Feasibility of laryngeal mask anesthesia combined with nerve block in adult patients undergoing internal fixation of rib fractures: a prospective observational study

Perioperative considerations for patients undergoing surgical stabilization of rib fractures: A narrative review

Surgical stabilization of rib fractures (SSRF) has become an increasingly common management strategy for traumatic rib fractures. Although historically managed with supportive care, patients with multiple rib fractures and flail chest increasingly undergo SSRF, and so the anesthesiologist must be well-versed in the perioperative management and pain control for these patients, as controlling pain in this population is associated with decreased length of stay and improved outcomes. There are multiple modalities that can be used for both pain control and as part of the anesthetic plan in patients undergoing SSRF. This narrative review provides a comprehensive summary of anesthetic considerations for surgical rib fracture patients, covering the preoperative, intraoperative, and postoperative periods. We describe an approach to the assessment of high-risk patients, analgesic and anesthetic techniques including emerging techniques within locoregional anesthesia, ventilation strategies, and potential complications. This review also identifies areas where additional research is needed to ensure optimal anesthetic management for patients undergoing SSRF.

Impacts of Ultrasound-Guided Nerve Block Combined with General Anesthesia with Laryngeal Mask on the Patients with Lower Extremity Fractures

Objective

Surgical reduction is the leading approach to patients with lower extremity fractures. The options of anesthetic drugs during surgery are of great significance to postoperative recovery of patients. There is no consensus on the optimum anesthesia method for patients undergoing lower extremity fracture surgery. Our study is aimed at investigating the impacts of nerve block combined with general anesthesia on perioperative outcomes of the patients.

Methods

In this retrospective study, 48 patients experienced general anesthesia only, and 42 patients received never block combined with general anesthesia. The perioperative hemodynamics was recorded, including mean arterial pressure (MAP), oxygen saturation of blood (SpO2), and heart rate (HR). Visual analogue scale (VAS) and Montreal Cognitive Assessment (MoCA) were carried out to evaluate postoperative pain and cognitive status. Furthermore, adverse reactions and recovery condition were observed between the patients receiving different anesthesia methods.

Results

At 15 minutes and 30 minutes after anesthesia, as well as 5 minutes after surgery, significant lower MAP was observed in the patients treated with general anesthesia (83.04 ± 8.661, 79.17 ± 9.427, 86.58 ± 8.913) compared to those receiving never block combined with general anesthesia (90.43 ± 4.618, 88.74 ± 6.224, 92.21 ± 4.015) (P < 0.05), and compared with general anesthesia group (68.5 ± 7.05, 69.63 ± 7.956, 72.75 ± 8.446), the combined anesthesia group (73.52 ± 9.451, 74.17 ± 10.13, 77.62 ± 9.768) showed obvious higher HR (P < 0.05). No significant difference in SpO2 was found between the two groups at multiple time points (P > 0.05). As for the score of VAS and MoCA, remarkably lower VAS and higher MoCA at 6 h, 12 h and 24 h after surgery were presented in the combined anesthesia group compared to general anesthesia group (P < 0.05). At 24 h after surgery, the two groups showed normal cognitive function (26.33 ± 0.7244 vs. 28.55 ± 0.7392). Incidence of nausea and vomiting in the combined anesthesia group was lower than that of the general anesthesia group (P < 0.05). The time to out-of-bed activity and hospital stay were shorter in the combined anesthesia group compared with general anesthesia (P < 0.05).

Conclusion

The application of never block combined with general anesthesia contributed to the stability of hemodynamics, alleviation of postoperative pain and cognitive impairment, along with decrease in adverse reactions and hospital stay in the patients with lower extremity fractures.