Block Anesthesia Group Research Articles

Peripheral Nerve Block Versus Spinal Anesthesia for Total Knee Replacement in Elderly Patients

Abstract Spinal anesthesia and peripheral nerve block anesthesia are used in total knee replacement. The aim of the study was to examine whether peripheral nerve block anesthesia would provide a more stable hemodynamic profile and analgesic effect in elderly patients undergoing total knee replacement, as compared to spinal anesthesia. This is a single-center case-control trial, with patients from our prospectively followed registry. The patients were divided into two groups, those with peripheral nerve block anesthesia and spinal anesthesia. Propensity score analysis was performed in 1:1 ratio. The primary outcome was analgesia with total analgesic effect and the secondary outcome was intraoperative hemodynamic status. The patients in peripheral nerve block anesthesia group had a longer length of analgesia (606.19±219.35 vs 359.48±106.82, P<0.01) and pain scores during 24h and 48h after the surgery were lower in the same group of patients (3.21±1.74 vs 5.02±2.23, P=0.037; 3.03±1.57 vs 5.67±2.51, P=0.028). Spinal anesthesia group had a larger number of patients with significant hypotension (3.84% vs 15.38%, P=0.01), as well as a larger number of patients who received vasopressors (0% vs 9.61%, P<0.01). Both anesthesia methods demonstrated sufficient analgesic efficacy in total knee replacement, although there was less pain severity and longer analgesic effect of peripheral nerve block anesthesia in patients who were 60 years old or older. Spinal anesthesia showed a significantly higher degree of hypotension than in those patients receivingperipheral nerve block anesthesia.

Effects of different anesthesia methods on cognitive function and inflammatory factors in elderly patients with lung cancer during perioperative period

Objective To explore the effects of different anesthesia methods on cognitive function and serum interleukin-6(IL-6), interleukin-8(IL-8) levels in elderly patients with lung cancer during perioperative period. Methods From March 2015 to March 2017, ninety elderly patients undergoing radical resection of lung cancer treated in Heji Hospital Affiliated to Changzhi Medical College were selected in the research.According to the different anesthesia methods, they were divided into inhalation anesthesia group(A group), general intravenous anesthesia group(B group) and epidural block anesthesia group(C group), with 30 cases in each group.The minimum mental state examination(MMSE) scores, cognitive dysfunction rate, serum IL-6 and IL-8 levels of the three groups before operation, one day after operation and three days after operation were compared. Results One day and three days after operation, the MMSE scores of C group were (25.62±2.11)points, (27.12±2.04)points, respectively, which were higher than those of group A[(22.61±2.75)points, (25.78±2.68)points] and B group[(22.34±2.01)points, (25.81±2.42)points], the differences were statistically significant(tA group=4.756, 2.179, tB group=6.165, 2.267, all P<0.05). One day and three days after operation, the cognitive dysfunction rates of C group were 26.67%(8/30), 6.67%(2/30), respectively, which were lower than those of A group[50.00%(15/30), 26.67%(8/30)] and B group[66.67%(20/30), 30.00%(9/30)], the differences were statistically significant(χA group2=3.455, 4.320, χB group2=9.643, 5.455, all P<0.05). One day and three days after operation, the serum IL-6 and IL-8 levels of C group[IL-6: (99.53±16.82)ng/mL, (83.24±8.34)ng/mL, IL-8: (50.43±7.84)ng/mL, (42.15±5.25)ng/mL] were lower than those of A group[IL-6: (122.43±18.41)ng/mL, (88.51±10.42)ng/mL, IL-8: (64.53±8.94)ng/mL, (55.62±6.78)ng/mL]and B group[IL-6: (124.52±20.10)ng/mL, (87.95±9.34)ng/mL, IL-8: (63.27±9.03)ng/mL, (54.62±6.30)ng/mL], the differences were statistically significant(IL-6: tA group=5.030, 2.163, tB group=5.222, 2.060, all P<0.05; IL-8: tA group=6.495, 8.604, tB group=5.881, 8.329, all P<0.05). Conclusion The influence of epidural block anesthesia on postoperative cognitive dysfunction in elderly patients with radical resection of lung cancer is minimal, which can inhibit the expression of inflammatory factors.It is better than the other two anesthesia methods, and it is worthy of radical operation for elderly patients with lung cancer. Key words: Lung neoplasms; Aged; Anesthesia, Inhalation; Anesthesia, General; Anesthesia, Epidural; Cognitive function; Inflammatory factors

Effects of nerve block anesthesia versus general anesthesia on intertrochanteric fractures in the elderly

Objective To retrospectively analyze the effects of nerve block anesthesia versus general anesthesia on intertrochanteric fracture in the elderly. Methods The 104 elderly inpatients undergoing closed reduction and intramedullary nailing for the treatment of femoral intertrochanteric fractures were recruited into this study at Department of Orthopedics, Xiangya Hospital, Central South University from January 2015 to June 2017.Medical records were collected and analyzed by SPSS 16.0 or GraphPad Prism 6.0 software. Results A total of 104 patients were divided into general anesthesia group(n=48)and nerve block anesthesia group(n=56). There was no statistical difference in the demographic characteristics between the two groups.The changes in heart rate, maximum changes of systolic/diastolic blood pressures, and infusion volume during surgery were lower in the nerve block anesthesia group than in the general anesthesia group[(12.7±7.3)vs.(18.1±7.8)beats/min, (22.5±8.8/12.2±7.5)mmHg vs.(34.3±7.9/21.6±6.6)mmHg, (792.9±387.0)ml vs.(1 083.0±445.5)ml, respectively, t=3.64, 7.14, 6.73, 5.16, all P<0.01]. There was no statistically significant difference between two groups in other perioperative data and the number of deaths at three months and one year after surgery. Conclusions As compared with the general anesthesia, the nerve block anesthesia has less effects on the heart rate, less maximum changes of systolic and diastolic blood pressures, and less infusion volume during surgery, and has no significant increase in postoperative mortality, which is safe and worthy of further promotion. Key words: Nerve block anesthesia; General anesthesia; Intertrochanteric fractures; Hemodynamics

Effect of different thoracic anesthesia on postoperative cough.

The objective of the study is to retrospectively analyze the cough status after double lumen tube (DLT) and spontaneous respiration thoracic anesthesia, to compare the degree of influence of anesthesia and surgical factors, and to investigate whether spontaneous respiration anesthesia can reduce the incidence of cough. Postoperative follow-ups were performed on 1,162 patients from July 2011 to December 2015 who meet the selected conditions, whose surgical approach is limited to VAST bullectomy, wedge resection, segmentectomy, or lobectomy. Patients' probability of cough in 1st day (T1), 2nd days (T2), 3rd days (T3), 1st month (T4), 3rd months (T5), 6th months (T6) and 12th months (T7) after thoracoscopic surgery were recorded, as well as the Leicester cough questionnaire (LCQ) survey results, visual cough score (VAS), and cough symptom scores. All cases were divided into double-lumen endotracheal tubes anesthesia group (group T, n=925 cases) and spontaneous respiratory anesthesia group (group S, n=456 cases), and group S was further divided into intravenous composite intercostal nerve block anesthesia group (group SB, n=157 cases) and intravenous combined epidural anesthesia group (group SE, n=299 cases). The probability of cough decreases with the increasing of postoperative time (P<0.05). The probability of cough is similar between group SE and group SB (P>0.05). The probability of cough in group T is significantly higher than other groups at any time point (P<0.05). In group T, the symptom of cough is the most severe, the scores of physiological, psychological, and social parts of LCQ are the lowest, and the VAS score is the highest (P<0.05), but all these are similar in group SE and group SB (P>0.05). The duration of antibiotic application, the days of chest drainage tube indwelling, and the days of hospital stay are all lower in group S than in group T (P<0.05). There is a correlation between pulmonary surgery and postoperative cough. The probability of postoperative cough is higher in the more invasive patients. The probability of coughing is approximately 27% to 36% at 3 months after surgery, and approximately 2.6% to 7.9% in one year after surgery. The combination of surgery and anesthesia methods increases the probability of cough from 48.9% to 65.1% at 3 months after surgery, and about 20.5% to 22.8% in 1 year after surgery. Spontaneous respiration anesthesia can significantly reduce the probability of cough, improve postoperative recovery, and improve postoperative quality of life.

Comparison of the Cost and Efficacy of Axillary Anesthesia and Wide-Awake Anesthesia in Finger Surgeries.

Objectives:Wide-awake anesthesia is a type of local anesthesia consisting of a combined application of lidocaine, epinephrine, and bicarbonate and has a wide potential in hand surgery as it offers the advantage of being applied without sedation and without using a tourniquet. In light of recent studies, its use has increased with the disappearance of the belief among surgeons that epinephrine can cause circulatory disturbance in fingers.Methods:Patients with finger pathologies who were operated upon at the Baltalimani Bone Diseases Teaching and Research Hospital between January 2015 and February 2016 were divided into two groups according to anesthesia type: wide-awake anesthesia and axillary block anesthesia, with 52 patients in each group. Start time of surgery, length of hospital stay, anesthesia cost, and patient satisfaction were compared. For the evaluation of patient satisfaction, the patients were postoperatively asked whether they would accept the same anesthesia method if they had to have the same experience. Each group was further divided into two subgroups: bone interventions (phalangeal fracture, bone biopsy, implant removal, and interphalangeal joint arthrodesis) and soft tissue interventions (digital nerve repair, fingertip local skin flap, flap division, releasing stiff joint, ligament repair, and debridment). Each subgroup included 26 patients.Results:Sufficient anesthesia to cover the whole duration of surgery was achieved in both the groups. Regarding the question “If you were experiencing the same experience, would you accept the same anesthesia again?” 26 and 33 patients responded positively, 16 and 7 patients repsonded negatively, and 10 and 12 patients remained neutral in the axillary block and wide-awake anesthesia groups, respectively. According to the Social Security Institution data, the average anesthesia cost was 316.1 TL in the axillary block anesthesia group and 25.3 TL in the wide-awake anesthesia group; the average length of hospital stay was 32.9 h in the former and 13.6 h in the latter. Start time of surgery was 34 minutes in axillary block anesthesia and 5.3 minutes in wide-awake anesthesia.Conclusion:We found that compared with axillary block anesthesia, the length of hospital stay was 19.3 h less and anesthesia cost was 290.8 TL less with wide-awake anesthesia; furthermore, the start time of surgery decreased by 29.7 min with the latter. Moreover, patient satisfaction rate was better in the wide-awake anesthesia group. No bleeding, patient incompatibility, and other complications that might interfere with the surgery were detected .

Fine motor control of the jaw following alteration of orofacial afferent inputs

ObjectiveThe study was designed to investigate if alteration of different orofacial afferent inputs would have different effects on oral fine motor control and to test the hypothesis that reduced afferent inputs will increase the variability of bite force values and jaw muscle activity, and repeated training with splitting of food morsel in conditions with reduced afferent inputs would decrease the variability and lead to optimization of bite force values and jaw muscle activity.Material methodsForty-five healthy volunteers participated in a single experimental session and were equally divided into incisal, mucosal, and block anesthesia groups. The participants performed six series (with ten trials) of a standardized hold and split task after the intervention with local anesthesia was made in the respective groups. The hold and split forces along with the corresponding jaw muscle activity were recorded and compared to a reference group.ResultsThe hold force and the electromyographic (EMG) activity of the masseter muscles during the hold phase were significantly higher in the incisal and block anesthesia group, as compared to the reference group (P < 0.001). However, there was no significant effect of groups on the split force (P = 0.975) but a significant decrease in the EMG activity of right masseter in mucosal anesthesia group as compared to the reference group (P = 0.006). The results also revealed that there was no significant effect of local anesthesia on the variability of the hold and split force (P < 0.677). However, there was a significant decrease in the variability of EMG activity of the jaw closing muscles in the block anesthesia group as compared to the reference group (P < 0.041), during the hold phase and a significant increase in the variability of EMG activity of right masseter in the mucosal anesthesia group (P = 0.021) along with a significant increase in the EMG activity of anterior temporalis muscle in the incisal anesthesia group, compared to the reference group (P = 0.018), during the split phase.ConclusionsThe results of the present study indicated that altering different orofacial afferent inputs may have different effects on some aspects of oral fine motor control. Further, inhibition of afferent inputs from the orofacial or periodontal mechanoreceptors did not increase the variability of bite force values and jaw muscle activity; indicating that the relative precision of the oral fine motor task was not compromised inspite of the anesthesia. The results also suggest the propensity of optimization of bite force values and jaw muscle activity due to repeated splitting of the food morsels, inspite of alteration of sensory inputs.Clinical relevanceSkill acquisition following a change in oral sensory environment is crucial for understanding how humans learn and re-learn oral motor behaviors and the kind of adaptation that takes place after successful oral rehabilitation procedures.

Perioperative Hypertension in Patients Undergoing Carotid Endarterectomy

CORSON, J.; CHANG, B.; LEOPOLD, P.; DELEO, B.; SHAH, D.; LEATHER, R.; KARMODY, A. Author Information