[Abstract]The number of lung transplantation is gradually increasing worldwide, which brings new challenges to the multi-disciplinary team of lung transplantation. The prognosis of lung transplant recipients is seriously affected by the pathophysiological state of specific lung diseases and perioperative risk factors. It is of great significance for these patients to optimize perioperative management according to these factors. Recently, several expert consensus have been published regarding anesthesia management of lung transplantation. Based on the current evidence and clinical practice of West China Hospital, this review summarizes the key points of anesthesia management for lung transplant recipients to guide anesthesiologists' clinical practice.
ObjectiveTo explore the effectiveness of traditional Chinese medicine (TCM) acupuncture analgesia after laparoscopic total extraperitoneal inguinal hernia repair (TEP), aiming to reduce the use of analgesics post-surgery. MethodsPatients who underwent unilateral TEP in the Department of Hernia and Abdominal Wall Surgery at our hospital from May 2022 to May 2023 were selected as research subjects. Those who met the inclusion and exclusion criterias were randomly assigned to three groups: TCM acupuncture analgesia group, traditional Chinese medicine acupuncture analgesia plus western medicine analgesia group (referred to as Chinese and western medicine analgesia group), and western medicine analgesia group. The basic information, postoperative numerical rating scale (NRS) pain scores, postoperative recovery indicators, and complication rates of the three groups were analyzed and compared.ResultsThere was no statistically significant differences in the basic data of patients across the three groups (P>0.05). There were significant differences in NRS score, recovery time of intestinal function, first urination time after operation and first ambulation time after operation at each time point after analgesia (6 h, the next morning, 48 h, 72 h and 96 h after operation) among the three groups (P<0.05). The NRS scores in both the TCM acupuncture analgesia group and the Chinese and western medicine analgesia group were lower than those in the western medicine analgesia group (P<0.05), Additionally, postoperative recovery outcomes were better in the TCM acupuncture analgesia group and the Chinese and western medicine analgesia group compared with the western medicine group (P<0.05). There was no significant difference of the above results compared between the TCM acupuncture analgesia group and the Chinese and western medicine analgesia group (P>0.05). There was no significant difference in postoperative complications among the three groups (P>0.05). ConclusionTCM acupuncture analgesia following TEP surgery is effective and leads to improved postoperative recovery compared with the use of oral analgesics alone, without an increase in adverse reactions.
As a novel analgesic method, erector spinae plane block is increasingly widely used during perioperative period. This technique mainly injects local anesthetic drugs into the connective tissue between the deep fascia of the erector muscle and the transverse process of the vertebral body to achieve a blocking effect. Its role in postoperative analgesia in adult patients has been verified. Currently, case reports have shown that it also has a certain analgesic effect in pediatric patients, which can reduce postoperative pain scores and opioid consumption. Therefore, this article explores the application of erector spinae plane block in pediatric patients from various aspects, summarizes existing research results, and aims to provide more evidence for clinicians to reasonably use this block technique in the pediatric population.
Objective To compare the analgesic efficacy and safety of liposomal bupivacaine (LB) versus ropivacaine for surgical incision local anesthesia after artificial intelligence (AI)-assisted direct anterior approach (DAA) total hip arthroplasty (THA). MethodsA prospective randomized controlled study was conducted. A total of 120 patients who underwent AI-assisted DAA-THA between March 2024 and January 2025 were enrolled and randomly assigned to the LB group (n=60) or the “cocktail” group (n=60). Patients in the LB group received an intraoperative injection of LB 266 mg (diluted to 100 mL) around the incision, whereas those in the “cocktail” group received a mixture of ropivacaine 200 mg, compound betamethasone 1 mL, and epinephrine 0.5 mg (diluted to 100 mL). Resting and active visual analogue scale (VAS) scores were recorded at 6, 12, 24, 36, 48, 60, and 72 hours and at 2 and 4 weeks postoperatively. Changes in Pain Catastrophizing Scale (PCS) score, Harris hip score, and hip flexion and abduction range of motion at 4 weeks postoperatively relative to preoperative values were assessed. In addition, operation time, incision length, total postoperative oral morphine consumption, time to first ambulation, length of hospital stay, and complications within 72 hours after surgery were recorded and compared between the two groups. ResultsThere was no significant difference between the two groups in incision length, time to first ambulation, length of hospital stay, or total postoperative oral morphine consumption (P>0.05). Operation time was significantly longer in the LB group than in the “cocktail” group (P<0.05). All patients were followed up for 6 months postoperatively. Both resting and active VAS scores decreased over time in the two groups (P<0.05). Intergroup comparison showed that resting and active VAS scores at 60 and 72 hours postoperatively were significantly lower in the LB group than in the “cocktail” group (P<0.05), whereas no significant difference was observed at other time points (P>0.05). There was no significant difference between the two groups in the changes in PCS score, Harris Hip Score, or hip range of motion at 4 weeks postoperatively (P>0.05). In the LB group, nausea and vomiting occurred in 3 cases, significant blood glucose fluctuations in 2 cases, superficial incision infection in 1 case, and local hematoma in 1 case; the corresponding numbers in the “cocktail” group were 5, 4, 0, and 1 case, respectively. No significant difference was observed between the two groups in the incidence of these complications (P>0.05). No local allergic reactions, deep vein thrombosis, significant blood pressure fluctuations, deep incision infection, skin necrosis, or pulmonary embolism occurred in either group. At last follow-up, satisfaction rates for analgesic efficacy and hip function both exceeded 90% in the two groups, with no significant difference between groups (P>0.05). Conclusion In AI-assisted DAA-THA, local infiltration anesthesia with LB provides analgesic efficacy comparable to that of the “cocktail” therapy during the early postoperative period (within 48 hours). Although VAS scores were slightly lower in the LB group at 60-72 hours postoperatively, the difference was small and the clinical benefit was limited. No significant difference was observed between the two groups in opioid consumption, complication rates, PCS scores, or postoperative functional recovery. In the context of AI-assisted DAA-THA, the clinical advantage of LB over the conventional “cocktail” therapy appears limited.