Local and Regional Anesthesia最新文献

英文中文

Obesity And Obstetric Anesthesia: Current Insights 肥胖与产科麻醉：最新见解

IF 2.9 Q2 Medicine

Local and Regional Anesthesia

Pub Date : 2019-11-01 DOI: 10.2147/LRA.S186530

C. Taylor, J. Dominguez, A. Habib

Abstract Obesity is a significant global health problem. It results in a higher incidence of complications for pregnant women and their neonates. Cesarean deliveries are more common in obese parturients as well. The increased burden of comorbidities seen in this population, such as obstructive sleep apnea, necessitates antepartum anesthetic consultation. These patients pose unique challenges for the practicing anesthesiologist and may benefit from optimization prior to delivery. Complications from anesthesia and overall morbidity and mortality are higher in this population. Neuraxial anesthesia can be challenging to place in the obese parturient, but is the preferred anesthetic for cesarean delivery to avoid airway manipulation, minimize aspiration risk, prevent fetal exposure to volatile anesthetic, and decrease risk of post-partum hemorrhage from volatile anesthetic exposure. Monitoring and positioning of these patients for surgery may pose specific challenges. Functional labor epidural catheters can be topped up to provide conditions suitable for surgery. In the absence of a working epidural catheter, a combined spinal epidural anesthetic is often the technique of choice due to relative ease of placement versus a single shot spinal technique as well as the ability to extend the anesthetic through the epidural portion. For cesarean delivery with a vertical supraumbilical skin incision, a two-catheter technique may be beneficial. Concern for thromboembolism necessitates early mobilization and a multimodal analgesic regimen can help accomplish this. In addition, thromboprophylaxis is recommended in this population after delivery—especially cesarean delivery. These patients also need close monitoring in the post-partum period when they are at increased risk for several complications.

摘要肥胖是一个重要的全球健康问题。这导致孕妇及其新生儿并发症的发生率更高。剖宫产在肥胖产妇中也更常见。这一人群中出现的合并症负担增加，如阻塞性睡眠呼吸暂停，需要进行产前麻醉咨询。这些患者给执业麻醉师带来了独特的挑战，并可能从分娩前的优化中受益。麻醉并发症、总体发病率和死亡率在这一人群中较高。在肥胖产妇中使用轴颈麻醉可能很有挑战性，但它是剖宫产的首选麻醉剂，可以避免气道操作，最大限度地降低抽吸风险，防止胎儿暴露于挥发性麻醉剂，并降低挥发性麻醉剂暴露导致产后出血的风险。对这些患者进行手术监测和定位可能会带来特定的挑战。功能性分娩硬膜外导管可以加满，以提供适合手术的条件。在没有工作的硬膜外导管的情况下，由于与单次注射脊髓技术相比，放置相对容易，并且能够将麻醉剂延伸到硬膜外部分，因此通常选择腰麻-硬膜外联合麻醉技术。对于垂直脐上皮肤切口的剖宫产，双导管技术可能是有益的。对血栓栓塞症的关注需要尽早动员，多模式镇痛方案可以帮助实现这一点。此外，建议在分娩后对这一人群进行血栓预防，尤其是剖宫产。这些患者在产后也需要密切监测，因为他们出现多种并发症的风险增加。

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引用次数: 27

Case Report Of Cryoneurolysis For The Treatment Of Refractory Intercostobrachial Neuralgia With Postherpetic Neuralgia 冷冻神经溶解术治疗顽固性肋间臂神经痛伴带状疱疹后神经痛1例报告

IF 2.9 Q2 Medicine

Local and Regional Anesthesia

Pub Date : 2019-11-01 DOI: 10.2147/LRA.S223961

G. Weber, K. Saad, M. Awad, Tiffany H. Wong

Abstract Postherpetic neuralgia is a common and potentially debilitating neuropathic pain condition. Current pharmacologic therapy can be inadequate and intolerable for patients. We present a case of a gentleman with refractory postherpetic neuralgia in the intercostobrachial nerve distribution that was successfully treated with cryoneurolysis/cryoanalgesia therapy.

带状疱疹后神经痛是一种常见的、可能使人衰弱的神经性疼痛。目前的药物治疗对患者来说可能是不充分和无法忍受的。我们提出一个病例的男士顽固性疱疹后神经痛在肋间臂神经分布，成功地治疗了冷冻神经溶解/冷冻镇痛疗法。

引用次数: 5

Evaluation of the attitudes of surgeons about regional anesthesia: a survey study 外科医生对区域麻醉态度的评价：一项调查研究

IF 2.9 Q2 Medicine

Local and Regional Anesthesia

Pub Date : 2019-09-16 DOI: 10.2147/LRA.S211469

Ferda Yılmaz İnal, Yadigar Yılmaz, H. Daşkaya, M. Toptaş, H. Koçoğlu, H. Uysal, I. Akkoc

Background The intraoperative attending anaesthesiologist ultimately makes decisions about the anaesthesiology technique to be performed, but the attitudes of surgeons and preferences of patients on this subject may affect their choice. In this questionnaire-based study, we aimed to evaluate the attitudes and behaviors of surgeons about the use of regional anaesthesia (RA) in surgical operations. Methods Surgeons from different surgical branches with residencies at 4 different hospitals were asked to complete questionnaires that included reasons for preferring (12 reasons) and not preferring (13 reasons) the use of RA techniques for surgeries, using a 5-point Likert scale. Results A total of 156 surgeons from 4 hospitals, out of 167 surgeons who were approached to participate in the study, completed the questionnaire. The most commonly observed reason for a preference towards regional anaesthesia among the surgeons was the risk of general anaesthesia for patients with an American Society of Anesthesiologists (ASA) risk class of III and above. The second most commonly observed reason was for protection from the complications of general anaesthesia, and the third most commonly observed reason was the lower risk of thromboembolisms with regional anaesthesia. The most commonly observed reasons for not choosing regional anaesthesia were found to be incompatibility of the patients and patients’ fears of feeling pain during surgery. Conclusion We conclude that programmes for informing surgeons and educating patients about the advantages of RA may increase the preference ratio among surgeons and decrease patients’ refusals to choose this procedure.

背景术中主治麻醉师最终决定要进行的麻醉术技术，但外科医生的态度和患者对该主题的偏好可能会影响他们的选择。在这项基于问卷的研究中，我们旨在评估外科医生对外科手术中使用区域麻醉（RA）的态度和行为。方法要求居住在4家不同医院的不同外科分支的外科医生使用5分Likert量表填写问卷，其中包括倾向于（12个原因）和不倾向于（13个原因）使用RA技术进行手术的原因。结果在167名参与研究的外科医生中，共有来自4家医院的156名外科医生完成了问卷调查。外科医生偏好区域麻醉的最常见原因是美国麻醉师协会（ASA）风险等级为III级及以上的患者全身麻醉的风险。第二个最常见的原因是预防全身麻醉并发症，第三个最常见原因是区域麻醉导致血栓栓塞的风险较低。不选择区域麻醉的最常见原因是患者的不相容性和患者对手术过程中感到疼痛的恐惧。结论我们的结论是，告知外科医生和教育患者RA的优点的计划可以增加外科医生的偏好比例，并减少患者拒绝选择该手术的情况。

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引用次数: 3

Evaluation Of The Attitudes Of Surgeons About Regional Anesthesia: A Survey Study [Corrigendum] 外科医生对区域麻醉态度的评价:一项调查研究[勘误]

IF 2.9 Q2 Medicine

Local and Regional Anesthesia

Pub Date : 2019-09-01 DOI: 10.2147/lra.s231688

Ferda Yılmaz İnal, Yadigar Yılmaz, H. Daşkaya, M. Toptaş, H. Koçoğlu, H. Uysal, I. Akkoc

[This corrects the article DOI: 10.2147/LRA.S211469.].

[这更正了文章DOI: 10.2147/LRA.S211469.]。

引用次数: 0

Anesthetic techniques: focus on transversus abdominis plane (TAP) blocks 麻醉技术:以腹横面(TAP)阻滞为主

IF 2.9 Q2 Medicine

Local and Regional Anesthesia

Pub Date : 2019-09-01 DOI: 10.2147/LRA.S138537

Deepanshu Mallan, Sandeep Sharan, S. Saxena, T. Singh, .. Faisal

Abstract Transverse abdominis plane (TAP) blocks, over the past decade, have emerged as a reliable tool in multimodal analgesia. Although they block only the somatic component of pain, studies have still revealed a consistent benefit in the first 24–48 hours after surgery in terms of pain scores and overall opioid consumption. The safety and dependability has increased with ultrasound usage. The aim of this review is to help the reader appreciate the applied anatomy required for a TAP block and its congeners, to standardize its nomenclature, and to help choose between variants of a TAP block and its complications and safety profile.

摘要:在过去的十年中，腹横平面(TAP)阻滞已成为一种可靠的多模式镇痛工具。尽管它们只阻断了疼痛的躯体部分，但研究仍然显示，在手术后24-48小时内，就疼痛评分和总体阿片类药物消耗而言，它们仍然有一致的益处。随着超声的使用，安全性和可靠性得到了提高。这篇综述的目的是帮助读者了解TAP块及其同族物所需的应用解剖学，标准化其命名，并帮助在TAP块的变体及其并发症和安全性之间进行选择。

引用次数: 12

Bilateral Brachial Plexus Block Using Chloroprocaine For Surgery Of Bilateral Radial Fractures 氯丙卡因用于双侧臂丛阻滞治疗双侧桡骨骨折

IF 2.9 Q2 Medicine

Local and Regional Anesthesia

Pub Date : 2019-09-01 DOI: 10.2147/LRA.S225471

Chanchal Mangla, H. Kamath, J. Yarmush

Abstract We report a case of a 41-year-old male with anticipated difficult airway undergoing a repair of a bilateral radial fracture under bilateral sequential brachial plexus block. Anesthesiologists are reluctant to perform bilateral blocks because of the fear of complications like diaphragmatic paralysis, local anesthetic (LA) toxicity, and pneumothorax. We advise that with the correct application of LA pharmacokinetics, careful patient selection and usage of ultrasound, bilateral blocks can be done safely. We used chloroprocaine as an LA in one of the blocks to reduce the dose required for the more toxic LAs. chloroprocaine’s fast metabolism also helped us to prevent the overlapping of peak plasma concentration of different LAs. To our knowledge, this is the first reported case in the literature where chloroprocaine was used for bilateral brachial plexus block.

摘要我们报告一例41岁男性，预期气道困难，在双侧臂丛神经阻滞下接受双侧桡骨骨折的修复。麻醉师不愿意进行双侧阻滞，因为担心并发症，如膈肌麻痹、局部麻醉剂（LA）毒性和肺气肿。我们建议，通过正确应用左心房药代动力学，仔细选择患者并使用超声，可以安全地进行双侧阻断。我们在其中一个区块中使用氯普鲁卡因作为LA，以减少毒性更强的LA所需的剂量。氯普鲁卡因的快速代谢也有助于我们防止不同LA的峰值血浆浓度重叠。据我们所知，这是文献中首次报道氯普鲁卡因用于双侧臂丛神经阻滞的病例。

引用次数: 3

Effect of bupivacaine and adjuvant drugs on skeletal muscle tissue oximetry and blood flow: an experimental study 布比卡因及辅助药物对骨骼肌组织血氧测定和血流量影响的实验研究

IF 2.9 Q2 Medicine

Local and Regional Anesthesia

Pub Date : 2019-08-29 DOI: 10.2147/LRA.S203569

A. Schubert, S. Müller, H. Wulf, T. Steinfeldt, T. Wiesmann

Background Skeletal muscle microvascular blood flow plays a critical role in many myopathologies. The influence of bupivacaine and adjuvants on skeletal muscle microvascular perfusion and tissue oximetry is poorly understood but might be a relevant risk factor for myopathies after local anesthetic administration. The aim of this experimental study was to determine the effects of bupivacaine alone or in combination with epinephrine or clonidine on skeletal muscle perfusion and tissue oximetry. Methods Combined tissue spectrophotometry and Laser-Doppler flowmetry and tissue oximetry were used to assess local muscle blood flow in anesthetized pigs after topical administration of test solutions (bupivacaine, bupivacaine with epinephrine or clonidine, saline). Measurements were performed for up to 60 mins. Results The application of bupivacaine alone did not alter relative muscle blood flow significantly, whereas the addition of epinephrine or clonidine to bupivacaine resulted in a significant reduction of relative muscle blood flow at T30 and T60. However, bupivacaine resulted in a significant decrease of tissue oximetry values when compared to saline control group at T30 and T60. The application of bupivacaine combined with clonidine or epinephrine resulted in no significant reduction of tissue oximetry when compared to bupivacaine alone. Conclusion Bupivacaine alone results in a significant decrease of tissue oximetry in skeletal muscle which is not increased by the addition of epinephrine or clonidine despite further reductions of microcirculatory perfusion. Overall, bupivacaine alone or with adjuvants does produce local muscle ischemia for which pathological consequences need to be addressed in further studies.

背景骨骼肌微血管血流在许多肌病中起着至关重要的作用。布比卡因和佐剂对骨骼肌微血管灌注和组织血氧测定的影响尚不清楚，但可能是局部麻醉后肌病的相关风险因素。本实验研究的目的是确定布比卡因单独或与肾上腺素或可乐定联合使用对骨骼肌灌注和组织血氧测定的影响。方法采用组织分光光度法、激光多普勒血流测定法和组织血氧计相结合的方法，对麻醉猪局部注射试验溶液（布比卡因、布比卡因加肾上腺素或可乐定、生理盐水）后的局部肌肉血流量进行评估。测量时间长达60分钟。结果单独应用布比卡因不会显著改变相对肌肉血流量，而在T30和T60时，在布比卡因中加入肾上腺素或可乐定会显著降低相对肌肉血流速。然而，在T30和T60时，与生理盐水对照组相比，布比卡因导致组织血氧测定值显著降低。与单独使用布比卡因相比，布比卡因与可乐定或肾上腺素联合使用并没有显著降低组织血氧饱和度。结论单独使用布比卡因可显著降低骨骼肌组织血氧饱和度，尽管微循环灌注进一步减少，但加入肾上腺素或可乐定并不能增加组织血氧饱和度。总的来说，布比卡因单独或与佐剂一起确实会产生局部肌肉缺血，其病理后果需要在进一步的研究中解决。

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引用次数: 0

Long-term placement of continuous popliteal nerve block catheter for management of a wounded patient in a combat field environment: a case report. 长期放置连续腘神经阻滞导管治疗战场环境中受伤患者一例报告。

IF 2.9 Q2 Medicine

Local and Regional Anesthesia

Pub Date : 2019-08-29 eCollection Date: 2019-01-01 DOI: 10.2147/LRA.S210462

Costantino Fontana, Monica Rocco, Luigi Vetrugno, Elena Bignami

Continuous peripheral nerve block is a relevant part of multimodal treatment of postoperative pain. In this context the continuous popliteal nerve block is described as an option for postoperative pain management for surgical procedures on the leg, and particularly on the ankle and foot. We applied continuous popliteal nerve block for different types of anesthesia and postoperative pain management via the same catheter. No clear evidence of this specific use has been described in the literature. A 38 year-old patient wounded in combat with a displaced fracture of left tibia and extensive loss of substance needed orthopedic surgeries as well as several reconstructive procedures. A continuous popliteal nerve block was applied via ultrasound-guided catheter for anesthesia at different times, and postoperative pain control for all surgical procedures. The continuous popliteal nerve block and its long-term positioning, of non-common evidence in literature, was utilized to treat a poly-traumatized patient, thereby avoiding repeated general anesthesia and opioid use and their adverse effects. This technique, within a complicated combat field environment, was demonstrated to be clinically effective with high patient satisfaction.

持续周围神经阻滞是术后疼痛多模式治疗的重要组成部分。在这种情况下，连续腘神经阻滞被描述为腿部外科手术后疼痛管理的一种选择，特别是在脚踝和足部。我们通过同一导管应用连续腘神经阻滞用于不同类型的麻醉和术后疼痛管理。文献中没有明确的证据说明这种特殊用途。一名38岁的患者在战斗中受伤，左胫骨移位性骨折并大面积丢失，需要进行骨科手术和几次重建手术。超声引导导管连续阻滞腘窝神经，在不同时间麻醉，并对所有手术过程进行术后疼痛控制。利用文献中不常见的腘神经连续阻滞及其长期定位治疗多处创伤患者，避免了反复全身麻醉和阿片类药物的使用及其不良反应。在复杂的战场环境中，该技术被证明是临床有效的，患者满意度高。

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引用次数: 0

Impact of serratus plane block on pain scores and incentive spirometry volumes after chest trauma 胸外伤后锯肌平面阻滞对疼痛评分和刺激肺活量的影响

IF 2.9 Q2 Medicine

Local and Regional Anesthesia

Pub Date : 2019-08-01 DOI: 10.2147/LRA.S207791

Nadia Hernandez, J. D. de Haan, Dallis Clendenin, D. Meyer, Semhar J. Ghebremichael, C. Artime, George Williams, H. Eltzschig, S. Sen

Background: Adequate pain control is difficult to achieve in patients with multiple rib fractures (MRF). Serratus plane block (SPB) is a novel technique for alleviating rib fracture pain. Several published case reports support this hypothesis. Purpose: The purpose of this study was to evaluate the use of SPB in MRF at our level 1 trauma center. Methods: Our hospital’s Regional Anesthesia Registry was queried for all trauma patients with MRF who underwent SPB between August 2014 and January 2018. Data were compared in each patient as a matched pair for the time periods before and after undergoing SPB. Thirty-four patients with similar baseline characteristics were enrolled. Results: The median number of rib fractures was 7. Ordinal pain scores were found to be improved 4 hrs after SPB from median 7/10 to 3/10 (P<0.001). Incentive spirometry (IS) volumes recorded 4 and 24 hrs postserratus plane block showed a median increase of 150 and 175 mL from baseline, respectively (P<0.001). IS volumes recorded at 48 hrs showed a median increase of 300 mL from baseline (P<0.001). Respiratory rate decreased from a median value of 24.5 to 16 breaths/min (P<0.001). SpO2 was improved at 24 hrs from median 96% to 99% (P<0.001). Conclusion: SPB improves pain scores and IS volumes in MRF. Because it is not limited by patient positioning or anticoagulation and has a better safety profile, it may offer a viable alternative to neuraxial techniques. Additional studies are necessary to evaluate its efficacy compared to neuraxial techniques.

背景：多发性肋骨骨折（MRF）患者很难实现充分的疼痛控制。Serratus平面阻滞（SPB）是一种新型的缓解肋骨骨折疼痛的技术。一些已发表的案例报告支持这一假设。目的：本研究旨在评估SPB在我们一级创伤中心MRF中的应用。方法：查询2014年8月至2018年1月期间接受SPB的所有MRF创伤患者的医院区域麻醉登记处。将每位患者在接受SPB前后的时间段内的数据作为匹配对进行比较。34名具有相似基线特征的患者被纳入研究。结果：肋骨骨折的中位数为7。SPB后4小时，常规疼痛评分从中位数7/10提高到3/10（P<0.001）。刺激性肺活量测定术（IS）记录的4小时和24小时后平面阻滞的容积显示，中位数比基线增加了150和175 mL，分别为（P＜0.001）。48小时记录的IS体积比基线增加了300mL（P＜0.01）。呼吸频率从24.5的中值降至16次呼吸/分钟（P＜001）。SpO2在24小时从中值96%提高到99%（P＜.001）。结论：SPB改善了MRF中的疼痛评分和IS体积。因为它不受患者定位或抗凝治疗的限制，并且具有更好的安全性，它可能为神经轴技术提供一种可行的替代方案。与神经轴技术相比，有必要进行更多的研究来评估其疗效。

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引用次数: 15

Improving intraoperative handoffs for ambulatory anesthesia: challenges and solutions for the anesthesiologist [Corrigendum]. 改善门诊麻醉的术中交接:麻醉师的挑战和解决方案[勘误]。

IF 2.9 Q2 Medicine

Local and Regional Anesthesia

Pub Date : 2019-07-01 eCollection Date: 2019-01-01 DOI: 10.2147/LRA.S217891

On page 38, Table 1, Summary of principal findings row, column 4 the text “(odds ratio 0.95, 95% CI 9.895 to 1.022, P=0.19)” should read “(odds ratio 0.95, 95% CI 0.895 to 1.022, P=0.19)” (i.e., change 9.985 to 0.895) and “(0.933, 95% CI 0.890–9.977, P<0.0001)” should read “(0.933, 95% CI 0.890–0.977, P<0.0001)” (i.e., change 9.977 to 0.977). On page 39, column 2, paragraph 3, the matching change to the text is for “(adjusted odds ratio 0.95, 95% CI 9.895–1.022, P=0.19)” to be “(adjusted odds ratio 0.95, 95% CI 0.895–1.022, P=0.19)” and “(odds ratio=0.933, 95% CI 0.890–9.977, P<0.0001)” to be “(odds ratio=0.933, 95% CI 0.890–0.977, P<0.0001)”.

引用次数: 0

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