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Comparative Analysis of Local Anaesthesia and Epidural Anaesthesia in Tension-Free Herniorrhaphy

Objective　To investigate the most suitable anaesthesia method for the tension-free herniorrhaphy.Methods　A total of 422 unilateral inguinal hernia cases from 2002 to 2005 were collected and randomly divided into the local anaesthesia group and epidural anaesthesia group. Observation indices and some relative data, such as operative duration, date of ambulation, date of foodintake, length of hospital stay, operation-correlated complications, anaesthesia complications, usage rate of ancillary drug, satisfactory rate for anesthesia, cost of hospitalization, were included and recorded in the questionnaire, and all the patients who took the tension-free herniorrhaphy were asked to answer it as the follow-up research. Results　It was found that the occurrence of postoperative anaesthetic complications, the cost of hospitalization, length of stay of local anaesthesia group were significantly less than those of epidural anaesthesia group, and the date of moving and the date of foodintake were also significantly earlier than those of the other group (P＜0.05). However, there was no significant difference of operative duration, postoperative recovery situation and the satisfactory rate between two groups (P＞0.05).Conclusion　The local anaesthesia is suitable for most of the tension-free herniorrhaphy, and it may be used as the conventional anaesthetic method.

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。

利多卡因衍生物QX-314的局部麻醉作用的研究進展

近年研究發現，通過辣椒素等激活與疼痛相關的瞬時感受器電位香草酸受體1（TRPV1），可以使以往不能通過細胞膜的利多卡因四價陽離子衍生物QX-314，進入與疼痛相關的神經元細胞內產生長時選擇性感覺阻滯作用。由此，TRPV1受體激動劑與QX-314聯用已逐漸成為局部麻醉的研究熱點。現對QX-314的發現、特性、局部麻醉作用及其作用機制作一綜述。

The application of transversus abdominis plane block anesthesia in peritoneal dialysis catheter implantation: a randomized controlled trial

Objective To investigate the efficacy and safety of ultrasound-guided TAP block for the anesthesia in peritoneal dialysis (PD) catheter implantation. Methods Patients with end-stage renal disease who intended to receive PD catheter implantation in the West China Hospital of Sichuan University were enrolled from April 2015 to February 2016. Those who met the inclusion criteria were randomly divided into two groups: the local filtration anesthesia (LF) group and the TAP group. The two groups got the ultrasound guided TAP block (The LF group got a shame TAP block by making the skin wheal and just inserting the needle into the TAP with the guidance of ultrasound), then the LF group received local filtration anesthesia twenty minutes later, with the TAP group had sham LF anesthesia by injection of saline at the incision subcutaneously. The anesthetist generated the random allocation sequence and performed all TAP/sham blocks according to the allocation of each patient. The patients, investigators were all blind to the allocation. The follow-up time was 3 months. The primary outcomes were the rate of alteration to general anesthesia and the VAS score during and after the surgery. The dosages of sufentanil for analgesia during and after were recorded. The satisfaction to the effect anesthesia by the operation doctors, PD catheter related complications and adverse events related to TAP block or anesthetic agent were also recorded. Statistic analysis was conducted using SPSS 19.0 software. Results A total of 36 patients were included, 12 cases in the LF group and 24 cases in the TAP group. The rate of alteration to general anesthesia in the TAP group was 4.12% and was significantly lower than that in the LF group (33.3%) (P=0.034). The VAS scores at the time points of incision of skin, division of subcutaneous tissue and anterior rectus sheath, opening the peritoneum, insertion of PDC, suture of skin, 2 hours and 24 hours after operation were significantly lower in the TAP group compared to the LF group (P values=0.001, 0.037, 0.000, 0.001, 0.029, 0.035, and 0.000, respectively). The TAP group consumed less sufentanil during the operation and showed a higher satisfaction of the operation doctors. There were no significant differences in the PD catheter related complications and adverse events between the two groups. Conclusion The ultrasound-guided TAP block can be an effective and safe anesthesia method for PD catheter implantation. Because of the limitation of small sample size of this study, a multiple center study with larger sample size is suggested.

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.

局部麻醉在腹壁疝修補術中的應用

目的總結局部麻醉下行腹壁疝修補術的臨床效果。 方法回顧性分析2010年7月至2014年6月期間我科收治的1 126例腹壁疝患者的臨床資料。 結果1 126例患者均于局部麻醉下行無張力疝修補術，其中腹股溝疝例1 088例，股疝21例，臍疝8例，切口疝4例，白線疝3例，戳孔疝2例。有3例患者改為全身麻醉。手術時間18～145 min，（63±12.4）min；術后住院時間1～6 d，（3.2±1.3）d；麻醉及術中監護費用（236.6±31.2）元。術后發生陰囊水腫積液3例，切口部位疼痛4例，無尿潴留、補片感染、腸瘺等發生。術后隨訪5～26個月，（19±4.8）個月，有2例腹股溝疝復發。 結論局部麻醉下行腹壁疝修補術可行及安全，術后恢復快，并發癥少，費用低。

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

Small incision tendinolysis under local anesthesia for 949 cases of pediatric stenosing tenovaginitis of thumb

Objective To investigate the therapeutic effect of minimally invasive small incision surgery under local anesthesia for pediatric stenosing tenovaginitis of thumb. Methods A retrospective analysis was conducted on the medical records of children with stenosing tenovaginitis of thumb who received small incision tendinolysis under local anesthesia at West China Hospital of Sichuan University between January 2013 and August 2022, to evaluate and analyze the safety and effectiveness of the surgery. Results A total of 949 pediatric patients were included, with an average age of (3.23±1.92) years. The average duration of surgery was (7.0±2.5) minutes, and the average follow-up time was (3.91±5.32) months. All patients did not need to fast for solids and liquids before surgery, and were immediately discharged from the hospital after outpatient surgery. The family members of the patients were highly satisfied with the treatment process and postoperative recovery. All patients had no nerve or vascular damage, and the wound margin skin showed linear healing with mild scars that fused with palm prints. There were 825 cases (86.93%) of children with thumb function fully restored to normal, 113 cases (11.91%) with limited maximum dorsiflexion function of the thumb, and 11 cases (1.16%) with recurrent stiffness of the thumb metacarpophalangeal joint. Conclusion Small incision tendinolysis under local anesthesia is a safe and effective treatment for pediatric stenosing tenovaginitis of thumb, with high satisfaction among the patients’ family members.