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完全清醒無止血帶局部麻醉技術在手外科手術中的應用

目的總結完全清醒無止血帶局部麻醉技術（wide awake local anesthesia no tourniquet，WALANT）在手外科手術中的應用效果。方法 2021年4月—10月，采用WALANT為28例手外傷患者實施麻醉并手術。男18例，女10例，年齡15～55歲，平均35歲。急診手術22例，擇期手術6例。骨折切開復位內固定術5例，骨折內固定物取出術l例，肌腱探查斷裂修復術18例，肌腱粘連松解術4例。采用疼痛視覺模擬評分（VAS）評估疼痛情況，術中觀察出血情況，術后觀察麻醉維持時間、手指血供變化及有無并發癥發生，采用主動運動總和法（TAM）評定手部功能。結果 術中麻醉與止血效果滿意，患者未訴疼痛。第1針刺入皮膚時VAS評分為2～4分；術中操作未引起明顯疼痛，VAS評分為0～1分；麻醉效果可持續6～8 h，VAS評分為2～6分。術后手術區域麻醉效果逐漸消失后，所有患者口服或靜脈滴注非甾體止痛藥能有效緩解疼痛。術后24 h內患者無頭痛、頭暈、惡心、嘔吐、乏力、皮疹等藥物不良反應，術后8 h手指皮溫及毛細血管反應同正常手指。術后未出現血運障礙等麻醉不良反應。28例患者均獲隨訪，隨訪時間6～12個月，平均8個月。末次隨訪時TAM評定獲優20例、良8例。結論手外科手術中應用WALANT止痛和止血效果良好、操作簡單、安全有效，術中能即刻觀察手術效果。

局部麻醉藥在腹腔鏡中膽囊切除術的應用

摘要:目的:探討通過腹腔內注射局部麻醉藥在腹腔鏡膽囊切除術中的鎮痛效果。方法:52例患者隨機分為4組,Ⅰ組術前腹腔內噴灑0.75％羅哌卡因20 mL;Ⅱ組術后腹腔內噴灑0.75％羅哌卡因20 mL;Ⅲ組為術后腹腔內噴灑0.5％布比卡因20 mL;Ⅳ組術后腹腔內噴灑生理鹽水20 mL。麻醉方法均為全憑靜脈麻醉。術后1、2、3、4 h 4個時間點記錄患者術后疼痛視覺模擬評分(VAS)。并觀察4組術后使用鎮痛藥物的例數和肩背痛、惡心嘔吐發生率。結果:術后1、2、3、4 h VAS評分Ⅱ組lt;Ⅲ組lt;Ⅰ組lt;Ⅳ組(Plt;0.05)。Ⅳ組使用鎮痛藥物的例數明顯高于Ⅰ組、Ⅱ組和Ⅲ組(Plt;0.05)。4組術后肩背痛、惡心嘔吐發生率差異無顯著性(Pgt;0.05)。結論:經腹腔給局麻藥鎮痛效果明顯,術畢給藥鎮痛效果優于術前給藥,羅哌卡因鎮痛效果優于布比卡因。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.

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.

局部麻醉輔助用藥的研究進展

局部麻醉藥在臨床上被廣泛應用，但在實際應用中總會產生各種無法避免的毒副作用。近年來相關研究通過加入各種輔助藥物使局部麻醉藥的毒副作用減輕且增強其麻醉效果，由于每一種輔助藥物與局部麻醉藥配伍各有其優缺點，尋找起效時間短、作用時間長、感覺運動分離且不良反應少的配伍藥物參與的局部麻醉效果，有待大家進一步的努力。現就該領域的最新研究進展作一闡述。

隆鼻術局部麻醉致眼動脈阻塞一例

The application of noninvasive local anesthesia for venipuncture in children: a meta-analysis of randomized controlled trials

ObjectiveTo systematically evaluate the efficacy and safety of local anesthesia for venipuncture in children, and to provide evidence for related nursing practice.MethodsWeb of Science, PubMed, Cochrane Library, Embase, China National Knowledge Infrastructure, Wanfang Data, Chinese Biomedical Database and VIP databases were searched for randomized controlled trials (RCTs) about the application of local anesthesia in venipuncture in children till June 25th, 2021. Two reviewers independently reviewed the literature, extracted data, and assessed the risk of bias of included RCTs. RevMan 5.3 software was used for meta-analysis.ResultsA total of 19 RCTs were included, comprising 2 566 patients. All of them were high-quality English articles included in SCI or Medline. The results of meta-analysis showed that: the painless rate [odds ratio (OR)=3.80, 95% confidence interval (CI) (1.88, 7.66), P=0.000 2] and satisfaction rate of venipuncture [OR=2.12, 95%CI (1.27, 3.54), P=0.004] in the local anesthesia group were higher than those in the non-anesthesia group, and the pain score [mean difference=?0.62, 95%CI (?0.77, ?0.48), P<0.000 01] in the local anesthesia group was lower than that in the non-anesthesia group. There was no statistically significant difference between the two groups in the success rate of the first puncture [OR=1.14, 95%CI (0.77, 1.68), P=0.52], the incidence of transient skin reactions [OR=1.15, 95%CI (0.67, 1.95), P=0.62], the incidence of paleness [OR=1.11, 95%CI (0.57, 2.15), P=0.76], or the incidence of edema at the puncture site [OR=0.64, 95%CI (0.21, 1.96), P=0.44].ConclusionsLocal anesthesia can effectively reduce pain and improve the satisfaction of children with venipuncture, and has good clinical safety. It can be used by nursing staff in clinical practice.

Reliability and validity of Chinese version of Amsterdam Preoperative Anxiety and Information Scale in preoperative anxiety of patients with local anesthesia

Objective To evaluate the reliability and validity of the Chinese version of the Amsterdam Preoperative Anxiety and Information Scale (APAIS) in preoperative anxiety in patients with local anesthesia. Methods From May to December 2020, a convenient sampling method was used to conduct an APAIS questionnaire survey on patients undergoing percutaneous renal biopsy in the Department of Nephrology, West China Hospital, Sichuan University, and the reliability and validity of the scale were analyzed. ResultsA total of 460 questionnaires were distributed and 444 valid questionnaires were returned, with a valid response rate of 96.5%. The Cronbach α of APAIS was 0.896, the Guttman split-half reliability was 0.811, and the content validity index was 0.891. The model fit was 12.122 for the chi-square fit index/degree of freedom, 0.916 for the goodness-of-fit index, 0.902 for the value-added fit index, 0.079 for the root mean square error of approximation, and 0.946 for the comparative fit index. The APAIS anxiety subscale score was positively correlated with the 7-item Generalized Anxiety Disorder Scale score (r=0.518, P<0.001). Conclusion The APAIS has good reliability and validity for evaluating the level of preoperative anxiety in patients with local anesthesia, but the application of the scale in other conditions requires further testing.

局部麻醉下微波治療痔的臨床觀察

【摘要】　目的　探討局部麻醉下微波治療痔的可行性及療效。方法　回顧云南省魯甸縣人民醫院2000 年4月至2007 年4 月期間局部麻醉下微波治療痔85 例(微波治療組) ,硬膜外麻醉下行痔切除80 例(常規治療組) ,并對2 組的手術時間、并發癥及治療效果進行比較分析。結果　微波治療組: 手術時間(10 ±5) min ; 并發癥中滲血4 例(4. 7 %) ,肛門狹窄1 例(1. 2 %) ,復發6 例(7. 1 %) ; 治愈74 例(87. 1 %) ,好轉及無效11 例(12. 9 %) 。常規治療組: 手術時間(40 ±5) min ; 并發癥中滲血6 例(7. 5 %) ,肛門狹窄2 例(2. 5 %) ,復發7 例(8. 8 %) ; 治愈65 例(81. 3 %) ,好轉及無效15 例(18. 8 %) 。2 組的手術時間、并發癥總發生率及治愈率比較差異有統計學意義( P lt;0. 05) 。結論　局部麻醉下微波治療痔安全可行,具有微創、簡單、有效、并發癥少及手術時間短的優點,有臨床推廣價值。

Effectiveness of partial anterior cruciate ligament suture repair with wide awake local anesthesia no tourniquet technique

ObjectiveTo investigate the effectiveness of partial anterior cruciate ligament (ACL) suture repair with wide awake local anesthesia no tourniquet (WALANT) technique.MethodsBetween July 2017 and July 2019, 18 patients with partial ACL injury were admitted. There were 10 males and 8 females, with an average age of 40.5 years (range, 22-57 years). There were 5 cases on the left knee and 13 cases on the right knee. Forteen cases had a clear history of trauma or sports injury, and 4 cases had no obvious cause. The time from injury to operation was 1-6 months (median, 3 months). Partial ligament was sutured using WALANT technique under arthroscopy. The operation time, total hospital stay, and postoperative hospital stay were recorded. Lachman test and anterior drawer test were performed to evaluate the knee joint stability after treatment, and Lysholm and International Knee Documentation Committee (IKDC) scores were used to evaluate the knee function. Five-point Likert scaling were used to evaluate postoperative patient satisfaction.ResultsThe operation time was 30-100 minutes (mean, 64.2 minutes). The total hospital stay was 2-12 days (mean, 4.5 days). Postoperative hospital stay was 1-4 days (mean, 1.8 days). All incisions healed by first intention after operation, and no surgery-related complications occurred. All patients were followed up 12-36 months (mean, 19.1 months). Lachman test and anterior drawer test were negative after operation. Lysholm score and IKDC score at 6 and 12 months after operation were significantly higher than those before operation, and at 12 months after operation were higher than those at 6 months after operation, the differences were significant (P<0.05). At last follow-up, according to five-point Likert scaling of patient satisfaction, 7 cases were very satisfied, 10 cases were relatively satisfied, and 1 case was general. The total patient satisfaction rate was 94.4% (17/18). MRI scan showed the good ligament tension.ConclusionUsing WALANT technique to repair partial ACL injuries under arthroscopy can retain the patient’s own ligament tissue to the maximum extent and achieve satisfactory short-term effectiveness.

局部麻醉藥心臟毒性不良反應的研究進展

自局部麻醉藥應用于臨床以來，臨床上出現了許多局部麻醉藥心臟毒性不良反應的案例，但目前對這方面的認識仍然存在爭議。該文對局部麻醉藥心臟毒性不良反應的構效關系、量效關系、診斷、預防及治療方面的研究進展進行了綜述。