effects encountered, total intraoperative opioid usage, effect on operative time, block performance time as well as block and surgery related complications. Results: Unadjusted mean PCA morphine consumption over 24 hours post-operatively comparing local infiltration analgesia (LIA) to that of PECS II at 95% confidence interval was -1.22 mg (95% CI: -3.77, 1.33). Total IV Fentanyl use comparing LIA to PECS II was 2.53 ± 0.98 mcg/kg and 1.96 ± 0.57 mcg, P = 0.035. There were no other significant differences in the secondary outcome. Conclusion: We conclude there is a lack of equivalence between that of LIA and PECS II block, with the PECS II block providing superior analgesia.

关键词： PECS-II Mastectomy Analgesia Anaesthesia Pain Opioids

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不同药物洗脱支架在糖尿病患者中应用的比较

临床荟萃 2012年第17期27卷 1492-1494,1497页

作者：拜文廉陈康寅 Rha Seung-woon 王林李永健李广平临夏州人民医院心内科甘肃临夏州731100 天津医科大学第二医院心脏科天津300211 韩国高丽大学附属九老医院心血管病中心首尔152703 天津胸科医院心内科天津300051 天津南开医院心内科天津300100

目的对比雷帕霉素、紫杉醇两种不同药物洗脱支架(DES)在糖尿病患者中应用的长期安全性和有效性。方法入选成功行经皮冠状动脉介入治疗(PCI)术的272例糖尿病患者,根据植入支架类型分为雷帕霉素洗脱支架组(sirolimus-eluting stent,SES,n=... 详细信息

目的对比雷帕霉素、紫杉醇两种不同药物洗脱支架(DES)在糖尿病患者中应用的长期安全性和有效性。方法入选成功行经皮冠状动脉介入治疗(PCI)术的272例糖尿病患者,根据植入支架类型分为雷帕霉素洗脱支架组(sirolimus-eluting stent,SES,n=133例,189病变),紫杉醇洗脱支架组(paclitaxel-eluting stent,PES,n=139例,288处病变),对比随访6个月时的冠状动脉造影结果和随访2年时的主要不良心血管事件(major adverse cardiacevents,MACE)的发生率。结果随访6个月时,复查冠状动脉造影发现,SES组最小管腔直径(2.59±0.61)mm vs(2.21±0.92)mm(P<0.01)显著大于PES组,支架内再狭窄率(16.57±14.24)%vs(30.75±24.16)%(P<0.01)和晚期管腔丢失(0.48±0.51)mm vs(0.93±0.72)mm,P<0.05)显著低于PES组;随访2年时,SES组的总死亡(11.3%vs 20.1%,P<0.05)、靶病变重建(target lesion revascularization,TLR)(9.8%vs 21.6%,P<0.01)、靶血管重建(target vessel revascularization,TVR)(17.3%vs 32.4%,P<0.01)、TVR-MACE(20.3%vs 35.3%,P<0.01)也显著低于PES组。多因素回归分析显示:应用PES是糖尿病患者PCI术后总死亡(OR=2.453,95%CI=1.012～5.932,P<0.05]、TLR(OR=2.403,95%CI=1.051～5.503,P<0.05)、TVR-MACE(OR=2.296,95%CI=1.237～4.261,P<0.01)发生的独立危险因素。结论在临床上对于糖尿病患者PCI术中选择SES相较于PES,可显著降低PCI术后不良心血管事件的发生。

关键词：糖尿病冠状血管造影术危险因素药物洗脱支架