Objective: To study the effect of ultrasonic guidance in radial artery catheterization. Methods: From January 2017 to January 2018, 100 patients who received surgical treatment in Taizhou Central Hospital of Zhejiang Province and needed puncture and catheterization anesthesia during operation were randomly divided into control group (n=50) and observation group (n=50) according to digital table method.The control group adopted the traditional touch pulse method, while the observation group was guided by ultrasound.The first puncture success rate, the second puncture success rate, puncture time, puncture times, the vital sign index, incidence of adverse events, pain score, comfort score were compared between the two groups. Results: The first puncture success rate (80%) and the second puncture success rate (100%) of the observation group were higher than 62% and 88% of the control group (χ²=3.934, 6.383, all P<0.05). The single puncture time [(59.85±8.31)s] and total puncture time [(107.14±35.37)s] of the observation group were shorter than those of the control group (t=5.766, 6.398, all P<0.05), and the puncture times [(1.27±0.54) times] of the observation group was less than that of the control group (t=5.689, P<0.05). After puncture, the heart rate [(73.79±2.46)times/min] and average arterial pressure [(96.75±6.76)mmHg] of the observation group were all lower than those of the control group (t=5.058, 4.635, all P<0.05). The total incidence of adverse events such as subcutaneous hematoma and arterial wall penetration in the observation group (4%) was lower than that in the control group (18%) (χ²=5.005, P<0.05). The pain scores at puncture and after puncture of the observation group [(1.53±0.71)points, (1.28±0.60)points] were lower than those of the control group (t=5.545, 6.233, all P<0.05). The comfort scores at puncture and after puncture of the observation group [(91.25±9.64)points, (97.31±11.37)points] were higher than those of the control group (t=6.147, 6.226, all P<0.05). Conclusion Ultrasonic guidance can effectively improve the puncture efficiency, reduce the fluctuation of vital signs, pain, reduce the adverse events during puncture, and make the patients feel more comfortable.

AIM: To evaluation the effects of esketamine and butorphanol on postoperative pruritus induced by epidural morphine injection in cesarean delivery parturients. METHODS: A total of 162 parturients who underwent elective cesarean section under continuous epidural anesthesia in Taizhou Central Hospital (Taizhou University Hospital), were selected and randomly divided into esketamine group (group K), butorphanol group (group B) and blank control group (group C). 5min after umbilicus amputation, parturients in group K was injected with 3 mg morphine diluent through epidural catheter, and esketamine 0.2 mg/kg intravenously. Parturients in groups B and C were given the same dose of morphine,and butorphanol 10 μg/kg or the same volume of normal saline, respectively. The incidence of postoperative pruritus at different times, the degree of pruritus and incidence of other adverse reactions were compared among three groups. RESULTS: The highest incidence of pruritus occurred within 4 hours after operation. The incidence of postoperative pruritus at 4 hours in group K and B was significantly lower than that in group C (3.7% vs. 3.7% vs. 29.6%, P < 0.05), the total incidence of postoperative pruritus within 48 hours was also significantly lower than that in group C (13.0% vs. 11.1% vs. 40.7%, P < 0.05), and the incidence of moderate to severe pruritus was also significantly lower than that of group C (5.6% vs. 3.7% vs. 31.5%, P < 0.05). There was no significant difference between group K and group B (all P > 0.05). There were no significant differences in the incidence of postoperative nausea, vomiting, dizziness and postoperative pain scores among three groups (P > 0.05). CONCLUSION: Both esketamine and butorphanol can reduce the incidence and degree of pruritus caused by epidural morphine injection in parturients, without affecting the analgesic effect of morphine and without increasing the incidence of adverse reactions. Esketamine is as effective and safe as butorphanol in preventing pruritus after cesarean section.