Background: Sub arachnoid block (SAB) performed by traditional landmark palpation technique can be inaccurate. This problem is exacerbated by altered patient anatomy due to obesity and age-related changes. A pre-proce...Background: Sub arachnoid block (SAB) performed by traditional landmark palpation technique can be inaccurate. This problem is exacerbated by altered patient anatomy due to obesity and age-related changes. A pre-procedural ultrasound scan of the lumbar spine has been shown to be of benefit in guiding lumbar epidural insertion in obstetric patients. Information on the use of real-time ultrasound (RUS) guided SAB, to date, been limited. This study compared RUS guided SAB to traditional landmark guided technique in patients undergoing spinal anesthesia for different surgical procedures. Methods: This was a prospective, single center, comparative observational study conducted in the department of anesthesiology at our center. 560 patients who underwent spinal anesthesia either by landmark based technique or real-time ultrasound-guided methods. The primary outcome was the first attempt success rate of dural puncture when employing the two methods. Results: Baseline characteristics were similar in the two study groups. The first attempt success rate of dural puncture in landmark guided group was 64.3% compared to 72.6% in the ultrasound guided group. This difference was not statistically significant. The procedure performance time was significantly shorter with landmark palpation compared to use of real-time ultrasound guided method. Conclusion: Use of RUS-guided technique does not significantly improve the first attempt success rate of SAB dural puncture during spinal anesthesia compared to the traditional landmark-guided technique.展开更多
Objective: To investigate the morphological chan ges of the roof of the subacromial bursa (SAB) and its involvement extent after rotator cuff tear. Methods: In the experimental group,the roof of SAB was obtaine d from...Objective: To investigate the morphological chan ges of the roof of the subacromial bursa (SAB) and its involvement extent after rotator cuff tear. Methods: In the experimental group,the roof of SAB was obtaine d from 30 cases of rotator cuff tear both at the tear site and a site 2.5 - 3.0 cm distal to the tear site during rotator cuff repair. In the control gr oup,the roof of SAB was obtained from the exposed site of recurrently dislocate d shoulder or fractured humeral shaft of 8 cases. The specimens were stained wit h hematoxylin and eosin and observed under a transmission electron microscope. T he cell number was quantitated through counting the blue-stained nucleus in SAB with a computer image analysis system.Results: The number of cells increased significantly in the roo f of SAB in the experimental group compared with that of the control group. Howe ver,no difference of the bursal reaction was found among the type of rotator cu ff tear,the bursa thickness and the presence of fluid in the bursa. The great m ajority of cells were type B cells observed under the transmission electron micr oscope.Conclusions: The increase in cell number in the roof of SAB in the experimental group is a reactive increase rather than an inflammatory proces s and the involvement of SAB is not limited in extent. The change of the roof of SAB is a secondary reaction to the rotator cuff tear.展开更多
文摘Background: Sub arachnoid block (SAB) performed by traditional landmark palpation technique can be inaccurate. This problem is exacerbated by altered patient anatomy due to obesity and age-related changes. A pre-procedural ultrasound scan of the lumbar spine has been shown to be of benefit in guiding lumbar epidural insertion in obstetric patients. Information on the use of real-time ultrasound (RUS) guided SAB, to date, been limited. This study compared RUS guided SAB to traditional landmark guided technique in patients undergoing spinal anesthesia for different surgical procedures. Methods: This was a prospective, single center, comparative observational study conducted in the department of anesthesiology at our center. 560 patients who underwent spinal anesthesia either by landmark based technique or real-time ultrasound-guided methods. The primary outcome was the first attempt success rate of dural puncture when employing the two methods. Results: Baseline characteristics were similar in the two study groups. The first attempt success rate of dural puncture in landmark guided group was 64.3% compared to 72.6% in the ultrasound guided group. This difference was not statistically significant. The procedure performance time was significantly shorter with landmark palpation compared to use of real-time ultrasound guided method. Conclusion: Use of RUS-guided technique does not significantly improve the first attempt success rate of SAB dural puncture during spinal anesthesia compared to the traditional landmark-guided technique.
文摘Objective: To investigate the morphological chan ges of the roof of the subacromial bursa (SAB) and its involvement extent after rotator cuff tear. Methods: In the experimental group,the roof of SAB was obtaine d from 30 cases of rotator cuff tear both at the tear site and a site 2.5 - 3.0 cm distal to the tear site during rotator cuff repair. In the control gr oup,the roof of SAB was obtained from the exposed site of recurrently dislocate d shoulder or fractured humeral shaft of 8 cases. The specimens were stained wit h hematoxylin and eosin and observed under a transmission electron microscope. T he cell number was quantitated through counting the blue-stained nucleus in SAB with a computer image analysis system.Results: The number of cells increased significantly in the roo f of SAB in the experimental group compared with that of the control group. Howe ver,no difference of the bursal reaction was found among the type of rotator cu ff tear,the bursa thickness and the presence of fluid in the bursa. The great m ajority of cells were type B cells observed under the transmission electron micr oscope.Conclusions: The increase in cell number in the roof of SAB in the experimental group is a reactive increase rather than an inflammatory proces s and the involvement of SAB is not limited in extent. The change of the roof of SAB is a secondary reaction to the rotator cuff tear.
