Objective To investigate the effect of dexmedetomidine added to ropivacaine administered locally on prevention of tourniquet?related hypertension in the patients undergoing total knee arthroplast. Methods Ninety patients of both sexes, aged 58-74 yr, weighing 60-78 kg, of American Society of Anesthesiologists physical statusⅠ?Ⅲ, scheduled for elective unilateral total knee arthroplast, were randomly divided into 3 groups ( n=30 each) using a random number table: ropivacaine group ( group R) , dexmedetomidine added to ropivacaine administered locally group ( group D + R ) , and dexmedetomidine administered intravenously + ropivacaine group ( group Div+R ) . Femoral nerve block:0.5% ropivacaine 15 ml was injected in group R; the mixture ( 15 ml) of 0. 5% ropivacaine 20 ml plus dexmedetomidine 60 μg was injected in group D+R; 0.5% ropivacaine 15 ml was injected in group Div+R. Lateral femoral cutaneous nerve block: 0.5% ropivacaine 5 ml was injected in group R; the mixture 5 ml was injected in group D+R; 0.5% ropivacaine 5 ml was injected in group Div+R. General anesthesia was induced after the end of nerve block. In group Div+R, dexmedetomidine was infused as a bolus of 0.5 μg∕kg over 10 min starting from anesthesia induction, followed by an infusion of 0.4 μg·kg-1 ·h-1 until 30 min before the end of surgery. A tourniquet was applied and inflated ( 266-304 mmHg) within 90 min. Before induction of anesthesia ( T0 ) , and at 0, 15, 30, 45, 60, 75 and 90 min after the tourniquet was inflated ( T1?7 ) , mean arterial pressure and heart rate were recorded. The occurrence of hypertension, hypotension, tachycardia and bradycardia was recorded when the tourniquet was inflated. Agitation was assessed and scored after removal of the endotracheal tube. The time for recovery of breathing, emergence time, and time for removal of the endotracheal tube were recorded. Results Compared with group R, the mean arterial pressure and heart rate were significantly decreased at T1?7 in D+R and Div+R groups, the incidence of hypertension and tachycardia was decreased, the incidence of bradycardia was increased, and agitation score was decreased in D+R and Div+R groups ( P<0.05 or 0.01) . There was no significant difference in the parameters mentioned above between group D+R and group Div+R (P>0.05). There was no significant difference in the time for recovery of breathing, emergence time, and time for removal of the endotracheal tube between the three groups ( P>0.05 ) . Conclusion Dexmedetomidine added to ropivacaine administered locally can exert effect on prevention of tourniquet?related hypertension in the patients undergoing total knee arthroplast, and the effect is similar to that of dexmedetomidine administered intravenously.

BACKGROUND:Epidural analgesia has been considered a gold standard for postoperative analgesia in the lower limbs. Its outcomes are accurate and adverse reactions are few, so it can be used in the clinic. However, this method has adverse reactions such as hypotension and urine retention. Low molecular weight heparin should be used after operation, which can increase the possibility of epidural hematoma, and limits its application to epidural analgesia in the clinic. At present, few studies concerned ultrasound guided continuous fascia iliaca compartment block technology.
OBJECTIVE:To evaluate the efficacy of postoperative pain relief and the joint rehabilitation between a continuous fascia iliaca compartment block and a continuous epidural analgesia for patients undergoing total hip arthroplasty.
METHODS:A total of 60 patients undergoing a selective total hip arthroplasty were assigned to continuous fascia iliaca compartment block group and continuous epidural analgesia group (n=30). Al patients in both groups received a pre-fluence before general anesthesia. Continuous fascia iliaca compartment block group were injected with 0.25%ropivacaine 30 mL via iliac fascia gap. Continuous epidural analgesia group received 0.20%ropivacaine 10 mL via epidural catheter, indwel ing catheter. When the analgesic effect was identified, anesthesia intubation was carried out. After operation, medicine was given via iliac fascia and epidural analgesia pump in both groups respectively. Postoperative analgesia in single dose was not given. If pain could not be endured, analgesia would be rescued (parecoxib 20-40 mg/time) according to pain degree. Visual analogue scale scores, supplemental analgesia of parecoxib, complication of anesthesia, Harris hip joint scores, day of first walk, and duration of hospital stay were recorded.
RESULTS AND CONCLUSION:No significant difference in visual analogue scale scores, supplemental analgesia, Harris hip joint scores and duration of hospital stay was detected. Day of first walk was earlier in the continuous fascia iliaca compartment block group than in the continuous epidural analgesia group. The complications were apparently lower in the continuous fascia iliaca compartment block group than in the continuous epidural analgesia group. These data indicated that after total hip arthroplasty, two kinds of analgesia methods could provide satisfactory postoperative outcomes. Hip joint was perfectly recovered. However, the complications of continuous fascia iliaca compartment block were less, and helpful to patients’ early off-bed activities, and could be considered as a good choice for analgesia after total hip arthroplasty.

OBJECTIVE: To observe the clinical effect of dexmedetomidine on patients during the extubation in general anesthesia.
 METHODS: A total of 90 patients scheduled for general anesthesia were divided into 3 groups (n=30): A dexmedetomidine group (DEX group), a midazolam group (MID group), and a control group(C group). Anesthesia drugs were stopped 10 minutes before the end of the operation. 
At the same time, the patients in the DEX group were given dexmedetomidine at the rate of 
1 g/(kg.h) for 10 min by vein first, which was continuously pumped at the rate of 0.3 g/(kg.h) for 20 min after the operation. The patients in the MID group were given midazolamin at 0.5 mg/kg for 60 s by vein first, which was continuously pumped at the rate of the 0.04 mg/(kg.h) for 20 min after the operation. The patients in the C group were not given any drug. Awakening time and extubation time after the operation were recorded. Ramsay scores, heart rate, mean arterial blood pressure, respiratory rate, and SpO₂were recorded at time of extubation, 10 min or 1 h after extubation. Chills, nausea, vomiting and other side effects after the operation were recorded.
 RESULTS: Awakening and extubation time were not affected in the DEX group, while delayed recovery occurred in the MID group (P<0.05). Compared with the C group, patients in the DEX and MID groups gained better sedative effect, with 2-4 Ramsay scores (P<0.05). The blood pressure and heart rate were steady in the DEX and MID groups, while inhibition of respiration appeared in the MID group.
 CONCLUSION Dexmedetomidine can provide an effective sedation for the patients without affecting the awakening and extubation time. The hemodynamics could be stably maintained by using dexmedetomidine in patients during the extubation in general anesthesia.
Airway Extubation ; Anesthesia, General ; Arterial Pressure ; Blood Pressure ; Dexmedetomidine ; therapeutic use ; Heart Rate ; Hemodynamics ; Humans ; Hypnotics and Sedatives ; therapeutic use ; Midazolam ; therapeutic use

Objective:To compare the clinical efficacy of robot-assisted and simple arthroscopic reconstruction of anterior cruciate ligament (ACL).Methods:A retrospective cohort study was conducted to analyze the clinical data of 37 patients with ACL tear admitted to Honghui Hospital of Xi′an Jiaotong University from January 2020 to September 2020. There were 24 males and 13 females, aged 16-45 years［(30.7±9.8)years］. A total of 17 patients were treated by robot-assisted ACL reconstruction (robot-assisted group), and 20 patients by simple arthroscopic ACL reconstruction (simple arthroscopy group). The operation time, number of guide wire drilling, positional accuracy of bone tunnel (distance between the central point of bone tunnel and ideal anatomical point) and perioperative complications were compared between the two groups. Knee stability was evaluated by Lachman test and KT-2000 measurement, and knee function by Lysholm score, International Knee Documentation Committee (IKDC) score and range of motion of joint flexion and extension before operation, at 4 months after operation and at the last follow-up.Results:All patients were followed up for 12-18 months［(13.1±4.1)months］. The operation time in robot-assisted group was (83.8±11.3)minutes, significantly longer than (50.4±9.1)minutes in simple arthroscopy group ( P<0.01). The number of guide wire drilling in robot-assisted group was (2.2±0.5)times, less than (2.5±0.4)times in simple arthroscopy group ( P<0.05). The distance between the central point of bone tunnel and ideal anatomical point was (1.3±0.3)mm in robot-assisted group, not significantly different from (1.4±0.3)mm in simple arthroscopy group ( P>0.05). There were no perioperative complications in both groups. The two groups showed no significant differences in Lachman test, KT-2000 measurement, Lysholm score, IKDC score and range of motion of joint flexion and extension before operation, at 4 months after operation and at the last follow-up (all P>0.05). The above indices in both groups were significantly improved at 4 months after operation and at the last follow-up as compared with those before operation (all P<0.01), and both groups showed no significant difference in the above indexes at 4 months after operation and at the last follow-up as compared with those before operation (all P>0.05). Conclusion:Compared with simple arthroscopic ACL reconstruction, robot-assisted ACL reconstruction can prepare a bone tunnel once with good location and direction in one time and achieve similar results in stability and functional recovery of the joint except for slightly longer operation time.

To observe the impacts of continuous lumbar plexus block (CLPB) on postoperative cognitive dysfunction (POCD) in elderly patients undergoing hip arthroplasty.
 Methods: Sixty elderly patients scheduled for hip arthroplasty with general anesthesia, were randomly allocated into a CLPB group and a PCIA group (n=30 each). In the CLPB group, lumbar plexus block was performed before trachea intubation, and CLPB was used for postoperative analgesia. In the PCIA group, intravenous analgesia was controlled in patients after operation. Visual Analogue Scale (VAS) at 12, 24, and 48 h after operation was recorded. Mini-Mental State Examination (MMSE) scale was used to evaluate the cognitive dysfunction at the 1st day before operation (D0) and at the 1st (D1), 3rd (D3), and 7th (D7) days after operation and the occurrence of POCD was recorded. S-100β concentrations were detected by ELISA at D1, D3, and D7. Postoperative adverse events were recorded.
 Results: VAS scores at 12, 24, and 48 h after operation in the CLPB group were significantly lower than those in the PCIA group (P<0.05). Compared with the PCIA group, the MMSE scores were significantly higher (P<0.05), and the incidence of POCD at D1 and D3 was obviously reduced in the CLPB group (P<0.05). S-100β concentration at D1 and D3 in the CLPB group was significantly lower than that in the PCIA group (P<0.05).
 Conclusion: Application of CLPB in elderly patients undergoing hip arthroplasty could obviously relieve their postoperative pain, inhibit the production of S-100β, and reduce the incidence of early postoperative cognitive dysfunction.
Aged ; Analgesics ; administration & dosage ; Arthroplasty, Replacement, Hip ; adverse effects ; Cognitive Dysfunction ; prevention & control ; Humans ; Incidence ; Lumbosacral Plexus ; Nerve Block ; methods ; Pain Measurement ; Pain, Postoperative ; prevention & control ; Postoperative Complications ; prevention & control

Since December 2019, the corona virus disease 2019 (COVID-19) caused by the 2019 novel coronavirus (2019-nCoV) has been reported in Wuhan, Hubei Province. Almost 70% of patients susceptible to 2019-nCoV are over age of 50 years, with extremely large proportion of critical illness and death of the elderly patients. Meanwhile, the elderly patients are at high risk of osteoporotic fractures especially osteoporotic vertebral compression fractures (OVCF). During the prevention and control of COVID-19 epidemic, orthopedists are confronted with the following difficulties including how to screen and protect OVCF patients, how to accurately diagnose and assess the condition of OVCF patients with suspected or confirmed COVID-19, and how to develop reasonable treatment plans and comprehensive protective measures in emergency and outpatient clinics. In order to standardize the diagnosis and treatment of patients with OVCF diagnosed with COVID-19, the authors jointly develop this expert consensus. The consensus systematically recommends the standardized emergency and outpatient screening and confirmation procedures for OVCF patients with suspected or confirmed COVID-19 and protective measures for emergency and outpatient clinics. Moreover, the consensus describes the grading and classification of OVCF patients diagnosed with COVID-19 according to the severity of illness and recommends different treatment plans and corresponding protective measures based on the different types and epidemic prevention and control requirements.