Diwan Sandeep, Nair Abhijit
Department of Anaesthesiology, Sancheti Hospital, Pune, Maharashtra, India.
Department of Anaesthesiology, Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, Telangana, India.
Saudi J Anaesth. 2020 Apr-Jun;14(2):224-227. doi: 10.4103/sja.SJA_575_19. Epub 2020 Mar 5.
Sternal fractures are high velocity injuries which is associated with thoracic or lumbar vertebral fractures. Severe pain associated with sternal fractures can lead to impaired ventilation, low partial pressure of arterial oxygen, need of non-invasive or invasive ventilation with an endotracheal tube thereby leading to significant morbidity. In a series of three patients with manubrium sternal dislocation, we administered continuous bilateral parasternal blocks and initiated infusion of local anesthetics for different periods of time in all patients. The high pain scores drastically decreased followed by improved spontaneous ventilation. There was improvement in partial pressure of oxygen in arterial blood gas. None of the patient required a non-invasive or invasive ventilation. The spread of local anesthetic using injection of radio-opaque contrast through bilaterally placed parasternal catheters was followed by a computed tomography scan. This was done after obtaining informed consent from patient and waiver for scan. To the best of our knowledge, this is first report of successful pain management in patients who sustained manubrium - sternal dislocations using bilateral continuous catheters for a prolonged period.
胸骨骨折是高速损伤，常伴有胸椎或腰椎骨折。与胸骨骨折相关的剧烈疼痛可导致通气障碍、动脉血氧分压降低，需要无创或有创通气并使用气管内插管，从而导致显著的发病率。在一组3例胸骨柄脱位患者中，我们对所有患者进行了连续双侧胸骨旁阻滞，并在不同时间段开始输注局部麻醉剂。高疼痛评分大幅下降，随后自主通气得到改善。动脉血气中的氧分压有所改善。没有患者需要无创或有创通气。通过双侧放置的胸骨旁导管注射不透射线的造影剂来观察局部麻醉剂的扩散情况，之后进行计算机断层扫描。这是在获得患者知情同意和扫描豁免后进行的。据我们所知，这是首例使用双侧连续导管对胸骨柄脱位患者进行长期成功疼痛管理的报告。
