Ropivacaine Research Articles

Effect of combined spinal epidural anesthesia with different doses of ropivacaine on maternal and child RAAS system in cesarean section

Objective To investigate the impact of different doses of ropivacaine combined with spinal epidural anesthesia for maternal and neonatal renin activity, angiotensin II and aldosterone in the cesarean section system. Methods From June 2015 to April 2017, 140 parturients undergoing cesarean section in the Maternal and Child Health Hospital of Anji County were selected in the research.Combined spinal-epidural ropivacaine were used in all patients during cesarean section anesthesia, and according to different dose of ropivacaine, the patients were divided into A group (8mg), B group(10mg), C group(12mg), D group(15mg), with 35 cases in each group.The analgesic effects of four groups and the changes of each index in the RAAS system of mother and baby in each time period were compared. Results All fetuses were delivered smoothly.Compared the analgesic effect of four groups, the analgesic effect of IV grade in A group was the lowest percentage [17.14%(6/35)], B, C group had similar proportions [42.86%(15/35), 45.71%(16/35)], D group had the highest proportion [71.42%(25/35)], the maternal proportion of anesthesia effect of IV grade in D group was significantly better than those in A, B, C group, and the differences were statistically significant(χ2=20.90, 5.83, 4.77, all P<0.05). There was no significant change in the level of PRA in each period of A group.The PRA levels in B, C and D group at T1-T3 time were significantly lower than T0(t=14.64, 37.04, 3.97; 15.34, 29.93, 4.73; 25.83, 33, 5.23; 12.47, 8.94, 5.96, all P< 0.05). AT-II in A group at T1-T3 time was decreased, but there was no statistically significant difference compared with T0.AT-II levels in B, C, D group at T1-T3 time were significantly lower than that of T0(t=5.95, 5.98, 3.19; 5.86, 5.54, 4.77; 7.96, 5.47, 6.13; all P<0.05). No significant changes in ALD level of A group in every period of time; ALD levels in B, C, D group at T1-T3 time period were significantly lower than that of T0(t=3.75, 4.92, 2.47; 4.08, 5.77, 2.05; 3.94, 6.13, 3.55, all P<0.05). The fetal umbilical artery and vein of PRA, AT-II and ALD concentration were measured in maternal value range. Conclusion When combined with 10-15 mg ropivacaine for combined spinal epidural anesthesia, the RAAS system of mother and baby is more stable, and the effect of anesthesia and analgesia is better. Key words: Cesarean section; Ropivacaine; Renin-angiotensin system; Aldosterone; Anaesthesia, union

Pre-emptive scalp infiltration with ropivacaine plus methylprednisolone versus ropivacaine alone for relief of postoperative pain after craniotomy in children (RP/MP vs RP): a study protocol for a randomised controlled trial

IntroductionPre-emptive scalp infiltration with local anaesthetics is the simplest and most effective method to prevent postoperative incisional pain. However, local infiltration of an anaesthetic only provides relatively short-term pain relief....

Efficacy of ultrasound-guided serratus anterior plane block for postoperative analgesia in patients undergoing thorascopic surgery

Objective To evaluate the efficacy of ultrasound-guided serratus anterior plane block (SAPB) for postoperative analgesia in patients undergoing thoracoscopic surgery. Methods Sixty American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients of both sexes, aged 18-64 yr, with body mass index of 18-24 kg/m2, scheduled for elective thoracoscopic surgery under general anesthesia, were divided into 3 groups (n=20 each) using a random number table method: control group (group C), thoracic paravertebral block(PVB)group (group PVB) and group SAPB.After the patients were turned to contralateral position, thoracic PVB was performed at T4, 6 thoracic vertebrae on the affected side under ultrasound guidance, and 0.25% ropivacaine 20 ml was injected in group PVB.In group SAPB, ultrasound-guided SAPB was performed on the affected side, and 0.33% ropivacaine 30 ml was injected.Patient-controlled intravenous analgesia (PCIA) was performed at the end of surgery.PCIA pump was pressed when numerical rating scale scores>3 after surgery and flurbiprofen axetil 2 mg/kg was intravenously injected when the efficacy was inadequate.The requirement for PCIA pressing, total consumption of drugs during PCIA and requirement for flurbiprofen axetil were recorded at day 3 after surgery.The consumption of sufentanil during operation was recorded, the dose was calculated, and the total amount of sufentanil consumed was recorded.The development of postoperative nausea and vomiting, pulmonary infection and chronic pain was also recorded. Results Compared with group C, the consumption, dose and total consumption of sufentanil were significantly decreased, the number of pressing times of PCIA and total consumption of drugs during PCIA were decreased, and the incidence of postoperative nausea and vomiting was decreased in PVB and SAPB groups (P 0.05). There was no significant difference in the incidence of chronic pain among the three groups (P>0.05), and no patients required additional flurbiprofen axetil. Conclusion Ultrasound-guided SAPB provides good efficacy for postoperative analgesia in the patients undergoing thoracoscopic surgery with fewer adverse effects. Key words: Nerve block; Ultrasonography; Analgesia, postoperative; Thoracoscopy

Analgesia effect of hydromorphone mixed with ropivacaine for patient-controlled epidural analgesia during delivery

目的 评价氢吗啡酮复合罗哌卡因用于硬膜外分娩镇痛的效果以及对产后泌乳的影响。 方法 选择衢州市人民医院2017年9月至2018年9月行分娩镇痛单胎足月妊娠产妇60例，年龄范围21～37岁，美国麻醉医师协会(ASA) Ⅰ或Ⅱ级，采用随机数字表法分为三组：0.15%罗哌卡因组(A组)、0.15%罗哌卡复合0.4 mg/mL吗啡组(B组)和0.15%罗哌卡复合4 μg/mL氢吗啡酮组(C组)，每组20例。记录分娩镇痛前(T0)、负荷剂量后10 min(T1)、30 min(T2)及宫口开全时(T3)的视觉模拟评分(VAS评分)，并记录注射负荷量后30 min的下肢运动阻滞程度评分(Bromage分级)。记录恶心、呕吐、皮肤瘙痒等不良反应情况。分别于分娩镇痛前、胎儿娩出时、娩出后2 h抽取产妇静脉血测定催乳素(PRL)浓度，记录泌乳开始时间。 结果 与A组比较，T1～T3时B组产妇VAS评分分别为(2.6±0.7)分、(1.6±0.4)分、(2.4±0.5)分，C组产妇VAS评分分别为(2.9±0.7)分、(1.5±0.5)分、(2.7±0.5)分，与A组比较均明显降低，差异均有统计学意义(F＝3.98、4.16、3.27，均P<0.05)。与B组比较，A组和C组的嗜睡、瘙痒发生率均明显降低(均P<0.05)。与A组比较，B组和C组胎儿娩生后2 h时血清PRL浓度均明显升高，产后泌乳开始时间均明显提前(均P<0.05)。三组产妇Bromage分级差异无统计学意义。 结论 氢吗啡酮4 μg/mL复合0.15%罗哌卡因用于硬膜外分娩镇痛时镇痛效果好，且可促进催乳素分泌，泌乳开始时间提前，不良反应发生率低。

Clinical application of ultrasound-guided femoral nerve and popliteal sciatic nerve block in patients undergoing foot and ankle surgery

Objective To observe the application of ultrasound-guided femoral nerve block(FNB) and popliteal sciatic nerve block(PSNB) in patients undergoing foot and ankle surgery. Methods From August 2015 to August 2017, 60 patients scheduled for foot and ankle surgery undergoing laryngeal mask airway (LMA) general anesthesia in the People′s Hospital of Langfang were randomly divided into 3 groups by the random number table, with 20 cases in each group.Before transfer patients from bed to operating table, A group received dezocine 5 mg iv, B group received FNB combined with PSNB(distal to the sciatic nerve bifurcation), C group received FNB combined with PSNB(proximal to the sciatic nerve bifurcation). A total of 40 mL of 0.375% ropivacaine were injected guided by ultrasound in B group and C group.The time of sufficient sensory block and awake, the dosage of remifentanil and propofol were recorded.Pain was assessed using visual analogue scale (VAS) pre- and post block.The incidence of sleepiness, postoperative nausea and vomiting (PONV), agitation, pain and adverse reaction were also recorded. Results The time of sufficient sensory block and awake, the dosage of remifentanil and propofol in A, B and C group: A group(not measured), (21.6±1.6)min, (1183±17)μg, (665.0±6.7)mg; B group (25.5±2.5)min, (15.3±1.4)min, (635±16)μg, (455.0±6.5)mg; C group (19.6±2.3)min, (14.9±1.5)min, (598±14)μg, (438.0±9.9)mg.The time of awake, the dosage of remifentanil and propofol in B group and C group were significantly lower than those in A group (F=44.07, 52.41, 62.45, all P<0.05). The time of sufficient sensory block in C group was lower than that in B group(t=15.69, P<0.05). The VAS scores at T2, T3 and T4 in A, B and C group: A group (4.5±0.6)point, (8.4±0.5)point, (6.1±0.9)point; B group (2.6±0.5)point, (3.9±0.3)point, (2.4±0.6)point; C group (2.5±0.4)point, (2.3±0.5)point, (1.1±0.5)point.The VAS scores in B group or C group were significantly lower than those in A group (F=52.36, 72.82, 75.41, all P<0.05). The VAS scores at T3 and T4 in C group were significantly lower than those in B group (t=18.42, q=14.55, all P<0.05). The incidence rates of sleepiness, PONV, agitation and incision pain in A, B and C group: A group (25%, 25%, 15%, 15%, 50%); B group(0%, 5%, 0%, 0%, 10%); C group(0%, 5%, 0%, 0%, 0%). The number of patients who had adverse reactions in B or C group were significantly lower than those in A group (χ2=8.51, 8.73, 10.11, 10.11, 9.69, all P<0.05). The incidence rate of incision pain at sober in C group was lower than that in B group(χ2=10.89, P<0.05). Conclusion The ultrasound-guided FNB and PSNB(proximal to the sciatic nerve bifurcation) can obviously shorten the onset time, reduce the dosage of general anaesthetic.It has effective analgesia during transfer of patients from bed to operating table and sober. Key words: Ultrasound; Femoral nerve block(FNB); Popliteal sciatic nerve block(PSNB); Foot and ankle surgery; Laryngeal mask airway(LMA); Distal popliteal sciatic nerve block; Proximal popliteal sciatic nerve block; Ropivacaine

Modifying efficacy of quadratus lumborum block combined with general anesthesia in patients undergoing percutaneous nephrolithotomy

Objective To evaluate the modifying efficacy of quadratus lumborum block (QLB) combined with general anesthesia in the patients undergoing percutaneous nephrolithotomy (PCNL). Methods Sixty American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients, aged 33-64 yr, with body mass index of 18-27 kg/m2, scheduled for elective PCNL with general anesthesia, were divided into general anesthesia group (group GA) and QLB combined with general anesthesia group (group QLB+ GA), with 30 patients in each group.In group QLB+ GA, the anterior approach to QLB was performed with 0.357% ropivacaine 20 ml on the side of operation under the ultrasound guidance before induction of anesthesia.Anesthesia was induced with IV midazolam, propofol, sufentanil and cisatracurium.Anesthesia was maintained by intravenously infusing propofol, remifentanil and cisatracurium.Patient-controlled intravenous analgesia (PCIA) was performed at the end of operation.PCIA solution contained sufentanil 2 μg/kg in 100 ml of normal saline.The PCA pump was set up with a 2 ml bolus dose, a 15-min lockout interval, and background infusion at a rate of 2 ml/h.Numeric rating scale score was maintained ≤ 3 after operation.When numeric rating scale score ≥4, flurbiprofen axetil 50 mg was intravenously injected as rescue analgesic.The intraoperative consumption of propofol and remifentanil, occurrence of adverse reactions (nausea and vomiting, agitation, respiratory depression, somnolence) in postanesthesia care unit, consumption of sufentanil for PCIA within 48 h after operation, the number of successfully delivered doses, requirement for rescue analgesics, recovery time of intestinal exhaust gas, and length of postoperative hospital stay were recorded. Results Compared with group GA, the intraoperative consumption of propofol and remifentanil was significantly reduced, the rate of rescue analgesia, consumption of sufentanil for PCIA within 48 h after operation and the number of successfully delivered doses were decreased, the incidence of agitation, respiratory depression and somnolence in postanesthesia care unit was decreased, and the recovery time of intestinal exhaust gas and length of postoperative hospital stay were shortened in group QLB+ GA (P<0.05). Conclusion QLB combined with general anesthesia is helpful in carrying out the anesthetic model of low-consumption opioids and more helpful in inhibiting postoperative pain responses and promoting postoperative recovery than general anesthesia alone in patients undergoing PCNL. Key words: Nerve block; Psoas muscles; Anesthesia, general

Modified strategy of anesthesia for laparoscopic radical resection of rectal carcinoma: ultrasound-guided anterior quadratus lumborum block combined with general anesthesia

Objective To evaluate the efficacy of ultrasound-guided anterior quadratus lumborum block combined with general anesthesia for laparoscopic radical resection of rectal carcinoma. Methods A total of 80 patients of both sexes, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, aged 40-64 yr, scheduled for elective laparoscopic radical resection of rectal carcinoma, were divided into 2 groups (n=40 each) using a random number table method: anterior quadratus lumborum block combined with general anesthesia group(group QG)and general anesthesia group(group G). In group QG, anterior quadratus lumborum block was performed with 0.33% ropivacaine 25 ml and dexamethasone 5 mg under ultrasound guidance before operation, and the same procedure was performed on the other side.Combined intravenous-inhalational anesthesia was applied, propofol 3-5 μg/ml and remifentanil 3-5 ng/ml were given by target-controlled infusion, and cisatracurium was intermittently injected in two groups.Patient-controlled intravenous analgesia with sufentanil 2 μg/kg was used for postoperative analgesia.The analgesic pump was set up to deliver a 2 ml bolus dose with a 15-min lockout interval.Bruggrmann comfort scale(BCS)scores were recorded at 1, 6, 12, 24 and 48 h after operation(T1-5). Tramadol was used for rescue analgesic after operation.The consumption of remifentanil and sufentanil, requirement for tramadol, occurrence of adverse reactions and patients′ satisfaction with postoperative analgesia were recorded.The emergence time, first ambulation time, time to first flatus/poo and length of hospital stay were also recorded.The development of anterior quadratus lumborum block-related complications was recorded. Results Compared with group G, BCS scores were significantly increased at T4, 5, the consumption of remifentanil, requirement for tramadol and incidence of nausea and vomiting were decreased, patients′ satisfaction with postoperative analgesia was increased, and the emergence time, first ambulation time, time to first flatus/poo and length of hospital stay were shortened in group QG(P<0.05). Conclusion Ultrasound-guided anterior quadratus lumborum block combined with general anesthesia can reduce the consumption of opioids in the perioperative period and is helpful in improving outcomes when used for laparoscopic radical resection of rectal carcinoma. Key words: Psoas muscles; Nerve block; Anesthesia, general; Colorectal surgery; Laparoscopy

Pre-operative methylprednisolone decreased early vascular endothelial injury after total knee arthroplasty

Objective To investigate the effect of methylprednisolone on markers of early vascular endothelial activation and damage after total knee arthroplasty. Methods We randomly selected 88 patients undergoing unilateral total knee arthroplasty. The patients were divided into two groups by a completely random grouping method(n=44), they were given either pre-operative intravenous methylprednisolone 120 mg (number of patients for methylprednisolone group) or isotonic saline (number of patients for control group). All operations were performed under lumbar spinal and epidural anesthesia. Blood samples were collected at 2, 6, 12 h and 24 h pre- and post-operation, respectively. By enzyme-linked immunosorbent assay(ELISA), we analyzed concentrations of Syndecan-1, plasma soluble thrombomodulin (sTM), E-selectin, vascular endothelial growth factor (VEGF) and C-reactive protein (CRP) at different time points. Results There was no significant difference in age, gender, body mass index (BMI), operation time and ropivacaine dose between patients in two groups (P>0.05). Syndecan-1、E-selectin and CRP were significantly decreased at 2, 6, 12 h and 24 h in methylprednisolone group, sTM and VEGF were significantly decreased at 6, 12 h and 24 h in methylprednisolone group (P<0.05) . Compared with preoperative, the level of Syndican-1 and E-selectin at 2, 6, 12 h and 24 h were significantly decreased, the level of CRP was significantly increased (P<0.05) , the level of sTM and VEGF were significantly decreased at 6, 12 h and 24 h in methylprednisolone group (P<0.05) . Conclusions Pre-operative administration of methylprednisolone 120 mg could reduce markers of endothelial activation, reduce the level of damage markers and reduce the systemic inflammatory response after total knee arthroplasty. Key words: Total knee arthroplasty; Syndecan-1; Soluble thrombomodulin; E-selectin; Vascular endothelial growth factor; C-reactive protein

Sucrose Acetate Isobutyrate as an In situ Forming Implant for Sustained Release of Local Anesthetics.

In this study, an injectable Sucrose Acetate Isobutyrate (SAIB) drug delivery system (SADS) was designed and fabricated for the sustained release of Ropivacaine (RP) to prolong the duration of local anesthesia. By mixing SAIB, RP, and N-methyl-2-pyrrolidone, the SADS was prepared in a sol state with low viscosity before injection. After subcutaneous injection, the pre-gel solution underwent gelation in situ to form a drug-released depot. The in vitro release profiles and in vivo pharmacokinetic analysis indicated that RP-SADS had suitable controlled release properties. Particularly, the RP-SADS significantly reduced the initial burst release after subcutaneous injection in rats. In a pharmacodynamic analysis of rats, the duration of nerve blockade was prolonged by over 3-fold for the RP-SADS formulation compared to RP solution. Additionally, RP-SADS showed good biocompatibility in vitro and in vivo. Thus, the SADS-based depot technology is a safe drug delivery strategy for the sustained release of local anesthetics with long-term analgesia effects.

Small-Dose Ropivacaine Hydrochloride with Fentanyl versus Large-Dose of Ropivacaine Hydrochloride for Cesarean Section.

To compare the effect of small-dose ropivacaine hydrochloride combined with fentanyl versus large-dose of ropivacaine hydrochloride for cesarean section. Experimental study. Department of Anesthesiology, Gansu People's Hospital, China, from February 2017 to April 2018. A total of 134 maternal women, who underwent cesarean section, were randomly divided into control group and observation group, with 67 cases in each group. Control group was anesthetized with a large dose (1.5 mL) of ropivacaine hydrochloride, and observation group was anesthetized with a small dose (1 mL) of ropivacaine hydrochloride in combination with 10 µg of fentanyl. Then anesthetic effects of the two groups were compared. The onset time of anesthesia and postoperative pain scores of the anesthesia in observation group were better than those in control group (both p<0.001). There was no significant difference in HR, SpO₂ and MAP between the two groups after 15 minutes of anesthesia, and after the operation (p=0.393, 0.275, 0.108, 0.740, 0.068 and 0.230, respectively). After the delivery of the fetuses, the HR, SpO₂ and MAP of the parturients in observation group were better than those in control group (all p<0.001). Frequency of adverse reactions of parturients in observation group was lower than that in control group (p=0.033). In comparison to large-dose of ropivacaine hydrochloride, small-dose of ropivacaine hydrochloride combined with fentanyl, in combined spinal-epidural analgesia on parturients accepting cesarean section, can more effectively maintain their hemodynamic stability, relieve postoperative pain, and have a low incidence of adverse reactions.

A randomized comparison of low dose ropivacaine programmed intermittent epidural bolus with continuous epidural infusion for labour analgesia.

Two methods of local anaesthetic administration into the epidural space in natural delivery pain management are compared in the article. Methods compared are programmed intermittent epidural bolus (PIEB) and continuous epidural infusion (CEI). Patient-controlled epidural analgesia was provided simultaneously in all cases. 84 primipara with average age 30.7 (27.5-34) years, and gestational age 39.1 (38.5-40) weeks planned to natural delivery were examined. PIEB and patient controlled epidural analgesia was used in the first group. Patient controlled epidural analgesia and continuous epidural infusion (CEI) of local anaesthetic was used in the second group. Ropivacaine hydrochloride 0.08% without any adjuvants was utilized as local anaesthetic. Pain assessment was conducted using VAS while motor block was assessed using the Bromage scale. Labor progression dynamics and condition of newborns were equally independent to the method of analgesia. However, analgesic endpoint was better and more long-lasting while using PIEB with patient controlled epidural analgesia. Moreover, a lesser amount of local anaesthetic was consumed. In the group with programmed bolus, the total volume of local anaesthetic was 59.9 (45-66) ml in comparison with 69.5 (44-92) ml in the continuous infusion group (p = 0.033). The time to first bolus requested by the puerpera was significantly longer in the programmed bolus group - 89.2 (57-108) min compared to 43.2 (35-65) minutes in the continuous infusion group (p = 0.021). Administration of low-concentrated ropivacaine solution 0.08% with no opioids using PIEB provides better and more prolonged analgesia with less local anaesthetic consumption and without any additional maternal and newborn side effects in comparison with continuous infusion.

Efficacy of transcutaneous electrical acupoint stimulation combined with epidural block for labor analgesia in parturients with preeclampsia

Objective To evaluate the efficacy of transcutaneous electrical acupoint stimulation (TEAS) combined with epidural block for labor analgesia in parturients with preeclampsia. Methods One hundred and twenty parturients with preeclampsia who were at full term with a singleton fetus in vertex presentation, aged 24-37 yr, weighing 66-105 kg, with height between 157-171 cm, of American Society of Anesthesiologists physical status Ⅲ, were divided into 3 groups (n=40 each) using a random number table method: epidural labor analgesia in active phase of labor group (group A), epidural labor analgesia in latent phase of labor group (group B) and TEAS combined with epidural labor analgesia in active phase of labor group (group C). Epidural labor analgesia was performed in active phase of labor (cervical dilatation≥3 cm) in group A and in latent phase of labor (cervical dilatation≥1 cm) in group B. In group C, TEAS was carried out in latent phase of labor, bilateral Hegu and Sanyinjiao acupoints were selected as the main acupoints and Zusanli as the auxiliary acupoints, patients received TEAS with a frequency 2/100 HZ, disperse dense waves, intensity (starting at a voltage of 15 mA) increasing to the maximum current that could be tolerated until delivery of fetus, and epidural labor analgesia was performed when parturients were in active phase of labor.Epidural labor analgesia solution contained the mixture (100 ml) of 0.08% ropivacaine and sufentanil 0.4 μg/ml, and the analgesia pump was set up to deliver a 5 ml bolus dose with a 30-min lockout interval and background infusion at 8 ml/h and then turned off after delivery of fetus.Mean arterial pressure and visual analogue scale (VAS) scores were recorded when the cervical dilation was 1, 2, 3, 4 and 10 cm and immediately after delivery.The labor time, volume of postpartum hemorrhage, requirement for oxytocin, cesarean section, adverse reactions and Apgar score of the newborn were recorded.Maternal venous blood samples were collected when the cervical dilation was 1 and 10 cm for determination of the concentrations of dynorphin (DYN) and cortisol in serum and adrenocorticotropic hormone, norepinephrine and epinephrine in plasma (by enzyme-linked immunosorbent assay) and serum glucose concentration (by glucose oxidase method). Results Compared with group C, the VAS scores and mean arterial pressure were significantly increased when the cervical dilation was 2 and 3 cm, the concentrations of DYN, cortisol and blood sugar in serum and adrenocorticotropic hormone, norepinephrine and epinephrine in plasma were increased when the cervical dilation was 10 cm(P 0.05), and the duration of the first stage of labor was significantly prolonged, the requirement for oxytocin was increased, the serum concentration of DYN was decreased when the cervical dilation was 10 cm (P 0.05). Conclusion Compared with epidural labor analgesia performed in the latent and active phases of labor, TEAS combined with epidural block provides better efficacy for labor analgesia in parturients with preeclampsia. Key words: Electric stimulation therapy; Analgesia, epidural; Labor pain; Pre-eclampsia

Effects of ultrasound-guided erector spinae plane block for pain relief in patients after rib tumor resection

Objective To explore the effects of ultrasound-guided erector spinae plane block(ESPB) for pain relief in patient after rib tumor resection. Methods A total of 40 patients (American Society of AnesthesiologistsⅠ-Ⅱ) undergoing rib tumor resection were randomly divided into two groups. Patients in group G received general anesthesia alone. Meanwhile, those in group E underwent ultrasound-guided ESPB combined under general anesthesia, and 20 ml of 0.5% ropivacaine was administered at the ESPB where rib tumor was located. Both groups received patient controlled intravenous analgesia (PCIA). The segments of sensory block on mid-axillary line were recorded 20 min after ESPB. The doses of remifentanil, mean arterial pressure (MAP), heart rate were recorded before entry into the operation room, after anesthesia induction, when the skin was excised, 30 min after surgery began and at the end of surgery. The rest and active visual analogue scale (VAS) at 1, 4, 12, 24 h and 36 h after operation, average hospitalization stay and patient satisfaction were recorded. Results Patients in group E reported 5.2±0.9 sensory block 20 min after ESPB. Compared with group G, group E used a less dose of remifentanil during operation, and demonstrated decreased MAP and heart rate when the skin was excised and at the end of surgery (P<0.05). Compared with group G, group E presented lower the rest and active VAS at 1, 4, 12, 24 h and 36h after operation and average hospitalization stay (P<0.05). Compared with group G, group E presented better patient satisfaction (P<0.05). Conclusions ESPB is safe and effective for patient after excision of rib tumor, with good patient satisfaction. Key words: Erector spinae plane block; Ultrasonic monitoring; Ribs; Bone neoplasms; Postoperative analgesia

A prospective randomised double blind clinical study comparing ropivacaine and fentanyl with bupivacaine and fentanyl for labour epidural analgesia

A prospective randomised double blind clinical study comparing ropivacaine and fentanyl with bupivacaine and fentanyl for labour epidural analgesia - IJCA- Print ISSN No: - 2394-4781 Online ISSN No:- 2394-4994 Article DOI No:- 10.18231/2394-4994.2019.0016, Indian Journal of Clinical Anaesthesia-Indian J Clin Anaesth

Distribution of regions of ultrasound-guided erector spinae plane block at the level of T5 transverse process

Objective To study the distribution of the regions of ultrasound-guided erector spinae plane block (ESPB) at the level of T5 transverse process. Methods Thirty male patients, aged 18-64 yr, with body mass index of 18-24 kg/m2, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, scheduled for elective thoracotomy, were enrolled in this study.ESPB was conducted with 0.5% ropivacaine hydrochloride 0.4 ml/kg at the level of T5 transverse process under ultrasound guidance before induction of general anesthesia.Blocks in each thorax and back region (the left side of the body was divided into 18 different regions based on the anatomical landmarks on the body surface, No.1-18) were assessed by cold stimulation.Effective block in each region was recorded at 10, 15, 20, 25, 30, 40 and 50 min after administration.The adverse reactions such as pneumothorax, puncture hematoma and local anesthetic intoxication were recorded. Results The blocking range was basically fixed at 30 min after a single ESPB injection at the level of T5 transverse process, and the regions covered from the sternal angle to the level of the rib arch.The regions of effective block were No.1-3 and 5-7 in ≥95% patients, and the regions of effective block were No.1-15 and 17 in patients ≥90% and < 95%.No patients developed adverse reactions such as pneumothorax, puncture hematoma or local anesthetic intoxication. Conclusion The regions of effective ultrasound-guided ESPB at the level of T5 transverse process are mainly distributed in T2-T8 thoracodorsal skin areas. Key words: Nerve block; Back muscles; Tissue distribution

Effect of different approaches to thoracolumbar interfascial plane block on analgesic efficacy after lumbar spinal fusion

Objective To evaluate the effect of different approaches to thoracolumbar interfascial plane (TLIP) block on the analgesic efficacy after lumbar spinal fusion. Methods Seventy-five patients of both sexes, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, aged 40-70 yr, with body mass index ≤40 kg/m2, undergoing posterior median approach to lumbar spinal fusion, were divided into 3 groups (n=25 each) using a random number table method: patient-controlled intravenous analgesia (PCIA) group (group P), medial approach to TLIP combined with PCIA group (group MP) and lateral approach to TLIP combined with PCIA group (group LP). TLIP block was performed by advancing the block needle in a lateral to medial direction and injecting 0.5% ropivacaine 20 ml locally between the bilateral multifidus and longissimus muscles in group MP.TLIP block was performed by advancing the block needle in a medial to lateral direction and injecting 0.5% ropivacaine 20 ml locally between the bilateral longissimus and iliocostalis muscles in group LP.The identification rate and distinction score between multifidus and iliocostalis muscles obtained from ultrasonic images were recorded before block in MP and LP groups.All the patients received PCIA until 48 h after surgery.PCIA solution contained sufentanil 100 μg and tropisetron 10 mg diluted to 100 ml with 0.9% normal saline.The PCA pump was set up with a 2 ml bolus dose, a 15-min lockout interval and background infusion at a rate of 1 ml/h.When visual analogue scale score at rest >4 after surgery, parecoxib 40 mg was intravenously injected for rescue analgesia.The development of adverse reactions such as nausea and vomiting was recorded within 48 h after surgery. Results The identification rate and distinction score of the iliocostalis was significantly higher than that of the multifidus (P 0.05). There was no significant difference in the parameters mentioned above between group MP and group LP(P>0.05). Conclusion Ultrasound-guided medial and lateral approaches to TLIP block is helpful in achieving low-dose opioid anesthesia mode and more helpful in enhancing the efficacy of PCIA when used for lumbar spinal fusion. Key words: Nerve block; Fascia; Analgesia, patient-controlled

Effect of dexmedetomidine combined with erector spinae plane block on inflammatory responses and cellular immune function after thoracic interbody fusion

Objective To evaluate the effect of dexmedetomidine combined with erector spinae plane block on inflammatory responses and cellular immune function after thoracic interbody fusion in patients. Methods Ninety American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients of both sexes, aged 18-60 yr, with body mass index of 19-25 kg/m2, scheduled for elective thoracic interbody fusion with the vertebral segments involved in the operation <6, were divided into 3 groups(n=30 each)using a random number table method: general anesthesia group(group G), dexmedetomidine group(group D)and dexmedetomidine plus erector spinae plane block group(group DE). In group D and group DE, dexmedetomidine was intravenously infused over 10 min at a loading dose of 0.5 μg/kg starting from 30 min before anesthesia induction, followed by continuous infusion of 0.5 μg·kg-1·h-1 until 15 min before the end of operation. In group DE, bilateral erector spinae blocks were performed under ultrasound guidance at 20 min before anesthesia induction, and 0.25% ropivacaine 30 ml was injected into each side. Patients received patient-controlled analgesia(PCA)after operation. The consumption of propofol was recorded. The patients were followed up for 48 h after operation, and the pressing times of PCA and consumption of sufentanil were recorded. The emergence time, extubation time and volume of blood loss were also recorded. Blood samples were collected from the radial artery immediately before induction(T1), at 30 min of operation(T2), and at 1 h and 1, 3 and 5 days after operation(T3-6)for determination of plasma CD42+ , HLA-DR+ and CD14+ concentrations, white blood cell(WBC)count(by electrical impedance method)and plasma C-reactive protein(CRP)concentrations(by latex-enhanced scattering turbidimetry assay). CD42+ /CD14+ and HLA-DR+ /CD14+ ratios were calculated. Results Compared with group G, the pressing times of PCA and consumption of sufentanil were significantly decreased, CD42+ /CD14+ ratio was decreased, and HLA-DR+ /CD14+ ratio was increased at T3-6 in group D, and the emergence time, extubation time, pressing times of PCA and consumption of sufentanil and propofol were significantly decreased, CD42+ /CD14+ ratio was decreased, HLA-DR+ /CD14+ ratio was increased at T3-6, and the plasma CRP concentrations and WBC count were decreased at T2-6 in group DE (P<0.05). Compared with group D, the emergence time, extubation time, pressing times of PCA and consumption of sufentanil and propofol were significantly decreased, CD42+ /CD14+ ratio was decreased at T5, HLA-DR+ /CD14+ ratio was increased at T3, 4, and the plasma CRP concentrations and WBC count were decreased at T3-6 in group DE (P<0.05). Conclusion Dexmedetomidine combined with erector spinae plane block can reduce inflammatory responses and improve cellular immune function after thoracic interbody fusion in patients. Key words: Dexmedetomidine; Nerve block; Inflammation; Immunity, cellular

Effect of different anesthetic and postoperative analgesic methods on early postoperative quality of recovery in patients undergoing radical mastectomy: efficacy of serratus plane block

Objective To evaluate the effect of serratus plane block(SPB)combined with general anesthesia and SPB with patient-controlled nerve analgesia(PCNA)after surgery on the early postoperative quality of recovery in the patients undergoing radical mastectomy. Methods Sixty American Society of Anesthesiologists physical status Ⅰ or Ⅱ female patients, aged 18-64 yr, weighing 45-70 kg, scheduled for elective unilateral modified radical mastectomy under general anesthesia, were assigned into 3 groups(n=20 each) using a computer software: SPB and general anesthesia plus patient-controlled intravenous analgesia(PCIA)group(SG+ PCIA group), SPB and general anesthesia plus SPB with PCNA group(SG+ PCNA group), and general anesthesia plus PCIA group(G+ PCIA group). Ultrasound-guided ipsilateral SPB was performed before anesthesia induction.Analgesia was maintained with propofol-remifentanil-sevoflurane, rocuronium or vecuronium was intermittently injected to maintain muscle relaxation.PCIA solution contained tramadol 800 mg and flurbiprofen axetil 100 mg in 54 ml of normal saline, and the PCA pump was set up to deliver a 2 ml bolus dose, with a 15 min lockout interval and background infusion at a rate of 0.5 ml/h after a loading dose of 5 ml.The location of the indwelling catheter was confirmed again using ultrasound at the end of surgery, PCNA solution contained 1% ropivacaine 500 mg in 250 ml of normal saline, and the PCA pump was set up to deliver a 5 ml bolus dose, with a 45 min lockout interval and background infusion at a rate of 5 ml/h after a loading dose of 5 ml.The PCA pumps were used until 48 h after surgery.The automatic key was pressed when pain scores(numerical rating scale [NRS] scores) ≥4 at rest or during activity (at 45° ipsilateral upper extremity-up tilt). Quality of Recovery-40 (QoR-40) score was used to assess the early postoperative quality of recovery at 24 and 48 h after surgery.NRS scores at rest or during activity were recorded at 6, 8, 12, 24 and 48 h after surgery.The total pressing times of PCA and occurrence of adverse reactions such as respiratory depression, pruritus, infection at the puncture site or pneumothorax were also recorded. Results Compared with group G+ PCIA, the postoperative QoR-40 scores were significantly increased, NRS scores at rest or during activity were decreased at each time point after surgery, and the total pressing times of PCA were reduced in SG+ PCIA and SG+ PCNA groups, the incidence of nausea and vomiting was significantly decreased in group SG+ PCIA, and the incidence of nausea and vomiting and dizziness was significantly decreased in group SG+ PCNA (P<0.05 or 0.01). Compared with group SG+ PCIA, the postoperative QoR-40 scores were significantly increased at 24 h after surgery, and NRS scores at rest or during activity were decreased after surgery in group SG+ PCNA(P<0.05 or 0.01). Conclusion SPB combined with general anesthesia and SPB with PCNA after surgery can raise the early postoperative quality of recovery in the patients undergoing modified radical mastectomy. Key words: Anesthesia, general; Nerve block; Analgesia, patient-controlled; Breast neoplasms; Rehabilitation

Anesthesia for cesarean section after failed labor under combined spinal and epidural analgesia: analysis of 58 cases

Objective To summarize the experience in anesthesia management for cesarean section(CS) after failed labor in women with combined spinal and epidural analgesia and to provide evidence for more effective and safer clinical practice. Methods We included 58 singleton pregnant women who received spinal and epidural analgesia during labor but converted to CS at Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology from October 2017 to October 2018. When CS was indicated, 10 ml of 0.125% ropivacaine was given through the epidural catheter immediately, and 5 ml of 1% lidocaine was given when arriving at the operating room. Five minutes later, 10 ml of 1% ropivacaine was administered. General anesthesia would be required when epidural anesthesia was considered to be failed 10 min after the usage of ropivacaine. Clinical datas were retrospectively reviewed. The management and effects of anesthesia for CS, maternal and neonatal outcomes were described. Results Of the 58 patients when CS was indicated during labor, 5.2%(3/58) received general anesthesia immediately. Among the other 94.8% (55/58) who received epidural anesthesia, 3.6%(2/55) converted to general anesthesia later. Adverse effects of epidural anesthesia included reduced mean artery pressure (8/53, 15.1%), nausea and vomiting (3/53, 5.7%). For the neonatal Apgar score at 1 min, one out of the 58 babies (1.7%) was between 0 and 3, ten (17.2%) between 4 and 7, and 47 (81.0%) between 8 and 10. The two babies (3.4%) with Apgar score between 4 and 7 at 5 min were both referred to the department of Neonatology, and the rest 56 neonates (96.6%) scored 8-10. Conclusions Spinal and epidural analgesia in labor can be safely and effectively adjusted to anesthesia for CS. Key words: Trial of labor; Analgesia, obstetrical; Analgesia, epidural; Treatment failure; Anesthesia, obstetrical; Cesarean section

Study on the analgesic effect of ultrasound-guided paravertebral nerve block on patients with radical mastectomy

Objective To investigate the analgesic effect of ultrasound-guided paravertebral nerve block on patients with radical mastectomy. Methods Sixty female patients who underwent unilateral radical mastectomy with general anesthesia in the Second Hospital of Shanxi Medical University from March 2016 to January 2018 were enrolled, and 58 cases were actually studied according to the inclusion and exclusion criteria. According to the random number table method, the patients were randomly divided into simple general anesthesia group (GA group, 30 cases) and paravertebral nerve block combined with general anesthesia group (PG group, 28 cases). In the PG group, 15 ml of 0.4% ropivacaine was injected into the T2-T6 paraspinal space on the surgical side with ultrasound. All patients received general anesthesia with intravenous propofol induction, and were given a self-controlled intravenous analgesia pump. When the visual analogue scale (VAS) score was ≥7 points, the patient was given intravenous morphine 5-10 mg. The t-test and χ2 test were used to compare the hemodynamic parameters at different time points, the VAS score at different time after operation, the postoperative analgesia pump use, and postoperative adverse reactions. Results There were no significant differences in hemodynamic parameters between the PG group and the GA group at different times (all P > 0.05). The static VAS scores of the PG group at different time points were lower than those of the GA group, but the difference was not statistically significant (all P > 0.05). The cough dynamic VAS scores of the patients in the PG group were lower than those in the GA group at 2, 6, 12, and 24 h after surgery, and the difference was statistically significant (all P < 0.05). The total amount of sufentanil [(35±10) μg vs. (50±8) μg, t = 6.308, P < 0.05], the number of remedial analgesia within 48 hours after operation [(550±105) mg vs. (680±128) mg, t = 4.240, P < 0.05], and the number of effective presses of analgesia pump (3.1±1.5 vs. 10.0±3.4, t = 10.117, P < 0.05) in the PG group were significantly lower than those in the GA group. The adverse reactions such as nausea, vomiting and lethargy in the PG group were significantly lower than those in the GA group, and the difference was statistically significant (χ2 values were 3.869 and 2.334, both P < 0.05). The postoperative analgesia comfort rate of the PG group was significantly higher than that of the GA group [96.4% (27/28) vs. 70.0% (21/30)], and the difference was statistically significant (χ2 = 7.089, P < 0.05). Conclusion The combined use of general anesthesia and ultrasound-guided paravertebral nerve block for postoperative analgesia in patients with radical mastectomy is superior to PCIA. Key words: Breast neoplasms; Surgical procedures, operative; Anesthesia; Ultrasound; Paravertebral nerve block; Analgesia