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Clinical effect of ultrasound-guided nerve block and dexmedetomidine anesthesia on lower extremity operative fracture reduction

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World Journal of Clinical Cases 2022年第13期10卷 4064-4071页

作者： Cheng-Bin Ao Ping-Lei Wu Liang Shao Jian-Ying Yu Wei-Guo Wu Department of Anesthesiology The People’s Hospital of YuhuanTaizhou 317600Zhejiang ProvinceChina Department of Orthopedics Taizhou Luqiao Second People’s HospitalTaizhou 318000Zhejiang ProvinceChina

BACKGROUND Lower extremity fractures are mainly treated by surgical reduction,but this operation is often affected by the patient’s level of agitation and the type of anesthesia used.The main treatment for lower-extremity fractures is operative reduction.However,operations can often be affected by both agitation and the degree of anesthesia.Therefore,it is of great importance to develop an effective anesthesia program to effectively ensure the progress of surgery.AIM To discuss the effect of ultrasound-guided nerve block combined with dexmedetomidine anesthesia in lower extremity fracture surgery.METHODS A total of 120 hospital patients with lower extremity fractures were selected for this retrospective study and divided into an observation group(n=60)and a control group(n=60)according to the anesthesia scheme;the control group received ultrasound-guided nerve block;the observation group was treated with dextromethomidine on the basis of the control group,and the mean arterial pressure,heart rate(HR),and blood oxygen saturation were observed in the two groups.RESULTS The mean arterial pressure of T1,T2 and T3 in the observation group were 94.40±7.10,90.84±7.21 and 91.03±6.84 mmHg,significantly higher than that of the control group(P<0.05).The observation group’s HR at T1 was 76.60±7.52 times/min,significantly lower than that of the control group(P<0.05);The observation group’s HR at T2 and T3 was 75.40±8.03 times/min and 76.64±7.11 times/min,significantly higher than that of the control group(P<0.05).The observation group’s visual analog score at 2 h,6 h and 12 h after operation was 3.55±0.87,2.84±0.65 and 2.05±0.***.the recovery time was 15.51±4.21 min,significantly lower than that of the control group(P<0.05).Six hours post-anesthesia,epinephrine and norepinephrine in the observation group were 81.10±21.19 pg/mL and 510.20±98.27 pg/mL,significantly lower than that of the control group(P<0.05),and the mini-mental state exam score of the observation group was 25.51±1.15,significantly higher than that in the contro

关键词： Ultrasound nerve block Dexmedetomidine Lower extremity fracture Anesthesia effect

Ultrasound-guided sphenopalatine ganglion block for effective analgesia during awake fiberoptic nasotracheal intubation: A case report

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World Journal of Clinical Cases 2024年第14期12卷 2451-2456页

作者： Hangil Kang Seongjae Park Yehun Jin Department of Anesthesiology and Pain Medicine National Cancer CenterGoyang-si 10408Gyeonggi-doSouth Korea

BACKGROUND Awake fiberoptic nasotracheal intubation(AFNI)is the preferred airway ma-nagement strategy for patients with difficult airways.However,this procedure can cause significant physical and psychological distress.This case report explores the application of a sphenopalatine ganglion(SPG)block as an alternative anal-gesic modality to mitigate the discomfort associated with AFNI.CASE SUMMARY A 63-year-old female with a history of right maxillary osteosarcoma underwent craniotomy for a suspected malignant brain lesion.The patient’s medical history included prior surgery,chemotherapy,and radiation therapy,resulting in signi-ficant jaw impairment and limited neck mobility.Considering the anticipated air-way challenges,AFNI was planned.A SPG block was performed under real-time ultrasound guidance,providing effective analgesia during nasotracheal intuba-tion.CONCLUSION The SPG block represents a promising analgesic approach in AFNI,offering po-tential benefits in alleviating pain involving the nasal and nasopharyngeal regions as well as improving patient cooperation.

关键词： Sphenopalatine ganglion block nerve block Regional anesthesia Analgesia Awake fiberoptic nasotracheal intubation Case report

Use of ultrasound to facilitate femoral nerve block with stimulating catheter

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Chinese Medical Journal 2011年第4期124卷 519-524页

作者： LI Min XU Ting HAN Wen-yong WANG Xue-dong JIA Dong-lin GUO Xiang-yang Department of Anesthesiology Peking University Third HospitalBeijing 100191 China

Background The adjunction of ultrasound to nerve stimulation has been proven to improve single-injection peripheral nerve block quality. However, few reports have been published determining whether ultrasound can facilitate continuous nerve blocks. In this study, we tested the hypothesis that the addition of ultrasound to nerve stimulation facilitates femoral nerve blocks with a stimulating catheter.Methods In this prospective randomized study, patients receiving continuous femoral nerve blocks for total knee replacement were randomly assigned to either the ultrasound guidance combined with stimulating catheter group （USNS group; n=60） or the stimulating catheter alone group （NS group; n=60）. The primary end point was the procedure time （defined as the time from first needle contact with the skin until correct catheter placement）. The numbers of needle passes and catheter insertions, onset and quality of femoral nerve blocks, postoperative pain score, and early knee function were also recorded.Results The procedure time was significantly less in the USNS group than in the NS group （9.0 （6.0-22.8） minutes vs.13.5 （6.0-35.9） minutes, P=0.024）. The numbers of needle passes and catheter insertions were also significantly less in the USNS group. A greater complete block rate was achieved at 30 minutes in the USNS group （63.3% vs. 38.3%;P=0.010）. The postoperative pain score, the number of patients who required bolus local anesthetic and intravenous patient-controlled analgesia, and knee flexion on the second postoperative day were not significantly different between the two groups of patients.Conclusions Ultrasound-assisted placement of a stimulating catheter for femoral nerve blocks decreases the time necessary to perform the block compared with just the nerve-stimulating technique. In addition, a more complete blockade is achieved using the ultrasound-assisted technique.

关键词： ultrasonography nerve block catheterization

Peripheral nerve block is Safely Administered in a Patient with Kearns-Sayre Syndrome

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Chinese Medical Journal 2016年第10期129卷 1251-1252页

作者： Woo-Jin Kwon Seung-Uk Bang Sae-Cheol Oh Jung-Woo Shim Department of Anesthesiology and Pain Medicine College of Medicine The Catholic University of Korea Seoul Republic of Korea

Kearns-Sayre syndrome （KSS） is an extremely rare form ofmitochondrial myopathy characterized by progressive external ophthalmoplegia, bilateral pigmentary retinopathy, and cardiac conduction abnormalities. In addition, KSS patients might present with proximal muscle weakness, diabetes mellitus, hearing loss, cerebellar ataxia, and elevated cerebrospinal fluid protein levels.

关键词： Anesthesia Kearns-Sayre Syndrome nerve block Ultrasonography

Observation on the Anesthesia Effect of Ultrasound-Guided nerve block for Elderly Patients with Lower Limb Fractures

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Proceedings of Anticancer Research 2021年第3期5卷 11-14页

作者： Lihong Cheng Shanzhi Luo Shuyang County Central Hospital Suqian 333600Jiangsu ProvinceChina

Objective:To explore the anesthesia effect of ultrasound-guided nerve block in elderly patients with lower limb fractures.Methods:From November 2017 to November 2020,50 elderly patients with lower limb fractures in our hospital were divided into experimental group(25 cases,general anesthesia+femoral nerve and sciatic nerve block)and control group(25 cases,general body anesthesia).Compare the MAP,HR,anesthesia effect,and adverse reactions between the two groups at each time period.Results:Before induction,the difference in MAP and HR between the two groups of patients did not form,p>0.05;the MAP and HR of the experimental group were compared with the control group at the time of skin incision,1 hour during the operation,and removal of the laryngeal mask,Pnerve and sciatic nerve block for elderly patients with lower limb fractures can enhance the effect of anesthesia,effectively reduce the use of anesthetics,and have fewer adverse reactions.It is worthy of promotion.

关键词： Ultrasound guidance nerve block Lower limb fracture Anesthesia effect

Impact of adding opioids to paravertebral blocks in breast cancer surgery patients:A systematic review and meta-analysis

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World Journal of Clinical Cases 2022年第6期10卷 1852-1862页

作者： Meng-Hua Chen Zheng Chen Da Zhao Lanzhou University Medical College Lanzhou 730000Gansu ProvinceChina Department of Breast Shandong Second Provincial General HospitalJinan 250021Shandong ProvinceChina Department of Oncology The First Hospital of Lanzhou UniversityLanzhou 730000Gansu ProvinceChina

BACKGROUND Several breast cancer studies have reported the use of adjuvant opioids with the paravertebral block(PVB)to improve outcomes.However,there is no level-1 evidence justifying its use.AIM To elucidate if the addition of opioids to PVB improves pain control in breast cancer surgery patients.METHODS We conducted an electronic literature search across PubMed,Embase,Scopus,and Google Scholar databases up to October 20,2020.Only randomized controlled trials(RCTs)comparing the addition of opioids to PVB with placebo for breast cancer surgery patients were included.RESULTS Six RCTs were included.Our meta-analysis indicated significantly reduced 24-h total analgesic consumption with the addition of opioids to PVB as compared to placebo[standardized mean difference(SMD)-1.57,95%confidence interval(CI):-2.93,-0.21,I2=94%].However,on subgroup analysis,the results were nonsignificant for studies using single PVB(SMD:-1.76,95%CI:-3.65,0.13 I2=95.09%)and studies using PVB infusion(SMD:-1.30,95%CI:-4.26,1.65,I2=95.49%).Analysis of single PVB studies indicated no significant difference in the time to first analgesic request between opioid and placebo groups(mean difference-11.28,95%CI:-42.00,19.43,I2=99.39%).Pain scores at 24 h were marginally lower in the opioid group(mean difference-1.10,95%CI:-2.20,0.00,I2=0%).There was no difference in the incidence of postoperative nausea and vomiting between the two groups.CONCLUSION Current evidence suggests a limited role of adjuvant opioids with PVB for breast cancer surgery patients.Further homogenous RCTs with a large sample size are needed to clarify the beneficial role of opioids with PVB.

关键词： Opioids Pain Surgery Breast cancer nerve block Paravertebral block

Combinations of nerve blocks in surgery for post COVID-19 pulmonary sequelae patient:A case report and review of literature

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World Journal of Clinical Cases 2023年第5期11卷 1198-1205页

作者： Yehun Jin Suzie Lee Daehyun Kim Jangho Hur Woosik Eom Department of Anesthesiology and Pain Medicine National Cancer CenterGoyang-si 10408Gyeonggi-doSouth Korea

BACKGROUND Regional anesthesia is a promising method in patients with post coronavirus disease 2019(COVID-19)pulmonary sequelae for preserving pulmonary function and preventing postoperative pulmonary complications,compared with general anesthesia.CASE SUMMARY We provided surgical anesthesia and analgesia suitable for breast surgery by performing pectoral nerve block type II(PECS-II),parasternal,and intercostobrachial nerve blocks with intravenous dexmedetomidine administration in a 61-year-old female patient with severe pulmonary sequelae after COVID-19infection.CONCLUSION Sufficient analgesia for 7 h was provided via PECS-II,parasternal,and intercostobrachial blocks perioperatively.

关键词： Analgesia Anesthesia COVID-19 Regional anesthesia nerve block Case report

Endoscopic ultrasound in chronic pancreatitis: Where are we now?

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World Journal of Gastroenterology 2010年第34期16卷 4253-4263页

作者： Andrada Seicean Third Medical Clinic University of Medicine and Pharmacy "Iuliu Hatieganu" 400162 Cluj-Napoca Romania

Endoscopic ultrasonography (EUS) is well suited for assessment of the pancreas due to its high resolution and the proximity of the transducer to the pancreas, avoiding air in the gut. Evaluation of chronic pancreatitis (CP) was an early target for EUS, initially just for diagnosis but later for therapeutic purposes. The diagnosis of CP is still accomplished using the standard scoring based on nine criteria, all considered to be of equal value. For diagnosis of any CP, at least three or four criteria must be fulf illed, but for diagnosis of severe CP at least six criteria are necessary. The Rosemont classif ication, more restrictive, aims to standardize the criteria and assigns different values to different features, but requires further validation. EUS-f ine needle aspiration (EUS-FNA) is less advisable for diagnosis of diffuse CP due to its potential side effects. Elastography and contrast-enhanced EUS are orientation in differentiating a focal pancreatic mass in a parenchyma with features of CP, but they cannot replace EUS-FNA. The usefulness of EUS-guided celiac block for painful CP is still being debated with regard to the best technique and the indications. EUS-guided drainage of pseudocysts is preferred in non-bulging pseudocysts or in the presence of portal hypertension. EUS-guided drainage of the main pancreatic duct should be reserved for cases in which endoscopic retrograde cholangiopancreatography has failed owing to difficult cannulation of the papilla or diff icult endotherapy. It should be performed only by highly skilled endoscopists, due to the high rate of complications.

关键词： Endoscopic ultrasonography Pancreatic neoplasms Chronic pancreatitis Contrast agents nerve block Pancreatic pseudocyst Drainage Elastography Main pancreatic duct

Effective background infusion rate of ropivacaine 0.2% for patient-controlled interscalene brachial plexus analgesia after rotator cuff repair surgery

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Chinese Medical Journal 2014年第23期127卷 4119-4123页

作者： Wei Yue Li Min Rong Yulan Guo Xiangyang Department of Anesthesiology Peking University Third Hospital Beijing 100191 China

Background Continuous interscalene nerve block （CISB） is considered to be the most effective method for postoperative analgesia after shoulder surgery with prolonged severe pain.This study was performed to evaluate the minimum effective background infusion rate and the effective background infusion rate of ropivacaine 0.2％ for CISB after arthroscopic rotator cuff repair surgery in 95％ of patients.Methods Patients scheduled for arthroscopic rotator cuff repair surgery under general anesthesia at Peking University Third Hospital were prospectively enrolled from December 2011 to May 2012.Preoperatively,an interscalene catheter （ISC） was placed under the guidance of ultrasound and nerve stimulation in each patient.Consecutively,30 patients with successful nerve block were included.A continuous infusion of ropivacaine 0.2％ with a 5 ml patient-controlled bolus available hourly was started at postoperative anesthesia care unit （PACU） after completion of surgery.The initial background infusion rate was 6 ml/h,which was subsequently varied for each consecutive patient according to the analgesic effects of the previous one.The minimum effective background rate was determined using the Dixon and Massey up-and-down method.The effective background rate in 95％ of patients was calculated using isotonic analysis.Results The minimum effective background rate based on the Dixon and Massey up-and-down method was 2.8 ml/h （95％ CI,2.3-3.3 ml/h）.The effective background rate in 95％ of patients calculated with the isotonic regression analysis was 4.4 ml/h （95％ CI,3.8-6.5 ml/h）.Conclusion The effective background rate for patient-controlled interscalene brachial plexus analgesia after shoulder surgery in 50％ and 95％ of the patients was 2.8 and 4.4 ml/h,respectively.

关键词： ropivacaine brachial plexus nerve block dose-response relationship drug