Department of Anesthesiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600, Yishan Rd., Shanghai, China.
BMC Anesthesiol. 2020 Jul 15;20(1):170. doi: 10.1186/s12871-020-01082-y.
The laryngeal mask airway (LMA) is occasionally used in internal fixation of rib fractures. We evaluated the feasibility of general anesthesia with an LMA associated to a thoracic paravertebral block (TPB) and/or an erector spinae plane block (ESPB) for internal fixation of rib fractures.
Twenty patients undergoing unilateral rib fracture fixation surgery were enrolled. Each patient received general anesthesia with an LMA combined with TPB and/or ESPB, which provided a successful blocking effect. All patients received postoperative continuous analgesia (PCA) with 500 mg of tramadol and 16 mg of lornoxicam, and intravenous injection of 50 mg of flurbiprofen twice a day. Our primary outcomes including the partial pressure of arterial oxygen (PaO) and arterial carbon dioxide (PaCO) were measured preoperatively and on the first day after surgery. Secondary outcomes including the vital signs, ventilation parameters, postoperative numerical rating scale (NRS) pain scores, the incidence of postoperative nausea and vomiting (PONV), perioperative reflux and aspiration, and nerve block-related complications were also evaluated.
Thirteen men and seven women (age 35-70 years) were enrolled. Six (30%) had a flail chest, nine (45%) had hemothorax and/or pneumothorax, and two (10%) had pulmonary contusions. The postoperative PaO was higher than the preoperative value (91.2 ± 16.0 vs. 83.7 ± 15.9 mmHg, p = 0.004). The preoperative and postoperative PaCO were 42.1 ± 3.7 and 43.2 ± 3.7 mmHg (p = 0.165), respectively. Vital signs and spontaneous breathing were stable during the surgery. The end-tidal carbon dioxide concentrations (EtCO) remained within an acceptable range (≤ 63 mmHg in all cases). NRS at T1, T2, and T3 were 3(2,4), 1(1,3), and 0(0,1), respectively. None had PONV, regurgitation, aspiration, and nerve block-related complications.
The technique of laryngeal mask anesthesia combined with a nerve block was feasible for internal fixation of rib fractures.
Current Controlled Trials ChiCTR1900023763 . Registrated on June 11, 2019.
喉罩气道（LMA）偶尔用于肋骨骨折的内固定。我们评估了喉罩麻醉联合胸椎旁阻滞（TPB）和/或竖脊肌平面阻滞（ESPB）用于肋骨骨折内固定的可行性。
20 名接受单侧肋骨骨折固定手术的患者入组。每位患者均接受喉罩麻醉联合 TPB 和/或 ESPB，以获得成功的阻滞效果。所有患者均接受术后持续镇痛（PCA），给予曲马多 500mg 和氯诺昔康 16mg，氟比洛芬 50mg 静脉注射，每日两次。我们的主要结局指标包括术前和术后第 1 天的动脉血氧分压（PaO）和动脉二氧化碳分压（PaCO）。次要结局指标包括生命体征、通气参数、术后数字评分量表（NRS）疼痛评分、术后恶心呕吐（PONV）发生率、围手术期反流和误吸以及神经阻滞相关并发症。
共纳入 13 名男性和 7 名女性（年龄 35-70 岁）。6 例（30%）有连枷胸，9 例（45%）有血胸和/或气胸，2 例（10%）有肺挫伤。术后 PaO 高于术前值（91.2±16.0 与 83.7±15.9mmHg，p=0.004）。术前和术后 PaCO 分别为 42.1±3.7mmHg 和 43.2±3.7mmHg（p=0.165）。手术期间生命体征和自主呼吸稳定。呼气末二氧化碳浓度（EtCO）保持在可接受范围内（所有病例均≤63mmHg）。T1、T2 和 T3 时的 NRS 分别为 3（2，4）、1（1，3）和 0（0，1）。无 PONV、反流、误吸和神经阻滞相关并发症。
喉罩麻醉联合神经阻滞技术可用于肋骨骨折内固定。
中国临床试验注册中心，ChiCTR1900023763 ；注册于 2019 年 6 月 11 日。
