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完全清醒无止血带局部麻醉技术在手外科手术中的应用

目的总结完全清醒无止血带局部麻醉技术（wide awake local anesthesia no tourniquet，WALANT）在手外科手术中的应用效果。方法 2021年4月—10月，采用WALANT为28例手外伤患者实施麻醉并手术。男18例，女10例，年龄15～55岁，平均35岁。急诊手术22例，择期手术6例。骨折切开复位内固定术5例，骨折内固定物取出术l例，肌腱探查断裂修复术18例，肌腱粘连松解术4例。采用疼痛视觉模拟评分（VAS）评估疼痛情况，术中观察出血情况，术后观察麻醉维持时间、手指血供变化及有无并发症发生，采用主动运动总和法（TAM）评定手部功能。结果 术中麻醉与止血效果满意，患者未诉疼痛。第1针刺入皮肤时VAS评分为2～4分；术中操作未引起明显疼痛，VAS评分为0～1分；麻醉效果可持续6～8 h，VAS评分为2～6分。术后手术区域麻醉效果逐渐消失后，所有患者口服或静脉滴注非甾体止痛药能有效缓解疼痛。术后24 h内患者无头痛、头晕、恶心、呕吐、乏力、皮疹等药物不良反应，术后8 h手指皮温及毛细血管反应同正常手指。术后未出现血运障碍等麻醉不良反应。28例患者均获随访，随访时间6～12个月，平均8个月。末次随访时TAM评定获优20例、良8例。结论手外科手术中应用WALANT止痛和止血效果良好、操作简单、安全有效，术中能即刻观察手术效果。

Value of Tension-Free Inguinal Hernioplasty under Local Anaesthesia in Community Hospitals

目的　探讨局部麻醉（以下简称局麻）腹股沟疝无张力修补术在基层医院的应用价值。方法　分析内蒙古医学院附属人民医院2010年10月至2011年12月期间242例行局麻腹股沟疝修补手术患者的临床资料。结果　除1例因过度紧张而停止手术外，其余手术顺利。平均手术时间50min，所有患者术后0.5～4h （平均2h） 均能下床活动，切口疼痛时间0.5～1d。无一例发生尿潴留；12例患者术后阴囊轻-中度水肿，切口感染1例。全部病例术后观察1～2d出院。门诊随访2～15个月（平均8个月），复发2例。结论　局麻下腹股沟疝无张力修补术安全、疼痛轻微、禁忌证少、复发率及费用低，值得在基层医院推广。

Evaluation of Efficacy of Local Spraying Anaesthesis in Preoperative Implantation of Nasogastric Tube inPatients with Laryngeal Carcinoma

目的：比较常规鼻胃管置入法与鼻咽部局部喷雾麻醉后置胃管法对喉癌患者的影响。方法：将需要安置胃管的100例患者随机分成两组，每组50例。实验组行鼻咽部喷雾麻醉，对照组按常规操作，比较两组患者流泪、恶心、呕吐、咳嗽反应，一次成功率及插管所需要时间、插入中暂停次数。结果：实验组一次成功率高，患者反应轻，插管所需时间有显著差异。结论：常规置胃管常因病员难受而中途暂停置管，实验组置胃管前先作鼻咽部局部喷雾麻醉，可明显减轻患者的痛苦，提高插胃管的一次成功率，插管过程中因病员难受暂停次数也明显减少，使临床护理工作时间缩短，对临床护理工作有积极意义。

三层阻滞局部麻醉在腹股沟疝无张力修补术中的应用

【摘要】　目的　总结三层阻滞局部麻醉法在腹股沟疝无张力疝修补术中的应用价值。　方法　对2008年3月－2010年3月收治的72例腹股沟疝患者分别采用传统局部麻醉（A组，37例）和三层阻滞局部麻醉（B组，35例）方法，两组患者性别、年龄、疝类型等一般资料比较差异无统计学意义（Pgt;0.05），有可比性。所有患者均接受无张力疝修补术。采用视觉模拟评分（visual analogue scale，VAS）比较术中及术后疼痛程度。　结果　B组术中VAS评分显著低于A组，差异有统计学意义（Plt;0.01）；术后各时间点两组VAS评分比较差异均无统计学意义（Pgt;0.05）。　结论　在腹股沟疝术中，三层阻滞局部麻醉法明显优于传统局部麻醉法，是一种操作简便、安全、有效的方法。

ARTHROSCOPIC TREATMENT OF POPLITEAL CYST EXCISION IN COMBINATION WITH DEBRIDEMENT OF THE KNEE UNDER LOCAL ANESTHESIA

ObjectiveTo evaluate the arthroscopic treatment effectiveness of popliteal cyst excision in combination with debridement of the knee under local anesthesia by comparing with continuous epidural anesthesia. MethodsBetween June 2002 and January 2013,145 patients with popliteal cyst underwent arthroscopic popliteal cyst excision in combination with debridement of the knee under local anesthesia (local anesthesia group).In addition,51 patients with popliteal cyst were treated with the same surgery under continuous epidural anesthesia between February 2000 and August 2005 served as control group.No significant difference was found in gender,age,side,disease duration,or cyst size between 2 groups (P>0.05).Then,anesthesia time,analgesia effect,anesthesia satisfaction,operation time,bleeding volume,and anesthesia complication were compared between 2 groups.The guidelines of Rauschning and Lindgren were used to assess the effectiveness,and recurrence rate was recorded. ResultsAll incisions healed primarily,no neurological or vascular injury was found.The patients were followed up 1 year and 1 month to 8 years (mean,3.7 years) in local anesthesia group,and 8 years to 13 years and 7 months (mean,10.8 years) in control group.Local anesthesia group had shorter anesthesia time,higher visual analogue scale (VAS) score,shorter operation time,and lower bleeding volume (P<0.05) than control group.Anesthesia satisfaction was reduced in local anesthesia group,but there was no significant difference (χ2=0.071,P=1.000).The anesthesia complication incidence of control group (15.7%,8/51) was significantly higher than that of local anesthesia group (0) (P=0.000).Recurrence was found in 12 patients of local anesthesia group (curative ratio 91.7%) and in 5 patients of control group (curative ratio 90.2%),showing no significant difference (χ2=0.111,P=0.774).According to the guidelines of Rauschning and Lindgren,there were 131 cases of grade 0,13 cases of grade I,and 1 case of grade Ⅱ in local anesthesia group,and 37 cases of grade 0,12 cases of grade I,and 2 cases of grade Ⅱ in control group; significant differences in grading were shown between at pre- and post-operation in 2 groups (Z=-10.683,P=0.000; Z=-6.385,P=0.000),and between 2 groups at post-operation (Z=-3.145,P=0.002). ConclusionCompared with under continuous epidural anesthesia,arthroscopic treatment of popliteal cyst excision under local anesthesia can obtain better results.Under local anesthesia,the condition of nerve and vessel can be timely and dynamically observed.Arthroscopic treatment of popliteal cyst excision in combination with debridement of the knee has the advantages of less trauma,lower recurrence rate,and satisfactory results.

The Experience of Application in Tension-Free Herniorrhaphy Under Local Anesthesia in Senile Inguinal Hernia

ObjectiveTo investigate the application of tension-free herniarepair under local anesthesia in senile inguinal hernia. MethodsClinical data of 163 cases of senile inguinal hernias with herniorrhaphy under local anesthesia in our department from October 2011 to October 2014 were analyzed retrospectively, including epidural anesthesia 90 patients and local anesthesia 73 patients. ResultsAll patients were successfully completed surgery. Hospital charges in local anesthesia were much cheaper than that in epidural anesthesia group (P=0.002). Hospital days in local anesthesia were much shorter than that in epidural anesthesia group (P=0.035). Lung complication in local anesthesia were much less than that in epidural anesthesia group (P=0.015). Other indicators were no significant difference between the two groups (P > 0.05). ConclusionTension-free herniorrhaphy under local anesthesia in elderly patients is safe, reliable, less invasive method with low costs, slight postoperative pain, and worthy of promotion.

隆鼻术局部麻醉致眼动脉阻塞一例

局部麻醉药在腹腔镜中胆囊切除术的应用

摘要:目的:探讨通过腹腔内注射局部麻醉药在腹腔镜胆囊切除术中的镇痛效果。方法:52例患者随机分为4组,Ⅰ组术前腹腔内喷洒0.75％罗哌卡因20 mL;Ⅱ组术后腹腔内喷洒0.75％罗哌卡因20 mL;Ⅲ组为术后腹腔内喷洒0.5％布比卡因20 mL;Ⅳ组术后腹腔内喷洒生理盐水20 mL。麻醉方法均为全凭静脉麻醉。术后1、2、3、4 h 4个时间点记录患者术后疼痛视觉模拟评分(VAS)。并观察4组术后使用镇痛药物的例数和肩背痛、恶心呕吐发生率。结果:术后1、2、3、4 h VAS评分Ⅱ组lt;Ⅲ组lt;Ⅰ组lt;Ⅳ组(Plt;0.05)。Ⅳ组使用镇痛药物的例数明显高于Ⅰ组、Ⅱ组和Ⅲ组(Plt;0.05)。4组术后肩背痛、恶心呕吐发生率差异无显著性(Pgt;0.05)。结论:经腹腔给局麻药镇痛效果明显,术毕给药镇痛效果优于术前给药,罗哌卡因镇痛效果优于布比卡因。Abstract: Objective: To investigate the effect of intraperitoneal local anesthetic on patients undergone laparoscopiccho1ecystectomy.Methods:Fiftytwo patients were randomly divided into four groups. Group Ⅰ received preoperational anesthetic spary with 20 mL of 0.75％ ropivacaine. Group Ⅱ was given the anesthetic ata same dosage after the operation. Group Ⅲ received preoperational anesthetic spary with 20 mL of 0.5％ bupivacaine. Group Ⅳ received preoperational anesthetic spary with 20 mL saline. The LC was completed under general anesthesia.After the operation,visual analog scale (VAS)was recorded at 1,2,3 and 4 hours to evaluate the degree of postoperative pain.Meanwhile,the number of the patients who received anesthetics after the surgery,as well as the incidence rates shoulder or back pain and nausea or vomiting were recorded. Results: Postoperative VAS of the group Ⅱ was significantly lower than that of the other three groups, while the VAS of group Ⅲ was significantly lower than that in group Ⅰ(both Plt;0.05).Compared to groups Ⅰ, Ⅱ and Ⅲ,more patients in the group Ⅳ needed anesthetics after the operation (Plt;0.05).No significant diference was noticed in the incidence rates of shoulder or back pain and nausea or vomiting among the four groups (Pgt;0.05).Conclusions: Intraperitoneal local anesthetic can significantly reduce postoperative pain after LC. It is more effective to give local anesthetic at the end of the procedure than using it before operation. The effect of ropivacaine is better than bupivacaine.

局部麻醉在腹壁疝修补术中的应用

目的总结局部麻醉下行腹壁疝修补术的临床效果。 方法回顾性分析2010年7月至2014年6月期间我科收治的1 126例腹壁疝患者的临床资料。 结果1 126例患者均于局部麻醉下行无张力疝修补术，其中腹股沟疝例1 088例，股疝21例，脐疝8例，切口疝4例，白线疝3例，戳孔疝2例。有3例患者改为全身麻醉。手术时间18～145 min，（63±12.4）min；术后住院时间1～6 d，（3.2±1.3）d；麻醉及术中监护费用（236.6±31.2）元。术后发生阴囊水肿积液3例，切口部位疼痛4例，无尿潴留、补片感染、肠瘘等发生。术后随访5～26个月，（19±4.8）个月，有2例腹股沟疝复发。 结论局部麻醉下行腹壁疝修补术可行及安全，术后恢复快，并发症少，费用低。

Comparison of the outcomes of local anesthesia and general anesthesia in transcatheter aortic valve replacement

ObjectiveTo compare the outcomes of local anesthesia and general anesthesia in transcatheter aortic valve replacement (TAVR).MethodsA total of 399 severe aortic stenosis patients were included, who underwent TAVR successfully in West China Hospital of Sichuan University between April 2012 and January 2019. The baseline characteristics, procedural details, postprocedural outcomes, and ultrasound data of those patients were collected. All patients were followed up and the end date of follow-up was June 20th 2020. According to anesthetic mode, the patients were divided into local anesthesia group and general anesthesia group. The differences between the two groups in incidence of postprocedural complications, hemodynamics, postprocedural 30-day mortality, and postprocedural 1-year mortality were retrospectively analyzed.ResultsOf the 399 patients, 206 (51.6%) received local anesthesia and 193 (48.4%) received general anesthesia. There was no statistical difference between the two groups in baseline characteristics. The symptoms of both groups were relieved. But the incidences of mild bleeding events (12.4% vs. 1.5%, P<0.001), severe bleeding events (10.4% vs. 0.5%, P<0.001), major vascular complications (0.5% vs. 3.6%, P=0.032), and postprocedural 30-day all causes mortality (1.9% vs. 6.7%, P=0.018) were significantly lower in the local anesthesia group than those in the general anesthesia group.ConclusionIn TAVR, compared with general anesthesia, local anesthesia is safer to use with lower incidence of postprocedural complications and postprocedural 30-day all causes mortality.