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
目的探究艾司氯胺酮联合髋关节囊周神经阻滞对老年全髋关节置换术患者围术期应激反应、免疫功能、认知功能及术后镇痛效果的影响。方法选取2022年2月至2025年2月在医院进行全髋关节置换手术的110例老年患者为研究对象,采用随机数字表法...目的探究艾司氯胺酮联合髋关节囊周神经阻滞对老年全髋关节置换术患者围术期应激反应、免疫功能、认知功能及术后镇痛效果的影响。方法选取2022年2月至2025年2月在医院进行全髋关节置换手术的110例老年患者为研究对象,采用随机数字表法分为对照组与观察组,每组55例。患者均接受全髋关节置管术治疗。对照组患者接受罗哌卡因20 mL联合髋关节囊周神经阻滞麻醉,观察组患者接受艾司氯胺酮联合髋关节囊周神经阻滞麻醉。比较两组患者入室时(T_(1))、麻醉后即刻(T_(2))、切皮时(T_(3))、手术30 min(T_(4))、切入口缝合时(T_(5))、手术结束即刻(T_(6))血压、心率、血氧饱和度、呼吸频率。对两组患者术前、术后3 d免疫功能指标、血清应激指标水平、认知功能评分进行检测、评估与比较,对两组患者术后3、6、9 h VAS疼痛评分进行比较,统计两组患者不良反应发生情况。结果两组患者T_(1)~T_(6)的HR、MAP、SpO_(2)、RR、BIS比较,结果:(1)不同时间点HR、MAP、SpO_(2)、BIS比较,差异有统计学意义(F=118.378、70.002、44.910、242.439,均P<0.001);(2)观察组与对照组HR、MAP、SpO_(2)、BIS比较,差异有统计学意义(F=206.643、195.586、93.077、3.953,P<0.001、P<0.001、P<0.001、P=0.049);(3)两组HR、MAP、SpO_(2)、RR、BIS变化趋势比较,差异有统计学意义(F=18.583、14.158、23.350、4.883、6.698,均P<0.001)。术后3 d观察组CD4+、CD4+/CD8+低于对照组(P<0.05)。观察组患者术中和术毕的MDA、SOD和皮质醇水平均低于对照组(P<0.05)。两组患者术后3 d MoCA评分、MMSE评分降低,且观察组高于对照组(P<0.05)。与对照组相比,观察组患者在术后3、6、9及12 h的VAS疼痛评分均处于更低水平。同时,观察组的不良反应出现概率为12.73%,显著低于对照组的29.09%,且该差异有统计学意义(P<0.05)。结论将艾司氯胺酮与髋关节囊周神经阻滞联合应用,能有效减轻老年全髋关节置换术患者在围手术期的应激反应,不仅可增强术后镇痛效果,还能降低不良反应的出现几率。展开更多
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.
文摘目的探究艾司氯胺酮联合髋关节囊周神经阻滞对老年全髋关节置换术患者围术期应激反应、免疫功能、认知功能及术后镇痛效果的影响。方法选取2022年2月至2025年2月在医院进行全髋关节置换手术的110例老年患者为研究对象,采用随机数字表法分为对照组与观察组,每组55例。患者均接受全髋关节置管术治疗。对照组患者接受罗哌卡因20 mL联合髋关节囊周神经阻滞麻醉,观察组患者接受艾司氯胺酮联合髋关节囊周神经阻滞麻醉。比较两组患者入室时(T_(1))、麻醉后即刻(T_(2))、切皮时(T_(3))、手术30 min(T_(4))、切入口缝合时(T_(5))、手术结束即刻(T_(6))血压、心率、血氧饱和度、呼吸频率。对两组患者术前、术后3 d免疫功能指标、血清应激指标水平、认知功能评分进行检测、评估与比较,对两组患者术后3、6、9 h VAS疼痛评分进行比较,统计两组患者不良反应发生情况。结果两组患者T_(1)~T_(6)的HR、MAP、SpO_(2)、RR、BIS比较,结果:(1)不同时间点HR、MAP、SpO_(2)、BIS比较,差异有统计学意义(F=118.378、70.002、44.910、242.439,均P<0.001);(2)观察组与对照组HR、MAP、SpO_(2)、BIS比较,差异有统计学意义(F=206.643、195.586、93.077、3.953,P<0.001、P<0.001、P<0.001、P=0.049);(3)两组HR、MAP、SpO_(2)、RR、BIS变化趋势比较,差异有统计学意义(F=18.583、14.158、23.350、4.883、6.698,均P<0.001)。术后3 d观察组CD4+、CD4+/CD8+低于对照组(P<0.05)。观察组患者术中和术毕的MDA、SOD和皮质醇水平均低于对照组(P<0.05)。两组患者术后3 d MoCA评分、MMSE评分降低,且观察组高于对照组(P<0.05)。与对照组相比,观察组患者在术后3、6、9及12 h的VAS疼痛评分均处于更低水平。同时,观察组的不良反应出现概率为12.73%,显著低于对照组的29.09%,且该差异有统计学意义(P<0.05)。结论将艾司氯胺酮与髋关节囊周神经阻滞联合应用,能有效减轻老年全髋关节置换术患者在围手术期的应激反应,不仅可增强术后镇痛效果,还能降低不良反应的出现几率。
