BACKGROUND Chronic obstructive pulmonary disease(COPD)is associated with high morbidity and mortality rates worldwide.Older patients have a degenerative cardiopulmonary function,weak compensatory capacity,and poor sur...BACKGROUND Chronic obstructive pulmonary disease(COPD)is associated with high morbidity and mortality rates worldwide.Older patients have a degenerative cardiopulmonary function,weak compensatory capacity,and poor surgical tolerance.Therefore,the mode of anesthesia must be optimized.Remimazolam is a new ultrashort-acting benzodiazepine with a rapid onset of action,rapid metabolism,and mild effects on pulmonary circulation.Remimazolam sedation combined with an epidural block has not been reported in hypertensive older adults with severe COPD and inguinal mass resection.CASE SUMMARY We report the case of a 73-year-old man with hypertension and severe COPD,who underwent resection of an enlarged inguinal mass that he had noticed more than 7 mo before presentation.The patient presented with a“right inguinal mass”and was recommended to undergo an enlarged inguinal mass resection.Surgery was relatively challenging,due to the large mass(13 cm×8 cm×7 cm),hard texture,and poor mobility.Considering the advanced age of the patient,gradeⅢhypertension,and severe COPD,we administered remimazolam combined with an epidural block for anesthesia to ensure perioperative safety and careful consideration.The anesthetic effect was precise;the procedure was performed smoothly without any complications,and the patient was successfully anesthetized.However,anesthetic management in such cases has not yet been reported by previous studies.CONCLUSION Remimazolam sedation combined with an epidural block is safe and effective in older patients with hypertension and severe COPD.展开更多
<b>Background:</b> Poor postoperative pain control leads to longer postoperative care, longer hospital stay and decreased patient overall satisfaction. <b>Aim:</b> To compare the efficacy and s...<b>Background:</b> Poor postoperative pain control leads to longer postoperative care, longer hospital stay and decreased patient overall satisfaction. <b>Aim:</b> To compare the efficacy and safety of bilateral ultrasound-guided quadratus lumborum block versus lumbar epidural block on the management of postoperative pain following major lower abdominal cancer surgery. <b>Methods:</b> The study was a double-blinded, and randomized study, conducted in South Egypt Cancer Institute, Assiut University, Egypt. It included cancer patients scheduled for major lower abdominal cancer surgery in the period from 2019 to 2020. They were divided into two groups: Group Ι received pre-emptive ultrasound-guided Quadratus Lumborum Block (QLB) with 25 mL of 0.25% bupivacaine on each side of the abdominal wall before induction of General Anesthesia (GA), and Group II received pre-emptive lumbar epidural block with 15 mL of 0.25% bupivacaine before induction of GA. VAS score, and time of the first analgesic request and postoperative total analgesic consumption were evaluated. <b>Results:</b> Sixty patients were included in our study. VAS score at rest was comparable between both studied groups in the first 6 h. At 8 and 10 h, Group II had a significantly higher VAS score at rest (P < 0.001 and 0.026 respectively). Meanwhile, at 12 h, patients in Group I had a significantly higher VAS score (P = 0.026). Mean time of the first request for rescue analgesia was significantly prolonged in Group I (13.27 ± 2.38 hrs.) compared to Group II (10.20 ± 1.42 hrs.) (P < 0.001) respectively, mean total morphine consumption, over the first 24 hours postoperatively, was significantly lower in Group I (5.17 ± 1.32 mg) than in Group II (7.33 ± 1.45 mg) (P < 0.001). A larger number of patients in Group II had nausea at different time points postoperatively than in Group I (P < 0.001), but no significant difference was observed between both studied groups regarding the incidence of vomiting. <b>Limitation:</b> Small sample size and shorter period for postoperative follow-up. <b>Conclusions:</b> Management of postoperative pain following major lower abdominal cancer surgery with US-guided QLB was associated with the reduction in the total analgesic consumption and delayed the first request of analgesia as compared to lumbar epidural block technique.展开更多
Introduction:Postherpetic neuralgia(PHN)is a painful condition that occurs after herpes zoster skin lesions have subsided and that lasts for more than 1 month.PHN is usually difficult to treat.Case presentation:Patien...Introduction:Postherpetic neuralgia(PHN)is a painful condition that occurs after herpes zoster skin lesions have subsided and that lasts for more than 1 month.PHN is usually difficult to treat.Case presentation:Patient 1 was a 54-year-old woman who had PHN for 35 days.Patient 2 was a 74-year-old woman who had PHN for 65 days.Both patients were treated with an epidural block and found to have spinal metastasis from a malignant tumor.Discussion:The routinely used dermatological medications for the treatment of herpes zoster and PHN have slow and unsatisfactory analgesic effects.Epidural block treatment provides a new approach for patients who cannot tolerate or do not respond to these commonly used drugs.Physicians should pay special attention to patients who have a history of a malignant tumor or are suspected to have spinal disease.Computed tomography or magnetic resonance imaging of the spine is recommended for such patients,and epidural block treatment should be performed after a spinal tumor or other lesions have been excluded.Conclusion:Epidural block treatment provides a new approach for patients of herpes zoster or PHN,but the treatment should be performed after a spinal tumor or other spinal lesions have been excluded.展开更多
BACKGROUND When herpes zoster is complicated with paralytic ileus,this mostly involves acute intestinal pseudo-obstruction of Ogilvie’s syndrome manifesting as obvious dilatation of the cecum and right colon;small in...BACKGROUND When herpes zoster is complicated with paralytic ileus,this mostly involves acute intestinal pseudo-obstruction of Ogilvie’s syndrome manifesting as obvious dilatation of the cecum and right colon;small intestinal obstruction is rare.Here,we present a patient with a very rare case of small bowel pseudo-obstruction.CASE SUMMARY A 76-year-old female patient complained of right upper quadrant pain.Two days later,a blistering,right-sided rash of the thoracoabdominal dermatome(T5-T10) emerged in conjunction with small intestinal dilatation and the inability to defecate.Computed tomography of the abdomen confirmed small bowel pseudoobstruction.Antiviral therapy,gastrointestinal decompression,and enemas proved unproductive.After 4 d of stagnation,an epidural block was performed for pain relief and prompted the passage of gas and stool,resolving the obstructive problem.Three days later,the rash appeared dry and crusted,and the pain diminished.After 5 d,no abnormality was visible by gastroenteroscopy,and the patient was discharged on day 7.CONCLUSION This case shows that herpes zoster may induce small bowel pseudo-obstruction in addition to colonic pseudo-obstruction.Epidural block can not only treat intercostal neuralgia but also resolve small bowel pseudo-obstruction caused by herpes zoster.展开更多
Objective To observe the effects of labor analgesia on maternal and neonatal outcome by epidural application of 0.125% bupivacaine combined with anisodamine on the labor stage, and modes of delivery and neonatal Apgar...Objective To observe the effects of labor analgesia on maternal and neonatal outcome by epidural application of 0.125% bupivacaine combined with anisodamine on the labor stage, and modes of delivery and neonatal Apgar's score. Methods A total of 220 primiparaes with full-term pregnancy, monocyesis and fetal head presentation without any obstetrical or systematic complications were chosen and divided into analgesic group and control group (110 in each group). The mixture of bupivacaine and anisodamine was injected into the epidural space of the parturients in the analgesic group while those patients in the control group did not receive any analgesics. Results The analgesic effect was satisfactory (91.8%), and no side effects occurred in the second stage of labor. The instrument delivery rate was lower in the analgesic group, and there was no significant difference between the two groups in neonatal Apgar's score. Conclusion The method is feasible in clinic for labor pain relief without increasing the rate of dystocia and complications of delivery.展开更多
文摘BACKGROUND Chronic obstructive pulmonary disease(COPD)is associated with high morbidity and mortality rates worldwide.Older patients have a degenerative cardiopulmonary function,weak compensatory capacity,and poor surgical tolerance.Therefore,the mode of anesthesia must be optimized.Remimazolam is a new ultrashort-acting benzodiazepine with a rapid onset of action,rapid metabolism,and mild effects on pulmonary circulation.Remimazolam sedation combined with an epidural block has not been reported in hypertensive older adults with severe COPD and inguinal mass resection.CASE SUMMARY We report the case of a 73-year-old man with hypertension and severe COPD,who underwent resection of an enlarged inguinal mass that he had noticed more than 7 mo before presentation.The patient presented with a“right inguinal mass”and was recommended to undergo an enlarged inguinal mass resection.Surgery was relatively challenging,due to the large mass(13 cm×8 cm×7 cm),hard texture,and poor mobility.Considering the advanced age of the patient,gradeⅢhypertension,and severe COPD,we administered remimazolam combined with an epidural block for anesthesia to ensure perioperative safety and careful consideration.The anesthetic effect was precise;the procedure was performed smoothly without any complications,and the patient was successfully anesthetized.However,anesthetic management in such cases has not yet been reported by previous studies.CONCLUSION Remimazolam sedation combined with an epidural block is safe and effective in older patients with hypertension and severe COPD.
文摘<b>Background:</b> Poor postoperative pain control leads to longer postoperative care, longer hospital stay and decreased patient overall satisfaction. <b>Aim:</b> To compare the efficacy and safety of bilateral ultrasound-guided quadratus lumborum block versus lumbar epidural block on the management of postoperative pain following major lower abdominal cancer surgery. <b>Methods:</b> The study was a double-blinded, and randomized study, conducted in South Egypt Cancer Institute, Assiut University, Egypt. It included cancer patients scheduled for major lower abdominal cancer surgery in the period from 2019 to 2020. They were divided into two groups: Group Ι received pre-emptive ultrasound-guided Quadratus Lumborum Block (QLB) with 25 mL of 0.25% bupivacaine on each side of the abdominal wall before induction of General Anesthesia (GA), and Group II received pre-emptive lumbar epidural block with 15 mL of 0.25% bupivacaine before induction of GA. VAS score, and time of the first analgesic request and postoperative total analgesic consumption were evaluated. <b>Results:</b> Sixty patients were included in our study. VAS score at rest was comparable between both studied groups in the first 6 h. At 8 and 10 h, Group II had a significantly higher VAS score at rest (P < 0.001 and 0.026 respectively). Meanwhile, at 12 h, patients in Group I had a significantly higher VAS score (P = 0.026). Mean time of the first request for rescue analgesia was significantly prolonged in Group I (13.27 ± 2.38 hrs.) compared to Group II (10.20 ± 1.42 hrs.) (P < 0.001) respectively, mean total morphine consumption, over the first 24 hours postoperatively, was significantly lower in Group I (5.17 ± 1.32 mg) than in Group II (7.33 ± 1.45 mg) (P < 0.001). A larger number of patients in Group II had nausea at different time points postoperatively than in Group I (P < 0.001), but no significant difference was observed between both studied groups regarding the incidence of vomiting. <b>Limitation:</b> Small sample size and shorter period for postoperative follow-up. <b>Conclusions:</b> Management of postoperative pain following major lower abdominal cancer surgery with US-guided QLB was associated with the reduction in the total analgesic consumption and delayed the first request of analgesia as compared to lumbar epidural block technique.
基金funded by the National Natural Science Fund of China(No.81872216)the PUMC Postgraduate Education and Teaching Reform Project in 2018(No.10023201801701).
文摘Introduction:Postherpetic neuralgia(PHN)is a painful condition that occurs after herpes zoster skin lesions have subsided and that lasts for more than 1 month.PHN is usually difficult to treat.Case presentation:Patient 1 was a 54-year-old woman who had PHN for 35 days.Patient 2 was a 74-year-old woman who had PHN for 65 days.Both patients were treated with an epidural block and found to have spinal metastasis from a malignant tumor.Discussion:The routinely used dermatological medications for the treatment of herpes zoster and PHN have slow and unsatisfactory analgesic effects.Epidural block treatment provides a new approach for patients who cannot tolerate or do not respond to these commonly used drugs.Physicians should pay special attention to patients who have a history of a malignant tumor or are suspected to have spinal disease.Computed tomography or magnetic resonance imaging of the spine is recommended for such patients,and epidural block treatment should be performed after a spinal tumor or other lesions have been excluded.Conclusion:Epidural block treatment provides a new approach for patients of herpes zoster or PHN,but the treatment should be performed after a spinal tumor or other spinal lesions have been excluded.
文摘BACKGROUND When herpes zoster is complicated with paralytic ileus,this mostly involves acute intestinal pseudo-obstruction of Ogilvie’s syndrome manifesting as obvious dilatation of the cecum and right colon;small intestinal obstruction is rare.Here,we present a patient with a very rare case of small bowel pseudo-obstruction.CASE SUMMARY A 76-year-old female patient complained of right upper quadrant pain.Two days later,a blistering,right-sided rash of the thoracoabdominal dermatome(T5-T10) emerged in conjunction with small intestinal dilatation and the inability to defecate.Computed tomography of the abdomen confirmed small bowel pseudoobstruction.Antiviral therapy,gastrointestinal decompression,and enemas proved unproductive.After 4 d of stagnation,an epidural block was performed for pain relief and prompted the passage of gas and stool,resolving the obstructive problem.Three days later,the rash appeared dry and crusted,and the pain diminished.After 5 d,no abnormality was visible by gastroenteroscopy,and the patient was discharged on day 7.CONCLUSION This case shows that herpes zoster may induce small bowel pseudo-obstruction in addition to colonic pseudo-obstruction.Epidural block can not only treat intercostal neuralgia but also resolve small bowel pseudo-obstruction caused by herpes zoster.
基金supported by the Scientific Technology Planning Foundation of Shaanxi Province (2003K10-G80)
文摘Objective To observe the effects of labor analgesia on maternal and neonatal outcome by epidural application of 0.125% bupivacaine combined with anisodamine on the labor stage, and modes of delivery and neonatal Apgar's score. Methods A total of 220 primiparaes with full-term pregnancy, monocyesis and fetal head presentation without any obstetrical or systematic complications were chosen and divided into analgesic group and control group (110 in each group). The mixture of bupivacaine and anisodamine was injected into the epidural space of the parturients in the analgesic group while those patients in the control group did not receive any analgesics. Results The analgesic effect was satisfactory (91.8%), and no side effects occurred in the second stage of labor. The instrument delivery rate was lower in the analgesic group, and there was no significant difference between the two groups in neonatal Apgar's score. Conclusion The method is feasible in clinic for labor pain relief without increasing the rate of dystocia and complications of delivery.
