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Objective:To discuss the efficacy and safety of ultrasound-guided rectus sheath block (RSB) combined with subcostal transversus abdominis plane block(TAPB) in peritoneal dialysis catheter implantation in patients with end-stage renal disease.Methods:A total of sixty patients (scheduled for elective peritoneal dialysis catheter placement from June 2018 to March 2019 in Wuhan First Hospital were randomly divided into two groups: local anesthesia group(group LA, 30 patients) and ultrasound-guided RSB combined with subcostal TAPB (group NB, 30 patients). Group LA: local infiltration anesthesia was performed with 1% lidocaine and 0.5% ropivacaine 20ml; group NB: RSB, 1% lidocaine and 0.5% ropivacaine 15 ml were injected into the lateral rectus sheath, and TAPB, 1% lidocaine and 0.5% ropivacaine 20 ml were injected into the transversus abdominis plane. Mean arterial blood pressure (MAP) and heart rate (HR) were recorded at the point of entering the operating room (T 0), after anaesthesia (T 1), at the beginning of operation (T 2), twenty minutes after the beginning of operation (T 3), and at the end of the operation (T 4). The duration of operation, the times of additional local anesthetia during the surgery, the score of visual analogue scale (VAS) during and 24 h after the surgery, the rate of alteration to general anesthesia and the occurrence of adverse reactions were recorded. Results:In group LA, compared with T 0, MAP and HR at T 2 and T 3 increased significantly: (93.1 ± 9.7), (99.8 ± 11.6) times/min vs. (78.4 ± 10.5) times/min and (105.1 ± 13.7), (110.5 ± 14.4) mmHg (1 mmHg = 0.133 kPa) vs. (92.1 ± 12.8) mmHg, P<0.05. In group NB, there were no differences among T 0-T 4. At T 2 and T 3, MAP and HR in group LA were higher than those in group NB ( P<0.05). Compared with that in group LA, the duration of operation time decreased significantly in group NB ( P<0.05). The times of additional local anesthetia during the surgery in group LA were more than those in group NB ( P<0.05). Compared with those in group LA, the VAS scores during and 24 h after the surgery in group NB were significantly lower: (3.25 ± 0.65) scores vs. (5.85 ± 0.76) scores, (1.46 ± 0.57) scores vs. (2.37 ± 0.45) scores, P<0.05. There were no significant differences in the rate of alteration to general anesthesia between the two groups: 3.33% (1/30) vs. 0, P>0.05. There was no adverse reaction in these two groups. Conclusions:Ultrasound-guided rectus sheath block combined with subcostal transversus abdominis plane block is safe and effective in peritoneal dialysis catheter implantation. The effect of intraoperative anesthesia is definite, with little influence on hemodynamics. The postoperative analgesia effect is good, without obvious anaesthesia-related adverse events.
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Objective To assess the efficacy and safety of multimodal analgesia with different doses of nalbuphine combined with flurbiprofen on patients who received intravenous patient -controlled analgesia(PCIA) after thoracotomy.Methods Sixty patients underwent thoracotomy,ASA Ⅰ -Ⅱ,18 -65 years old,who underwent postoperative PCIA,were randomly divideded into three groups according to the digital table,nalbuphine 60 mg group (N60 group),nalbuphine 80 mg group(N80 group)and nalbuphine 100 mg group (N100 group),20 cases in each group.All patients were given 150mg flurbiprofen,a total of 100mL.PCIA solution:the background dose was 2mL/h, PCIA dose of 0.5mL,locking time of 15min.10min before surgery,each patient was intravenously given flurbiprofen 50mg,given a loading dose of 0.1mL/kg when closed chest.All patients were followed up for 48h.The incidence of adverse reactions such as vital signs,number of times,visual analog scale(VAS)score,sedation score,nausea and vomiting were recorded.Results There were no significant differences in the age,gender,body mass index and surgery duration among the three groups(all P >0.05).The vital signs were stable within 48h after operation.The VAS scores of N60 group were higher than the other two groups(N80 group:t =7.94,6.35,6.49,5.21,5.63,all P =0.00;N100 group:t =8.41,9.10,5.80,8.07,8.18,all P =0.00)at 4,6,8,24 and 48h after operation(all P 0.05).The effective /actual compression ratio of PCIA of N80 group and N100 group were significantly higher than that of N60 group (t =7.30,8.35,all P 0.05;group N100:χ2 =3.14,0.23,1.03,all P >0.05).Conclusion Postoperative PCIA with nalbu-phine (80 mg)combined with flurbiprofen(150 mg)has significant analgesic effect and lower costs.
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Objective To assess the efficacy and safety of nalbuphine in preventing the side effect of pruritus induced by intrathecal morphine after cesarean section. Methods Sixty patients aged 18- 35 years with ASAⅠ~Ⅱand undergoing cesarean section with combined spinal-epidural anesthesia were randomly and double blindly divided into two groups. Patients in Group N (30 patients) received nalbuphine 4 mg (2 ml) by intravenous route after clamping of the umbilical cord; Patients in Group P (30 patients) received 0.9% NaCl (2 ml) by intravenous route after clamping of the umbilical cord. The protocol of postoperative analgesia was intrathecal morphine 0.2 mg. The patients were followed up for 4 h , and the vital signs were detected at the time of returning to patient s room (T0), 1 h (T1), 2 h(T2), 3 h(T3) and 4 h(T4) after operation. The VAS scores, pruritus severity scores, time of pruritus onset, Ramsay sedation scores and and other adverse effects were recorded. Results The levels of MAP, SpO2, HR in two groups at T0, T1, T2, T3, T4 had no significant differences (P>0.05). The rate of pruritus severity score 0-1 score in group N was significantly higher than that in group P (χ2=17.4, P=0.00). The VAS scores and the rate of drowsiness, nausea, vomiting, shivering and dizziness in two groups had no significant difference (P>0.05). Conclusions Nalbuphine provides a significant reduction of morphine induced pruritus for patients who received intrathecal morphine analgesia after cesarean section.
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Objective To study the effects of controlled hypotension with sevoflurane on hymo-dynamics and cerebral metabolic rate of oxygen in neurosurgery.Methods Thirty-seven ASA Ⅰ or Ⅱpatients undergoing elective intracranial surgery were enrolled.The patients were treated with general anesthesia and assigned to two experimental groups,sevoflurane group (group S,n=20)and sodium nitroprusside group (group N,n=1 7).HR,BP,SpO2 and ECG were continuously monitored during operation.Blood samples were taken from radial artery and internal jugular bulb to determine cerebral arteriovenous oxygen differences (Da-jvO2 ) and cerebral metabolic rate of oxygen (CMRO2 ). Results The HR in group S were decreased during hypotension,5 min,10 min,20 min,and 30 min compared with group N (P <0.05).Da-jvO2 and CMRO2 both in two groups were decreased during hypotension(P < 0.05 ),but there was no difference between the two groups.RPP was lower in group S than in group N during hypotension.Conclusion Controlled hypotension with sevoflurane does not increase HR and improves cerebral blood flow-metabolism coupling.