Combined Axillary Block with Spinal Block Anaesthesia

Arsil Radiansyah, John Frans Sitepu, Luwih Bisono
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Abstract

Background:  Patients undergoing upper limb trauma surgery have reported various benefits of regional anesthesia over general anesthesia, including better perioperative analgesia, less opiate use, less postoperative nausea and vomiting (PONV), and a shorter post-anesthesia care period. …………………………….. Case Illustration: We reported an evaluation of 72 years old, 165 cm height and 60 kg weight male patient who was planned for open reduction and internal fixation surgery for neglected left radius ulna close fracture and left neglected tibia fibula close fracture that he was beneath follow-up for hypertension (HT), and was using antihypertensive drugs. Preoperative risk of the patient was assessed as with American Society of Anesthesiologists (ASA) with score 3.General anesthesia would be unsafe due to geriatric issue, cardiovascular problem and delayed surgery term, we chosed to utilize combine axillary block with spinal block. we utilized USG guided infusion procedure in arrange to diminish local anesthetic dosage, and minimize error. During surgical procedure there is no hypotension, bradycardia or decreased oxygen saturation. Surgical anesthesia occurred in left hand within 20 minutes after drug delivery and 10 minutes in lower extremity. Surgery complications was not reported particularly related to vascular punction or adjacent anesthetic and nerve block applications. No complaint was detailed from the patient who was watched for 12 hours after the surgery.Conclusion: Peripheral nerve block and neuraxial block, when utilized appropriately in combination, appear be able to supplant common anesthesia within the larger part of case.
腋窝阻滞与脊髓阻滞联合麻醉
背景:接受上肢创伤手术的患者报告了区域麻醉比全麻的各种好处,包括更好的围术期镇痛,更少的阿片类药物使用,更少的术后恶心和呕吐(PONV),以及更短的麻醉后护理期。...................................病例说明:我们报告了一名身高165 cm,体重60 kg的72岁男性患者,因左侧桡骨尺骨闭合性骨折和左侧胫骨腓骨闭合性骨折被忽视而计划行切开复位内固定手术,该患者因高血压(HT)未得到随访,并正在使用降压药。患者术前风险按照美国麻醉医师协会(ASA)评分3分进行评估。由于老年问题、心血管问题和手术期的延迟,全麻不安全,我们选择腋窝阻滞联合脊柱阻滞。我们采用USG引导输注程序,以减少局麻剂量,并尽量减少误差。手术过程中无低血压、心动过缓或血氧饱和度降低。手术麻醉在给药后20分钟内发生在左手,在给药后10分钟内发生在下肢。手术并发症没有特别与血管穿刺或邻近麻醉和神经阻滞应用有关的报道。手术后观察了12小时,患者没有详细的抱怨。结论:周围神经阻滞和轴神经阻滞在适当的情况下联合应用,在很大程度上可以替代普通麻醉。
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