BACKGROUND Femur fractures are one of the most serious injuries that occur in the older population and are associated with severe pain and increased mortality.The primary objective of this study was to find if there w...BACKGROUND Femur fractures are one of the most serious injuries that occur in the older population and are associated with severe pain and increased mortality.The primary objective of this study was to find if there was a significant difference in pain scores in patients treated with femoral nerve blocks(FNB)compared with patients treated with the standard analgesia protocol.The secondary objective was to find if there was a significant difference in morbidity between the two groups.AIM To evaluate the effectiveness of ultrasound(US)-guided FNB in managing preoperative pain and reducing morbidity in patients with neck femur fractures compared to the standard analgesia protocol.The study seeks to determine whether FNB offers superior outcomes in terms of pain control,rehospitalization rates,and mortality.METHODS This retrospective cohort study included 1577 patients suffering from neck femur fractures.387 patients were treated with a FNB for pain management upon arrival at the emergency department,the rest were treated with standard analgesia.Pain was assessed from electronic medical records using the visual analogue scale(VAS)pre surgery,12-and 24-hour post-surgery.To determine morbidity and mortality during hospitalizations and 6 months after,it was collected from electronic medical records.RESULTS In a cohort of 1577 patients,those receiving US-guided FNB had significantly lower preoperative VAS pain scores(1.46±2.49 vs 1.82±2.59,P=0.001),reduced rehospitalization rates(0.99±1.96 vs 1.46±2.34,P<0.001),and lower mortality(16%vs 32%,P<0.001)compared to standard analgesia.CONCLUSION US guided FNB is more effective for pain management compared with standard analgesia.This method was also found to significantly reduce the risk of morbidity in those patients.展开更多
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,co...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.展开更多
AIM To report the effects of greater occipital nerve(GON) blocks on refractory chronic migraine headache.METHODS Nine patients who were receiving the conventionally accepted preventive therapies underwent treatment wi...AIM To report the effects of greater occipital nerve(GON) blocks on refractory chronic migraine headache.METHODS Nine patients who were receiving the conventionally accepted preventive therapies underwent treatment with repeated GON block to control chronic migraine resistant to other treatments. GON blocking with lidocaine and normal saline mixture was administered by the same physician at hospital once a month(for three times in total). Patients were assessed before the injection and every month thereafter for pain frequency and severity, number of times analgesics were used and any appearant side effects during a 6 mo follow-up.RESULTS Eight of nine patients reported a marked decrease in frequency and severity of migraine attacks in comparison to their baseline symptoms; one reported no significant change(not more than 50%) from baseline and did not accept the second injection. GON block resulted in considerable reduction in pain frequency and severity and need to use analgesics up to three months after the injection in the present cases. The patients did not report any adverse effects. CONCLUSION Hereby we noticed a remarkable success with refractory chronic migraine patients. We believe that this intervention can result in rapid relief of pain with the effects lasting for perhaps several weeks or even months. Further controlled clinical trials are warranted to evaluate the effect of GON block in the treatment of refractory migraine cases.展开更多
In order to examine whether repeated sciatic nerve blocks showed tachyphylaxis and continuity of sciatic nerve with spinal cord affected development of tachyphylaxis when assayed in vivo by duration of depression comp...In order to examine whether repeated sciatic nerve blocks showed tachyphylaxis and continuity of sciatic nerve with spinal cord affected development of tachyphylaxis when assayed in vivo by duration of depression compound action potentials (CAP), rats were anesthetized with halothane, ventilated, monitored and supported with stable hemodynamics and temperature. Posterior tibial nerve distally and sciatic nerve in thigh were exposed, placed on bipolar silver electrodes for stimulation and recording respectively. Three sequential sciatic nerve blocks were performed between these electrodes using 0.15 ml of 3 % chloroprocaine. Nine rats were chosen to observe the effects of repeated sciatic nerve blocks on CAP. In another 18 rats, a second investigator exposed the sciatic nerve near its origin at spinal cord and randomly performed nerve cut and sham (n=9), and closed the incision blinding the electrophysiologic investigator. The results showed that electrical stimulated tibial nerve induced sciatic nerve Aα/β, Aδ, C fiber mediated CAP waves. CAP amplitudes were remained stable during whole experimental procedure. CAP amplitudes were decreased completely with 3% chloroprocaine blocked sciatic nerve and recovered fully. The duration of CAP depression were reduced with repeated blocks. There were no selective blocked effects on Aα/β, Aδ, C fiber mediated CAP. With sciatic nerve cut proximally, there was no statistical significant tachyphylaxis with 3 % chloroprocaine repeated blocked sciatic nerve, and the duration of first and third blocked Aδ fiber mediated CAP was 108±20 and 92±14 min respectively (P>0.05). In normal rats the duration of first and third blocked Aδ fiber mediated CAP was 110±20 and 75±16 min respectively (P<0.05). It was suggested that tachyphylaxis to local anesthetics can occur in rats repeated blocked sciatic nerve when assayed in vivo by duration of depression CAP. The continuity of sciatic nerve with spinal cord is one of the important factors affecting the development of tachyphylaxis.展开更多
BACKGROUND Osteonecrosis or avascular necrosis(AVN)of the hip was one of the dreaded complications of coronavirus disease 2019(COVID-19),which emerged in patients who received steroid therapy.Corticosteroids have been...BACKGROUND Osteonecrosis or avascular necrosis(AVN)of the hip was one of the dreaded complications of coronavirus disease 2019(COVID-19),which emerged in patients who received steroid therapy.Corticosteroids have been a mainstay in the treatment protocol of COVID-19 patients.Popular corticosteroid drugs used in patients suffering from COVID-19 were intravenous(IV)or oral dexamethasone,methylprednisolone or hydrocortisone.The use of such high doses of corticost-eroids has shown very positive results and has been lifesaving in many cases.Still,long-term consequences were drug-induced diabetes,osteoporosis,Cushing syndrome,muscle wasting,peripheral fat mobilization,AVN,hirsutism,sleep disturbances and poor wound healing.A significant number of young patients were admitted for bilateral total hip replacements(THR)secondary to AVN following steroid use for COVID-19 treatment.AIM To assess the efficacy of bilateral pericapsular end nerve group(PENG)blocks in patients posted for bilateral THR post-steroid therapy after COVID-19 infection and assess the time taken to first ambulate after surgery.METHODS This prospective observational study was conducted between January 2023 and August 2023 at Care Hospitals,Hyderabad,India.Twenty young patients 30-35 years of age who underwent bilateral THR were studied after due consent over 8 months.All the patients received spinal anaesthesia for surgery and bilateral PENG blocks for postoperative analgesia.RESULTS The duration of surgery was 2.5 h on average.Seventeen out of twenty patients(85%)had a Visual Analog Score(VAS)of less than 2 and did not require any supplementation.One patient was removed from the study,as he required re-exploration.The remaining two patients had a VAS of more than 8 and received IV morphine post-operatively as a rescue analgesic drug.Fifteen out of seventeen patients(88.2%)could be mobilized 12 h after the procedure.CONCLUSION Osteonecrosis or AVN of the hip was one of the dreaded complications of COVID-19,which surfaced in patients who received steroid therapy requiring surgical intervention.Bilateral PENG block is an effective technique to provide post-operative analgesia resulting in early mobilization and enhanced recovery after surgery.展开更多
BACKGROUND Subcutaneous implantable cardioverter-defibrillator(S-ICD)implantation requires effective anesthesia.General anesthesia(GA)carries risks like hemodynamic instability,while ultrasound-guided intercostal nerv...BACKGROUND Subcutaneous implantable cardioverter-defibrillator(S-ICD)implantation requires effective anesthesia.General anesthesia(GA)carries risks like hemodynamic instability,while ultrasound-guided intercostal nerve block(US-ICNB)may offer better pain control.This study hypothesized US-ICNB is superior in perioperative safety and pain management.AIM To compare perioperative outcomes of GA and US-ICNB in S-ICD implantation.METHODS This retrospective single-center study included 64 patients who received S-ICD implantation between February 2021 and December 2024.They were divided into GA and US-ICNB groups based on anesthesia type.Demographic data,perioperative parameters(operation time,pain scores,analgesic usage),and postoperative outcomes(complications,defibrillation events)were collected and analyzed.Statistical tests were used to compare the two groups.RESULTS This study included 64 patients(20 in the GA group and 44 in the US-ICNB group).Baseline left ventricular ejection fraction was significantly lower in the US-ICNB group(39.20%±12.00%vs 56.20%±11.50%in GA,P<0.001),while American Society of Anesthesiologists scores and comorbidities were comparable.US-ICNB showed superior pain control,with significantly lower numeric rating scale scores at 6-48 hours(P<0.001)and fewer patients requiring analgesics(P=0.02).The US-ICNB group had shorter operation times(P<0.001),total hospital stays(P<0.001),and later first analgesia times(P<0.001).No anesthesia-related complications occurred in either group.CONCLUSION Both anesthetic methods were safe in the short term.However,US-ICNB was superior in reducing operation and hospital stay times and alleviating peri-operative pain.It has high safety in S-ICD implantation and deserves further clinical promotion,though large-scale,multi-center,randomized controlled trials are needed to confirm these findings.展开更多
BACKGROUND Far lateral lumbar disc herniation(FLLDH)is a special type of lumbar disc herniation with high rate of missed diagnosis.Selective nerve root block(SNRB)has special advantages in identifying the responsible ...BACKGROUND Far lateral lumbar disc herniation(FLLDH)is a special type of lumbar disc herniation with high rate of missed diagnosis.Selective nerve root block(SNRB)has special advantages in identifying the responsible nerve root.Percutaneous transforaminal endoscopic discectomy(PTED)is a minimally invasive and effective method to treat FLLDH.However,no report has investigated PTED combined with SNRB to treat FLLDH.AIM To explore the diagnosis and treatment process,surgical technique and clinical efficacy of PTED combined with SNRB to treat FLLDH.METHODS This is a multicenter center,retrospective,observational study.Between January 2020 and January 2022,32 patients were initially diagnosed with FLLDH.All the patients were identified using SNRB to determine the responsible segment and involved nerve roots.Because of poor symptomatic control following SNRB,2 patients were excluded.30 patients diagnosed with FFLDH underwent PTED.The clinical characteristics,operative and postoperative outcomes,complication and subsequent follow-up were collected.RESULTS 30 patients who underwent SNRB combined with PTED were followed up.The average visual analogue scale(VAS)-leg score,VAS-back score,Oswestry disability index(ODI)score at the Follow-up(1 day,1 month,3 months and last follow-up)were significantly different compared per-operation.According to the modified Macnab efficacy evaluation standard,the satisfaction degree at the last follow-up was excellent(28,93.33%),good(1,3.33%),medium(1,3.33%)and poor(0,0%).CONCLUSION SNRB provides an effective method for the definite diagnosis of FLDH and responsible nerve roots.Combination therapy offers several advantages including minimal invasiveness,precision,effectiveness,safety and low recurrence rates.展开更多
BACKGROUND Knee diseases are more common in middle-aged and elderly people,so artificial knee replacement is also more used in middle-aged and elderly people.Although the patient’s pain can be reduced through surgery...BACKGROUND Knee diseases are more common in middle-aged and elderly people,so artificial knee replacement is also more used in middle-aged and elderly people.Although the patient’s pain can be reduced through surgery,often accompanied by moderate pain after surgery and neutralization,which not only increases the psychological burden of the patient,but also greatly reduces the postoperative recovery effect,and may also lead to the occurrence of postoperative adverse events in severe cases.AIM To investigate the analgesic effect of artificial intelligence(AI)and ultrasoundguided nerve block in total knee arthroplasty(TKA).METHODS A total of 92 patients with TKA admitted to our hospital from January 2021 to January 2022 were opted and divided into two groups according to the treatment regimen.The control group received combined spinal-epidural anesthesia.The research group received AI technique combined with ultrasound-guided nerve block anesthesia.The sensory block time,motor block time,visual analogue scale(VAS)at different time points and complications were contrasted between the two groups.RESULTS The time of sensory block onset and sensory block perfection in the research group was shorter than those in the control group,but the results had no significant difference(P>0.05).Duration of sensory block in the research group was significantly longer than those in the control group(P<0.05).The time of motor block onset and motor block perfection in the research group was shorter than those in the control group,but the results had no significant difference(P>0.05).Duration of motor block in the research group was significantly longer than those in the control group.The VAS scales of the research group were significantly lower than that of the control group at different time points(P<0.05).The postoperative hip flexion and abduction range of motion in the research group were significantly better than those in the control group at different time points(P<0.05).The incidence of complications was significantly lower in the research group than in the control group(P=0.049).CONCLUSION In TKA,the combination of AI technology and ultrasound-guided nerve block has a significantly effect,with fewer postoperative complications and significantly analgesic effect,which is worthy of application.展开更多
Background and Purpose: Postoperative pain after knee arthroplasty (TKA) is reported as severe in up to 60% of patients. Continuous femoral nerve blocks (CFNB) are a choice for major knee repair, but controversies rem...Background and Purpose: Postoperative pain after knee arthroplasty (TKA) is reported as severe in up to 60% of patients. Continuous femoral nerve blocks (CFNB) are a choice for major knee repair, but controversies remain about the need of supplemental sciatic nerve blocks (SNB) for better analgesia. Our aim is to assess the effect of the association of a SNB to a CFNB to reduce postoperative pain after TKA. Methods: A prospective randomized, single blinded, controlled study, on 50 patients undergoing TKA. Control group received a CFNB before general anesthesia;in the intervention group a single shot SNB was added after the CFNB was done. After the end of surgery all patients started a continuous local anesthetic infusion through the femoral catheter in the PACU (post-anesthesia care unit). Pain scores were measured in the PACU and at 12 h and 24 h postoperative using a visual analog scale (VAS). Results: VAS pain scores (mm) were lower and statistically significant for the intervention group up to 12 h postoperative: PACU admission mean VAS = 59.4 vs 30.2, P = 0.001;at 12 h mean VASr = 26.1 vs 9.2, P = 0.006;at 24 h mean VASr = 30.1 vs 32.7, P = 0.723. Conclusions: The association of a single shot SNB with a CFNB significantly reduces postoperative pain scores after TKA up to 12 h. At 24 h there are no differences between groups.展开更多
BACKGROUND Thoracic surgery for radical resection of lung tumor requires deep anesthesia which can lead to an adverse inflammatory response,loss of hemodynamic stability,and decreased immune function.Herein,we evaluat...BACKGROUND Thoracic surgery for radical resection of lung tumor requires deep anesthesia which can lead to an adverse inflammatory response,loss of hemodynamic stability,and decreased immune function.Herein,we evaluated the feasibility and benefits of ultrasound-guided paravertebral nerve block anesthesia,in combination with general anesthesia,for thoracic surgery for lung cancer.The block was performed by diffusion of anesthetic drugs along the paravertebral space to achieve unilateral multi-segment intercostal nerve and dorsal branch nerve block.AIM To evaluate the application of ultrasound-guided paravertebral nerve block anesthesia for lung cancer surgery to inform practice.METHODS The analysis was based on 140 patients who underwent thoracic surgery for lung cancer at our hospital between January 2018 and May 2020.Patients were randomly allocated to the peripheral+general anesthesia(observation)group(n=74)or to the general anesthesia(control)group(n=66).Patients in the observation group received ultrasound-guided paravertebral nerve block anesthesia combined with general anesthesia,with those in the control group receiving an epidural block combined with general anesthesia.Measured outcomes included the operative and anesthesia times,as well as the mean arterial pressure(MAP),heart rate(HR),and blood oxygen saturation(SpO;)measured before surgery,15 min after anesthesia(T1),after intubation,5 min after skin incision,and before extubation(T4).RESULTS The dose of intra-operative use of remifentanil and propofol and the postoperative use of sufentanil was lower in the observation group(1.48±0.43 mg,760.50±92.28 mg,and 72.50±16.62 mg,respectively)than control group(P<0.05).At the four time points of measurement(T1 through T4),MAP and HR values were higher in the observation than control group(MAP,90.20±9.15 mmHg,85.50±7.22 mmHg,88.59±8.15 mmHg,and 90.02±10.02 mmHg,respectively;and HR,72.39±8.22 beats/min,69.03±9.03 beats/min,70.12±8.11 beats/min,and 71.24±9.01 beats/min,respectively;P<0.05).There was no difference in SpO;between the two groups(P>0.05).Postoperative levels of epinephrine,norepinephrine,and dopamine used were significantly lower in the observation than control group(210.20±40.41 pg/mL,230.30±65.58 pg/mL,and 54.49±13.32 pg/mL,respectively;P<0.05).Similarly,the postoperative tumor necrosis factor-αand interleukin-6 levels were lower in the observation(2.43±0.44 pg/mL and 170.03±35.54 pg/mL,respectively)than control group(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).CONCLUSION Ultrasound-guided paravertebral nerve block anesthesia improved the stress and hemodynamic response in patients undergoing thoracic surgery for lung cancer,with no increase in the rate of adverse events.展开更多
OBJECTIVE:To observe the clinical efficacy of acupuncture along fascia,meridians,and nerves combined with ultrasound-guided nerve blockage in the treatment of postherpetic neuralgia.METHODS:A total of 61 outpatients w...OBJECTIVE:To observe the clinical efficacy of acupuncture along fascia,meridians,and nerves combined with ultrasound-guided nerve blockage in the treatment of postherpetic neuralgia.METHODS:A total of 61 outpatients with post-chest and back herpes zoster neuralgia were recruited in the Department of Pain at the Xiyuan Hospital,China Academy of Chinese Medical Sciences from May 2019 to June 2021.They were randomly divided into two groups.Thirty-one patients in the control group were treated with ultrasound-guided thoracic paravertebral nerve block(PVB)alone,one patient declined to continue during treatment(n=30),and thirty patients in the observation group received the acupuncture along the fascia,meridians,and nerves combined with ultrasound-guided PVB treatment(n=30).Both control and observation group received treatment weekly for 4 weeks.The medical history data such as age,sex,presence or absence of comorbidities and disease course were analyzed.The visual analog scale(VAS)score was used to assess the pain degree of two groups at T0(before treatment),T1(1-time treatment ended),T2(2 times treatment ended),T3(3 times treatment ended),and T4(4 times treatment ended).The sleep state was examined by Pittsburgh Sleep Quality Index(PSQI)before and after the study.RESULTS:There was no significant difference in general conditions between the control group and the observation group(P>0.05).The VAS score in both control and observation group was decreased in a time-dependent manner after 1-4 weeks of treatment.There were no significant differences in VAS scores between the two groups after 1 or 2 weeks of treatment(P>0.05).After 3 and 4 weeks of treatment,the VAS score was significantly decreased in the observation group compared with that in the control group(P<0.001).In addition,the reduction in VAS score(after treatment-before treatment)between the two groups was statistically significant[D value:-1.53,95%CI(-2.32,0.74),P<0.001].Furthermore,the sleep state of patients in both groups markedly improved and much obvious in the observation group than that in the control group(P<0.05).CONCLUSION:These results suggest that a combination of acupuncture along fascia,meridians,and nerves with ultrasound-guided PVB treatment is more effective than ultrasound-guided PVB treatment alone.展开更多
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-extr...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±0.40.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 control group(P<0.05).CONCLUSION Ultrasound-guided nerve block combined with dexmedetomidine has a good anesthetic effect in the operation of lower limb fractures and has little effect on the hemodynamics of patients.展开更多
BACKGROUND: Fascia iliaca compartment nerve block(FICNB) has been an established technique for postoperative analgesia after surgery for femoral bone fracture. FICNB is technically easy, effective for postoperative pa...BACKGROUND: Fascia iliaca compartment nerve block(FICNB) has been an established technique for postoperative analgesia after surgery for femoral bone fracture. FICNB is technically easy, effective for postoperative pain control after operation for femoral bone fracture and decreases the complications induced by systemic analgesic drugs. The severity of postoperative pain is affected by genetics, cultural and social factors across the world. In this study we assessed the efficacy of fascia iliaca compartment nerve block when it is used as part of multimodal analgesia after surgery for femoral bone fracture.METHODS: An institution-based case control study was conducted from September, 2013 to May, 2014. All patients who had been operated on under spinal anesthesia for femoral bone fracture were included. The patients divided into a FICNB group(n=20) and a control group(n=20). The FICNB group was given 30 mL of 0.25% bupivacaine at the end of the operation. Postoperative pain was assessed within the f irst 24 hours, i.e. at 15 minutes, 2 hours, 6 hours, 12 hours and 24 hours using 100 mm visual analogue scale(VAS), total analgesic consumption, and the time for the f irst analgesic request.RESULTS: VAS pain scores were reduced within the f irst 24 hours after operation in the FICNB group compared wtih the control group. VAS scores at 2 hours were taken as median values(IQR) 0.00(0.00) vs.18.00(30.00), P=0.001; at 6 hours 0.00(0.00) vs. 34.00(20.75), P=0.000; at 24 hours 12.50(10.00) vs. 31.50(20.75), P=0.004; and at 12 hours(17.80±12.45) vs.(29.95±12.40), P=0.004, respectively. The total analgesic consumption of diclofenac at 12 and 24 hours was reduced in the FICNB group, and the time for the fi rst analgesic request was signifi cantly prolonged(417.50 vs. 139.25 minutes, P=0.000).CONCLUSIONS: A single injection for FICNB could lead to postoperative pain relief, reduction of total analgesic consumption and prolonged time for the fi rst analgesic request in the FICNB group after surgery for femoral bone fracture. We recommend FICNB for analgesia after surgery for femoral bone fracture and for patients with femoral bone fracture at the emergency department.展开更多
Objective： To provide the clinical evidence to evaluate the feasibility and refine the protocol for acupotomy combined with fire needle and pudendal nerve block therapy in treatment of sacral nerve dysfunction syndr...Objective： To provide the clinical evidence to evaluate the feasibility and refine the protocol for acupotomy combined with fire needle and pudendal nerve block therapy in treatment of sacral nerve dysfunction syndrome（SNDS）. Methods： Seventy-five patients with SNDS were randomized into the treatment group（acupotomy and fire needle and pudendal nerve block therapy） and the control group（pudendal nerve block therapy）. After a course of treatment, Visual Analogue Scales（VAS） of anorectal pain, defecation disorders, anal incontinence, VAS of lumbar pain or soreness, VAS of abdominal distension and pain were compared before and after the treatment. Result： Scores of defecation disorders, including defecation interval time index, defecation time index, fecal property index and defecation difficulty index, of patients with SNDS in the two groups were statistically different before and after the treatment in the same group（all P〈0.05）, but the differences of those indexes between two groups were not statistically significant（all P〈0.05） after the treatment,. Scores of anal incontinence, VAS scores of lumbar pain or soreness, VAS scores of abdominal pain and distension in the two groups were statistically different before and after the treatment（all P〈0.05）. However, after treatment, the differences between two groups were not statistically significant（all P〈0.05）. VAS scores of anorectal pain in the two groups were statistically different before and after the treatment（both P〈0.05）, and that of the treatment group was statistically lower than control group after the treatment（1.61 ± 0.95 vs. 3.04 ± 1.81, P〈0.01）, the total effective rate of the treatment group was higher than that of the control group, and the difference was statistically significant（94.74% vs. 81.08%, P〈0.01）, there was no difference in self-evaluation between the two groups（P〈0.05）. Conclusion： In treating SNDS, acupotomy combined with fire needle and pudendal nerve block therapy can more effectively alleviate anorectal pain and improve the total effective rate.展开更多
BACKGROUND When herpes zoster is complicated with paralytic ileus,this mostly involves acute intestinal pseudo-obstruction of Ogilvie’s syndrome manifesting as obvious dilatation of the cecum and right colon;small in...BACKGROUND When herpes zoster is complicated with paralytic ileus,this mostly involves acute intestinal pseudo-obstruction of Ogilvie’s syndrome manifesting as obvious dilatation of the cecum and right colon;small intestinal obstruction is rare.Here,we present a patient with a very rare case of small bowel pseudo-obstruction.CASE SUMMARY A 76-year-old female patient complained of right upper quadrant pain.Two days later,a blistering,right-sided rash of the thoracoabdominal dermatome(T5-T10) emerged in conjunction with small intestinal dilatation and the inability to defecate.Computed tomography of the abdomen confirmed small bowel pseudoobstruction.Antiviral therapy,gastrointestinal decompression,and enemas proved unproductive.After 4 d of stagnation,an epidural block was performed for pain relief and prompted the passage of gas and stool,resolving the obstructive problem.Three days later,the rash appeared dry and crusted,and the pain diminished.After 5 d,no abnormality was visible by gastroenteroscopy,and the patient was discharged on day 7.CONCLUSION This case shows that herpes zoster may induce small bowel pseudo-obstruction in addition to colonic pseudo-obstruction.Epidural block can not only treat intercostal neuralgia but also resolve small bowel pseudo-obstruction caused by herpes zoster.展开更多
<strong>Objective:</strong> The aim of this study was to observe and investigate the location of mental foramen, providing scientific and reasonable anatomic basic for clinical mental nerve block. <stro...<strong>Objective:</strong> The aim of this study was to observe and investigate the location of mental foramen, providing scientific and reasonable anatomic basic for clinical mental nerve block. <strong>Methods:</strong> The shape, orientations, relationship with teeth and number of accessory mental foramina in 50 (100 side) adult mental foramina were observed. The long and short diameters of the mental foramen and the distance between the mental foramen and the peripheral anatomical markers were measured by a vernier caliper, and statistical analysis of the data was performed to obtain the final results. <strong>Results:</strong> The probability of mental foramen being elliptical in shape accounted for 27%, circular for 73%;10% of the mental foramen openings are outward and 90% are outward and upward;The mental foramina were located under the first premolars in 20%, under the second premolars in 75%, and 5% situated in the bottom of the first molars. The incidence of accessory mental foramina was 1%;the long diameter of the mental foramen was (2.42 ± 0.71) mm, and the short diameter of the mental foramen was (2.15 ± 0.14) mm;the vertical distance from the mental foramen center to the alveolar crest and the lower margin of the mandible were (14.09 ± 3.23) mm and (14.56 ± 1.74) mm;the distance between the midpoints of the vertical line to the center of the mental foramen was (1.26 ± 0.97) mm;the horizontal distance from the center of the mental foramen to the anterior median line was (23.57 ± 1.82) mm. <strong>Conclusion:</strong> The point of mental nerve block was selected below and behind the second premolars, above the midline of the mandible. The distance from the anterior median line was 2.5 cm, and the mental foramen was explored forward and downward after the insertion.展开更多
Objective： To assess the effect of transrectal ultrasound guided prostatic nerve blockade on the discomfort associated with systematic biopsy of the prostate. Methods： 73 patients receiving systematic 13 cores biops...Objective： To assess the effect of transrectal ultrasound guided prostatic nerve blockade on the discomfort associated with systematic biopsy of the prostate. Methods： 73 patients receiving systematic 13 cores biopsy of the prostate were randomized into two groups. Group A（37 cases） received an injection of 5 ml 1% lidocaine into the prostatic neurovascular bundles on each side at the base of the prostate under ultrasound guidance and group B（36 cases） received 5 ml saline injection （0.9% sodium chloride） at the same site. Pain during biopsy was assessed by using a 10-point linear visual analog score （VAS） immediately after the biopsy. Results： The mean pain scores during transrectal prostate biopsy were significantly lower in group A than group B（1.1±0.6 versus 5.9±3.1, t=4.81, P〈0.01）. During this study no patient in either group had any adverse effect from the injection. Conclusion： Transcrectal ultrasound guided prostatic nerve blockade is a safe and efficacious method for providing satisfactory anesthesia in transrectal prostate biopsy. We recommend its routine administration in all patients during this procedure.展开更多
Objective:To explore the application of thoracic nerve block and propofol anesthesia in the treatment and perioperative period.Methods:A total of 40 patients with thoracotomy for esophageal cancer between May 2020 and...Objective:To explore the application of thoracic nerve block and propofol anesthesia in the treatment and perioperative period.Methods:A total of 40 patients with thoracotomy for esophageal cancer between May 2020 and September 2021 in the hospital were selected to participate in this study.All the patients were divided into reference and experimental groups according to the anesthesia protocol.For the experimental group,the parathoracic vertebral nerve block scheme was used under ultrasound guidance,with general anesthesia in the same manner,and after the surgical treatment of both groups,the patient-controlled intravenous analgesia(PCIA)regimen was applied to both patients.The time of surgery for the two patient groups,intraoperative propofol,postoperative pain conditions and postoperative blood glucose and NE,E,DA levels were measured and conducted for comparative analysis.Results:There is no significant differences between the two groups,besides,in the experimental group,propofol in surgery was less than that in the reference group;At the T6~T9 timepoint,patients in the experimental group had lower VAS scores in quiet and active conditions than those in the reference group;At the T9 timepoint,blood glucose and NE levels were higher than the T1,T4,T5 time point levels in each group;At the T4,T4 timepoint,E levels in both groups were lower than the T1,T9 time point level in each group;at T9 time point,the DA level was higher in the reference group than the T1,T4 time point level in each group;at T9 Time point,blood glucose and NE,E,DA were lower than those in the reference group.Conclusions:In the treatment of thoracotomy in elderly patients,thoracic paravertebral nerve block compound propofol anesthesia program can be used to patients,with striking anesthesia effect and remarkable recovery effect in perioperative period,which is conducive to relieving postoperative pain and worth promotion and application.展开更多
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 a...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.展开更多
BACKGROUND Neuralgia is frequently noted in patients with Kummell’s disease,and its mechanism is complex,rendering it challenging to treat.Percutaneous kyphoplasty(PKP)has been widely used to treat osteoporotic verte...BACKGROUND Neuralgia is frequently noted in patients with Kummell’s disease,and its mechanism is complex,rendering it challenging to treat.Percutaneous kyphoplasty(PKP)has been widely used to treat osteoporotic vertebral compression fractures with satisfactory outcomes.However,it is not optimal for managing severely collapsed vertebrae,as cement injection may not be feasible.This report describes the use of a selective nerve block for the treatment of neuralgia caused by severely collapsed vertebrae in a patient with Kummell’s disease.CASE SUMMARY In our patient,three vertebrae were involved.The collapse of T11 was particularly severe.After managing T8 and T9 using PKP,these two segments were effectively strengthened;consequently,back pain was significantly relieved.However,the structure and strength of T11 could not be effectively restored using a minimally invasive surgical method because there was little room for cement injection.This caused obvious neuralgia according to the postoperative status of the PKP.Thus,we performed selective nerve blocks for the treatment of neuralgia,which resulted in satisfactory outcomes.CONCLUSION Selective nerve block may be a possible therapeutic strategy for neuralgia due to severely collapsed vertebrae in Kummell’s disease.展开更多
文摘BACKGROUND Femur fractures are one of the most serious injuries that occur in the older population and are associated with severe pain and increased mortality.The primary objective of this study was to find if there was a significant difference in pain scores in patients treated with femoral nerve blocks(FNB)compared with patients treated with the standard analgesia protocol.The secondary objective was to find if there was a significant difference in morbidity between the two groups.AIM To evaluate the effectiveness of ultrasound(US)-guided FNB in managing preoperative pain and reducing morbidity in patients with neck femur fractures compared to the standard analgesia protocol.The study seeks to determine whether FNB offers superior outcomes in terms of pain control,rehospitalization rates,and mortality.METHODS This retrospective cohort study included 1577 patients suffering from neck femur fractures.387 patients were treated with a FNB for pain management upon arrival at the emergency department,the rest were treated with standard analgesia.Pain was assessed from electronic medical records using the visual analogue scale(VAS)pre surgery,12-and 24-hour post-surgery.To determine morbidity and mortality during hospitalizations and 6 months after,it was collected from electronic medical records.RESULTS In a cohort of 1577 patients,those receiving US-guided FNB had significantly lower preoperative VAS pain scores(1.46±2.49 vs 1.82±2.59,P=0.001),reduced rehospitalization rates(0.99±1.96 vs 1.46±2.34,P<0.001),and lower mortality(16%vs 32%,P<0.001)compared to standard analgesia.CONCLUSION US guided FNB is more effective for pain management compared with standard analgesia.This method was also found to significantly reduce the risk of morbidity in those patients.
文摘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.
文摘AIM To report the effects of greater occipital nerve(GON) blocks on refractory chronic migraine headache.METHODS Nine patients who were receiving the conventionally accepted preventive therapies underwent treatment with repeated GON block to control chronic migraine resistant to other treatments. GON blocking with lidocaine and normal saline mixture was administered by the same physician at hospital once a month(for three times in total). Patients were assessed before the injection and every month thereafter for pain frequency and severity, number of times analgesics were used and any appearant side effects during a 6 mo follow-up.RESULTS Eight of nine patients reported a marked decrease in frequency and severity of migraine attacks in comparison to their baseline symptoms; one reported no significant change(not more than 50%) from baseline and did not accept the second injection. GON block resulted in considerable reduction in pain frequency and severity and need to use analgesics up to three months after the injection in the present cases. The patients did not report any adverse effects. CONCLUSION Hereby we noticed a remarkable success with refractory chronic migraine patients. We believe that this intervention can result in rapid relief of pain with the effects lasting for perhaps several weeks or even months. Further controlled clinical trials are warranted to evaluate the effect of GON block in the treatment of refractory migraine cases.
文摘In order to examine whether repeated sciatic nerve blocks showed tachyphylaxis and continuity of sciatic nerve with spinal cord affected development of tachyphylaxis when assayed in vivo by duration of depression compound action potentials (CAP), rats were anesthetized with halothane, ventilated, monitored and supported with stable hemodynamics and temperature. Posterior tibial nerve distally and sciatic nerve in thigh were exposed, placed on bipolar silver electrodes for stimulation and recording respectively. Three sequential sciatic nerve blocks were performed between these electrodes using 0.15 ml of 3 % chloroprocaine. Nine rats were chosen to observe the effects of repeated sciatic nerve blocks on CAP. In another 18 rats, a second investigator exposed the sciatic nerve near its origin at spinal cord and randomly performed nerve cut and sham (n=9), and closed the incision blinding the electrophysiologic investigator. The results showed that electrical stimulated tibial nerve induced sciatic nerve Aα/β, Aδ, C fiber mediated CAP waves. CAP amplitudes were remained stable during whole experimental procedure. CAP amplitudes were decreased completely with 3% chloroprocaine blocked sciatic nerve and recovered fully. The duration of CAP depression were reduced with repeated blocks. There were no selective blocked effects on Aα/β, Aδ, C fiber mediated CAP. With sciatic nerve cut proximally, there was no statistical significant tachyphylaxis with 3 % chloroprocaine repeated blocked sciatic nerve, and the duration of first and third blocked Aδ fiber mediated CAP was 108±20 and 92±14 min respectively (P>0.05). In normal rats the duration of first and third blocked Aδ fiber mediated CAP was 110±20 and 75±16 min respectively (P<0.05). It was suggested that tachyphylaxis to local anesthetics can occur in rats repeated blocked sciatic nerve when assayed in vivo by duration of depression CAP. The continuity of sciatic nerve with spinal cord is one of the important factors affecting the development of tachyphylaxis.
文摘BACKGROUND Osteonecrosis or avascular necrosis(AVN)of the hip was one of the dreaded complications of coronavirus disease 2019(COVID-19),which emerged in patients who received steroid therapy.Corticosteroids have been a mainstay in the treatment protocol of COVID-19 patients.Popular corticosteroid drugs used in patients suffering from COVID-19 were intravenous(IV)or oral dexamethasone,methylprednisolone or hydrocortisone.The use of such high doses of corticost-eroids has shown very positive results and has been lifesaving in many cases.Still,long-term consequences were drug-induced diabetes,osteoporosis,Cushing syndrome,muscle wasting,peripheral fat mobilization,AVN,hirsutism,sleep disturbances and poor wound healing.A significant number of young patients were admitted for bilateral total hip replacements(THR)secondary to AVN following steroid use for COVID-19 treatment.AIM To assess the efficacy of bilateral pericapsular end nerve group(PENG)blocks in patients posted for bilateral THR post-steroid therapy after COVID-19 infection and assess the time taken to first ambulate after surgery.METHODS This prospective observational study was conducted between January 2023 and August 2023 at Care Hospitals,Hyderabad,India.Twenty young patients 30-35 years of age who underwent bilateral THR were studied after due consent over 8 months.All the patients received spinal anaesthesia for surgery and bilateral PENG blocks for postoperative analgesia.RESULTS The duration of surgery was 2.5 h on average.Seventeen out of twenty patients(85%)had a Visual Analog Score(VAS)of less than 2 and did not require any supplementation.One patient was removed from the study,as he required re-exploration.The remaining two patients had a VAS of more than 8 and received IV morphine post-operatively as a rescue analgesic drug.Fifteen out of seventeen patients(88.2%)could be mobilized 12 h after the procedure.CONCLUSION Osteonecrosis or AVN of the hip was one of the dreaded complications of COVID-19,which surfaced in patients who received steroid therapy requiring surgical intervention.Bilateral PENG block is an effective technique to provide post-operative analgesia resulting in early mobilization and enhanced recovery after surgery.
文摘BACKGROUND Subcutaneous implantable cardioverter-defibrillator(S-ICD)implantation requires effective anesthesia.General anesthesia(GA)carries risks like hemodynamic instability,while ultrasound-guided intercostal nerve block(US-ICNB)may offer better pain control.This study hypothesized US-ICNB is superior in perioperative safety and pain management.AIM To compare perioperative outcomes of GA and US-ICNB in S-ICD implantation.METHODS This retrospective single-center study included 64 patients who received S-ICD implantation between February 2021 and December 2024.They were divided into GA and US-ICNB groups based on anesthesia type.Demographic data,perioperative parameters(operation time,pain scores,analgesic usage),and postoperative outcomes(complications,defibrillation events)were collected and analyzed.Statistical tests were used to compare the two groups.RESULTS This study included 64 patients(20 in the GA group and 44 in the US-ICNB group).Baseline left ventricular ejection fraction was significantly lower in the US-ICNB group(39.20%±12.00%vs 56.20%±11.50%in GA,P<0.001),while American Society of Anesthesiologists scores and comorbidities were comparable.US-ICNB showed superior pain control,with significantly lower numeric rating scale scores at 6-48 hours(P<0.001)and fewer patients requiring analgesics(P=0.02).The US-ICNB group had shorter operation times(P<0.001),total hospital stays(P<0.001),and later first analgesia times(P<0.001).No anesthesia-related complications occurred in either group.CONCLUSION Both anesthetic methods were safe in the short term.However,US-ICNB was superior in reducing operation and hospital stay times and alleviating peri-operative pain.It has high safety in S-ICD implantation and deserves further clinical promotion,though large-scale,multi-center,randomized controlled trials are needed to confirm these findings.
基金Supported by the National Key R&D Program of China,No.Key Special Project for Marine Environmental Security and Sustainable Development of Coral Reefs 2022-3.5the National Natural Science Foundation of China,No.82102605,82472458,and 82272533.
文摘BACKGROUND Far lateral lumbar disc herniation(FLLDH)is a special type of lumbar disc herniation with high rate of missed diagnosis.Selective nerve root block(SNRB)has special advantages in identifying the responsible nerve root.Percutaneous transforaminal endoscopic discectomy(PTED)is a minimally invasive and effective method to treat FLLDH.However,no report has investigated PTED combined with SNRB to treat FLLDH.AIM To explore the diagnosis and treatment process,surgical technique and clinical efficacy of PTED combined with SNRB to treat FLLDH.METHODS This is a multicenter center,retrospective,observational study.Between January 2020 and January 2022,32 patients were initially diagnosed with FLLDH.All the patients were identified using SNRB to determine the responsible segment and involved nerve roots.Because of poor symptomatic control following SNRB,2 patients were excluded.30 patients diagnosed with FFLDH underwent PTED.The clinical characteristics,operative and postoperative outcomes,complication and subsequent follow-up were collected.RESULTS 30 patients who underwent SNRB combined with PTED were followed up.The average visual analogue scale(VAS)-leg score,VAS-back score,Oswestry disability index(ODI)score at the Follow-up(1 day,1 month,3 months and last follow-up)were significantly different compared per-operation.According to the modified Macnab efficacy evaluation standard,the satisfaction degree at the last follow-up was excellent(28,93.33%),good(1,3.33%),medium(1,3.33%)and poor(0,0%).CONCLUSION SNRB provides an effective method for the definite diagnosis of FLDH and responsible nerve roots.Combination therapy offers several advantages including minimal invasiveness,precision,effectiveness,safety and low recurrence rates.
文摘BACKGROUND Knee diseases are more common in middle-aged and elderly people,so artificial knee replacement is also more used in middle-aged and elderly people.Although the patient’s pain can be reduced through surgery,often accompanied by moderate pain after surgery and neutralization,which not only increases the psychological burden of the patient,but also greatly reduces the postoperative recovery effect,and may also lead to the occurrence of postoperative adverse events in severe cases.AIM To investigate the analgesic effect of artificial intelligence(AI)and ultrasoundguided nerve block in total knee arthroplasty(TKA).METHODS A total of 92 patients with TKA admitted to our hospital from January 2021 to January 2022 were opted and divided into two groups according to the treatment regimen.The control group received combined spinal-epidural anesthesia.The research group received AI technique combined with ultrasound-guided nerve block anesthesia.The sensory block time,motor block time,visual analogue scale(VAS)at different time points and complications were contrasted between the two groups.RESULTS The time of sensory block onset and sensory block perfection in the research group was shorter than those in the control group,but the results had no significant difference(P>0.05).Duration of sensory block in the research group was significantly longer than those in the control group(P<0.05).The time of motor block onset and motor block perfection in the research group was shorter than those in the control group,but the results had no significant difference(P>0.05).Duration of motor block in the research group was significantly longer than those in the control group.The VAS scales of the research group were significantly lower than that of the control group at different time points(P<0.05).The postoperative hip flexion and abduction range of motion in the research group were significantly better than those in the control group at different time points(P<0.05).The incidence of complications was significantly lower in the research group than in the control group(P=0.049).CONCLUSION In TKA,the combination of AI technology and ultrasound-guided nerve block has a significantly effect,with fewer postoperative complications and significantly analgesic effect,which is worthy of application.
文摘Background and Purpose: Postoperative pain after knee arthroplasty (TKA) is reported as severe in up to 60% of patients. Continuous femoral nerve blocks (CFNB) are a choice for major knee repair, but controversies remain about the need of supplemental sciatic nerve blocks (SNB) for better analgesia. Our aim is to assess the effect of the association of a SNB to a CFNB to reduce postoperative pain after TKA. Methods: A prospective randomized, single blinded, controlled study, on 50 patients undergoing TKA. Control group received a CFNB before general anesthesia;in the intervention group a single shot SNB was added after the CFNB was done. After the end of surgery all patients started a continuous local anesthetic infusion through the femoral catheter in the PACU (post-anesthesia care unit). Pain scores were measured in the PACU and at 12 h and 24 h postoperative using a visual analog scale (VAS). Results: VAS pain scores (mm) were lower and statistically significant for the intervention group up to 12 h postoperative: PACU admission mean VAS = 59.4 vs 30.2, P = 0.001;at 12 h mean VASr = 26.1 vs 9.2, P = 0.006;at 24 h mean VASr = 30.1 vs 32.7, P = 0.723. Conclusions: The association of a single shot SNB with a CFNB significantly reduces postoperative pain scores after TKA up to 12 h. At 24 h there are no differences between groups.
文摘BACKGROUND Thoracic surgery for radical resection of lung tumor requires deep anesthesia which can lead to an adverse inflammatory response,loss of hemodynamic stability,and decreased immune function.Herein,we evaluated the feasibility and benefits of ultrasound-guided paravertebral nerve block anesthesia,in combination with general anesthesia,for thoracic surgery for lung cancer.The block was performed by diffusion of anesthetic drugs along the paravertebral space to achieve unilateral multi-segment intercostal nerve and dorsal branch nerve block.AIM To evaluate the application of ultrasound-guided paravertebral nerve block anesthesia for lung cancer surgery to inform practice.METHODS The analysis was based on 140 patients who underwent thoracic surgery for lung cancer at our hospital between January 2018 and May 2020.Patients were randomly allocated to the peripheral+general anesthesia(observation)group(n=74)or to the general anesthesia(control)group(n=66).Patients in the observation group received ultrasound-guided paravertebral nerve block anesthesia combined with general anesthesia,with those in the control group receiving an epidural block combined with general anesthesia.Measured outcomes included the operative and anesthesia times,as well as the mean arterial pressure(MAP),heart rate(HR),and blood oxygen saturation(SpO;)measured before surgery,15 min after anesthesia(T1),after intubation,5 min after skin incision,and before extubation(T4).RESULTS The dose of intra-operative use of remifentanil and propofol and the postoperative use of sufentanil was lower in the observation group(1.48±0.43 mg,760.50±92.28 mg,and 72.50±16.62 mg,respectively)than control group(P<0.05).At the four time points of measurement(T1 through T4),MAP and HR values were higher in the observation than control group(MAP,90.20±9.15 mmHg,85.50±7.22 mmHg,88.59±8.15 mmHg,and 90.02±10.02 mmHg,respectively;and HR,72.39±8.22 beats/min,69.03±9.03 beats/min,70.12±8.11 beats/min,and 71.24±9.01 beats/min,respectively;P<0.05).There was no difference in SpO;between the two groups(P>0.05).Postoperative levels of epinephrine,norepinephrine,and dopamine used were significantly lower in the observation than control group(210.20±40.41 pg/mL,230.30±65.58 pg/mL,and 54.49±13.32 pg/mL,respectively;P<0.05).Similarly,the postoperative tumor necrosis factor-αand interleukin-6 levels were lower in the observation(2.43±0.44 pg/mL and 170.03±35.54 pg/mL,respectively)than control group(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).CONCLUSION Ultrasound-guided paravertebral nerve block anesthesia improved the stress and hemodynamic response in patients undergoing thoracic surgery for lung cancer,with no increase in the rate of adverse events.
文摘OBJECTIVE:To observe the clinical efficacy of acupuncture along fascia,meridians,and nerves combined with ultrasound-guided nerve blockage in the treatment of postherpetic neuralgia.METHODS:A total of 61 outpatients with post-chest and back herpes zoster neuralgia were recruited in the Department of Pain at the Xiyuan Hospital,China Academy of Chinese Medical Sciences from May 2019 to June 2021.They were randomly divided into two groups.Thirty-one patients in the control group were treated with ultrasound-guided thoracic paravertebral nerve block(PVB)alone,one patient declined to continue during treatment(n=30),and thirty patients in the observation group received the acupuncture along the fascia,meridians,and nerves combined with ultrasound-guided PVB treatment(n=30).Both control and observation group received treatment weekly for 4 weeks.The medical history data such as age,sex,presence or absence of comorbidities and disease course were analyzed.The visual analog scale(VAS)score was used to assess the pain degree of two groups at T0(before treatment),T1(1-time treatment ended),T2(2 times treatment ended),T3(3 times treatment ended),and T4(4 times treatment ended).The sleep state was examined by Pittsburgh Sleep Quality Index(PSQI)before and after the study.RESULTS:There was no significant difference in general conditions between the control group and the observation group(P>0.05).The VAS score in both control and observation group was decreased in a time-dependent manner after 1-4 weeks of treatment.There were no significant differences in VAS scores between the two groups after 1 or 2 weeks of treatment(P>0.05).After 3 and 4 weeks of treatment,the VAS score was significantly decreased in the observation group compared with that in the control group(P<0.001).In addition,the reduction in VAS score(after treatment-before treatment)between the two groups was statistically significant[D value:-1.53,95%CI(-2.32,0.74),P<0.001].Furthermore,the sleep state of patients in both groups markedly improved and much obvious in the observation group than that in the control group(P<0.05).CONCLUSION:These results suggest that a combination of acupuncture along fascia,meridians,and nerves with ultrasound-guided PVB treatment is more effective than ultrasound-guided PVB treatment alone.
文摘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±0.40.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 control group(P<0.05).CONCLUSION Ultrasound-guided nerve block combined with dexmedetomidine has a good anesthetic effect in the operation of lower limb fractures and has little effect on the hemodynamics of patients.
文摘BACKGROUND: Fascia iliaca compartment nerve block(FICNB) has been an established technique for postoperative analgesia after surgery for femoral bone fracture. FICNB is technically easy, effective for postoperative pain control after operation for femoral bone fracture and decreases the complications induced by systemic analgesic drugs. The severity of postoperative pain is affected by genetics, cultural and social factors across the world. In this study we assessed the efficacy of fascia iliaca compartment nerve block when it is used as part of multimodal analgesia after surgery for femoral bone fracture.METHODS: An institution-based case control study was conducted from September, 2013 to May, 2014. All patients who had been operated on under spinal anesthesia for femoral bone fracture were included. The patients divided into a FICNB group(n=20) and a control group(n=20). The FICNB group was given 30 mL of 0.25% bupivacaine at the end of the operation. Postoperative pain was assessed within the f irst 24 hours, i.e. at 15 minutes, 2 hours, 6 hours, 12 hours and 24 hours using 100 mm visual analogue scale(VAS), total analgesic consumption, and the time for the f irst analgesic request.RESULTS: VAS pain scores were reduced within the f irst 24 hours after operation in the FICNB group compared wtih the control group. VAS scores at 2 hours were taken as median values(IQR) 0.00(0.00) vs.18.00(30.00), P=0.001; at 6 hours 0.00(0.00) vs. 34.00(20.75), P=0.000; at 24 hours 12.50(10.00) vs. 31.50(20.75), P=0.004; and at 12 hours(17.80±12.45) vs.(29.95±12.40), P=0.004, respectively. The total analgesic consumption of diclofenac at 12 and 24 hours was reduced in the FICNB group, and the time for the fi rst analgesic request was signifi cantly prolonged(417.50 vs. 139.25 minutes, P=0.000).CONCLUSIONS: A single injection for FICNB could lead to postoperative pain relief, reduction of total analgesic consumption and prolonged time for the fi rst analgesic request in the FICNB group after surgery for femoral bone fracture. We recommend FICNB for analgesia after surgery for femoral bone fracture and for patients with femoral bone fracture at the emergency department.
基金Youth Foundation Project of Jiangsu Natural Science Foundation of China,NO.BK20160135The twelfth batch of high-level talents training target of "Six Talent Peaks",NO.2015-WSW-070+1 种基金Third level of training target candidates of the fifth phase of the Jiangsu"333 Project":2016Ⅲ-0094Nanjing Medical Science and Technology Development Project,NO.YKK15127~~
文摘Objective： To provide the clinical evidence to evaluate the feasibility and refine the protocol for acupotomy combined with fire needle and pudendal nerve block therapy in treatment of sacral nerve dysfunction syndrome（SNDS）. Methods： Seventy-five patients with SNDS were randomized into the treatment group（acupotomy and fire needle and pudendal nerve block therapy） and the control group（pudendal nerve block therapy）. After a course of treatment, Visual Analogue Scales（VAS） of anorectal pain, defecation disorders, anal incontinence, VAS of lumbar pain or soreness, VAS of abdominal distension and pain were compared before and after the treatment. Result： Scores of defecation disorders, including defecation interval time index, defecation time index, fecal property index and defecation difficulty index, of patients with SNDS in the two groups were statistically different before and after the treatment in the same group（all P〈0.05）, but the differences of those indexes between two groups were not statistically significant（all P〈0.05） after the treatment,. Scores of anal incontinence, VAS scores of lumbar pain or soreness, VAS scores of abdominal pain and distension in the two groups were statistically different before and after the treatment（all P〈0.05）. However, after treatment, the differences between two groups were not statistically significant（all P〈0.05）. VAS scores of anorectal pain in the two groups were statistically different before and after the treatment（both P〈0.05）, and that of the treatment group was statistically lower than control group after the treatment（1.61 ± 0.95 vs. 3.04 ± 1.81, P〈0.01）, the total effective rate of the treatment group was higher than that of the control group, and the difference was statistically significant（94.74% vs. 81.08%, P〈0.01）, there was no difference in self-evaluation between the two groups（P〈0.05）. Conclusion： In treating SNDS, acupotomy combined with fire needle and pudendal nerve block therapy can more effectively alleviate anorectal pain and improve the total effective rate.
文摘BACKGROUND When herpes zoster is complicated with paralytic ileus,this mostly involves acute intestinal pseudo-obstruction of Ogilvie’s syndrome manifesting as obvious dilatation of the cecum and right colon;small intestinal obstruction is rare.Here,we present a patient with a very rare case of small bowel pseudo-obstruction.CASE SUMMARY A 76-year-old female patient complained of right upper quadrant pain.Two days later,a blistering,right-sided rash of the thoracoabdominal dermatome(T5-T10) emerged in conjunction with small intestinal dilatation and the inability to defecate.Computed tomography of the abdomen confirmed small bowel pseudoobstruction.Antiviral therapy,gastrointestinal decompression,and enemas proved unproductive.After 4 d of stagnation,an epidural block was performed for pain relief and prompted the passage of gas and stool,resolving the obstructive problem.Three days later,the rash appeared dry and crusted,and the pain diminished.After 5 d,no abnormality was visible by gastroenteroscopy,and the patient was discharged on day 7.CONCLUSION This case shows that herpes zoster may induce small bowel pseudo-obstruction in addition to colonic pseudo-obstruction.Epidural block can not only treat intercostal neuralgia but also resolve small bowel pseudo-obstruction caused by herpes zoster.
文摘<strong>Objective:</strong> The aim of this study was to observe and investigate the location of mental foramen, providing scientific and reasonable anatomic basic for clinical mental nerve block. <strong>Methods:</strong> The shape, orientations, relationship with teeth and number of accessory mental foramina in 50 (100 side) adult mental foramina were observed. The long and short diameters of the mental foramen and the distance between the mental foramen and the peripheral anatomical markers were measured by a vernier caliper, and statistical analysis of the data was performed to obtain the final results. <strong>Results:</strong> The probability of mental foramen being elliptical in shape accounted for 27%, circular for 73%;10% of the mental foramen openings are outward and 90% are outward and upward;The mental foramina were located under the first premolars in 20%, under the second premolars in 75%, and 5% situated in the bottom of the first molars. The incidence of accessory mental foramina was 1%;the long diameter of the mental foramen was (2.42 ± 0.71) mm, and the short diameter of the mental foramen was (2.15 ± 0.14) mm;the vertical distance from the mental foramen center to the alveolar crest and the lower margin of the mandible were (14.09 ± 3.23) mm and (14.56 ± 1.74) mm;the distance between the midpoints of the vertical line to the center of the mental foramen was (1.26 ± 0.97) mm;the horizontal distance from the center of the mental foramen to the anterior median line was (23.57 ± 1.82) mm. <strong>Conclusion:</strong> The point of mental nerve block was selected below and behind the second premolars, above the midline of the mandible. The distance from the anterior median line was 2.5 cm, and the mental foramen was explored forward and downward after the insertion.
文摘Objective： To assess the effect of transrectal ultrasound guided prostatic nerve blockade on the discomfort associated with systematic biopsy of the prostate. Methods： 73 patients receiving systematic 13 cores biopsy of the prostate were randomized into two groups. Group A（37 cases） received an injection of 5 ml 1% lidocaine into the prostatic neurovascular bundles on each side at the base of the prostate under ultrasound guidance and group B（36 cases） received 5 ml saline injection （0.9% sodium chloride） at the same site. Pain during biopsy was assessed by using a 10-point linear visual analog score （VAS） immediately after the biopsy. Results： The mean pain scores during transrectal prostate biopsy were significantly lower in group A than group B（1.1±0.6 versus 5.9±3.1, t=4.81, P〈0.01）. During this study no patient in either group had any adverse effect from the injection. Conclusion： Transcrectal ultrasound guided prostatic nerve blockade is a safe and efficacious method for providing satisfactory anesthesia in transrectal prostate biopsy. We recommend its routine administration in all patients during this procedure.
文摘Objective:To explore the application of thoracic nerve block and propofol anesthesia in the treatment and perioperative period.Methods:A total of 40 patients with thoracotomy for esophageal cancer between May 2020 and September 2021 in the hospital were selected to participate in this study.All the patients were divided into reference and experimental groups according to the anesthesia protocol.For the experimental group,the parathoracic vertebral nerve block scheme was used under ultrasound guidance,with general anesthesia in the same manner,and after the surgical treatment of both groups,the patient-controlled intravenous analgesia(PCIA)regimen was applied to both patients.The time of surgery for the two patient groups,intraoperative propofol,postoperative pain conditions and postoperative blood glucose and NE,E,DA levels were measured and conducted for comparative analysis.Results:There is no significant differences between the two groups,besides,in the experimental group,propofol in surgery was less than that in the reference group;At the T6~T9 timepoint,patients in the experimental group had lower VAS scores in quiet and active conditions than those in the reference group;At the T9 timepoint,blood glucose and NE levels were higher than the T1,T4,T5 time point levels in each group;At the T4,T4 timepoint,E levels in both groups were lower than the T1,T9 time point level in each group;at T9 time point,the DA level was higher in the reference group than the T1,T4 time point level in each group;at T9 Time point,blood glucose and NE,E,DA were lower than those in the reference group.Conclusions:In the treatment of thoracotomy in elderly patients,thoracic paravertebral nerve block compound propofol anesthesia program can be used to patients,with striking anesthesia effect and remarkable recovery effect in perioperative period,which is conducive to relieving postoperative pain and worth promotion and application.
文摘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.
文摘BACKGROUND Neuralgia is frequently noted in patients with Kummell’s disease,and its mechanism is complex,rendering it challenging to treat.Percutaneous kyphoplasty(PKP)has been widely used to treat osteoporotic vertebral compression fractures with satisfactory outcomes.However,it is not optimal for managing severely collapsed vertebrae,as cement injection may not be feasible.This report describes the use of a selective nerve block for the treatment of neuralgia caused by severely collapsed vertebrae in a patient with Kummell’s disease.CASE SUMMARY In our patient,three vertebrae were involved.The collapse of T11 was particularly severe.After managing T8 and T9 using PKP,these two segments were effectively strengthened;consequently,back pain was significantly relieved.However,the structure and strength of T11 could not be effectively restored using a minimally invasive surgical method because there was little room for cement injection.This caused obvious neuralgia according to the postoperative status of the PKP.Thus,we performed selective nerve blocks for the treatment of neuralgia,which resulted in satisfactory outcomes.CONCLUSION Selective nerve block may be a possible therapeutic strategy for neuralgia due to severely collapsed vertebrae in Kummell’s disease.
