OBJECTIVE: To evaluate the early effectiveness of local infiltration anesthesia (LIA) with compound betamethasone in total knee arthroplasty (TKA). METHODS: The clinical data of 102 patients with knee osteoarthritis who were treated by TKA and met the selection criteria between May 2022 and March 2023 were retrospectively analyzed. They were divided into control group and study group according to whether LIA preparation was added with compound betamethasone, with 51 cases in each group. There was no significant difference of baseline data, such as age, gender, body mass index, operative side, preoperative range of motion (ROM), Knee Society Score (KSS), white blood cell (WBC), and hematocrit between the two groups ( P>0.05). The intraoperative total blood loss and hidden blood loss were recorded, and WBC was recorded on the 1st, 2nd, and 3rd days after operation. Pain was assessed by visual analogue scale (VAS) score on the 1st, 2nd, and 3rd days after operation and morphine intake milligrames equivalent within 48 hours after operation. Passive ROM, maximum extension and flexion angles of knee joint were measured on the 3rd day after operation; the early postoperative complications were recorded. RESULTS: There was no significant difference in total blood loss and hidden blood loss between the two groups ( P>0.05). The postoperative pain levels in both groups were relatively mild, and there was no significant difference in VAS scores in the first 3 days after operation and in morphine intake milligrams equivalent within 48 hours after operation between the two groups ( P>0.05). The WBC in the first 3 days after operation was significantly improved in both groups ( P<0.05). The WBC in the study group was significantly higher than that in the control group on the 1st and 2nd days after operation ( P<0.05), but there was no significant difference between the two groups on the 3rd day after operation ( P>0.05). On the 3rd day after operation, the maximum extension angle of knee joint in the study group was smaller than that in the control group, while the maximum flexion angle and passive ROM of knee joint in the study group were larger than those in the control group, and the differences were significant ( P<0.05). There were 6 cases of fever and 17 cases of deep venous thrombosis in the control group, and 1 case and 14 cases in the study group, respectively. There was no poor wound healing and periprosthetic joint infection in the two groups, and there was no significant difference in the incidence of complications between the two groups ( P>0.05). CONCLUSION The application of compound betamethasone in LIA during TKA is a safe and optimal strategy to promote the early postoperative rehabilitation of patients.
Humans ; Arthroplasty, Replacement, Knee ; Anesthesia, Local ; Retrospective Studies ; Treatment Outcome ; Knee Joint/surgery* ; Osteoarthritis, Knee/surgery* ; Blood Loss, Surgical ; Morphine

OBJECTIVE: To review the research progress of injection sites of local infiltration analgesia (LIA) in total knee arthroplasty (TKA). METHODS: The relevant domestic and foreign literature in recent years was extensively reviewed. The neuroanatomy of the knee, and the research progress of the selection and the difference of effectiveness between different injection sites of LIA in clinical studies were summarized. RESULTS: Large concentrations of nociceptors are present throughout the various tissues of the knee joint. Patellar tendon, subpatellar fat pad, lateral collateral ligament insertions, iliotibial band insertions, suprapatellar capsule, and posterior capsule were more sensitive to pain. Most current studies support injections into the lateral capsule, collateral ligament, retinaculum, quadriceps tendon, fat pad, and subcutaneous tissue. Whether to inject into the back of the knee and subperiosteum is controversial. CONCLUSION The relative difference of knee tissue sensitivity to pain has guiding significance for the selection of LIA injection site after TKA. Although researchers have conducted clinical trials on injection site and technique of LIA in TKA, there are certain limitations. The optimal scheme has not been determined yet, and further studies are needed.
Humans ; Arthroplasty, Replacement, Knee/methods* ; Pain, Postoperative/prevention & control* ; Pain Management/methods* ; Analgesia/methods* ; Knee Joint/anatomy & histology* ; Anesthesia, Local/methods*

Wide-awake local anesthesia has many advantages. We describe a new method to use wide-awake local anesthesia with more flexibility. A 32-year-old man with a severe right-hand contracture after an iatrogenic tourniquet accident during an anterolateral thigh flap for a partial hand amputation underwent contracture release using external fixation after proximal row carpectomy and subsequent tenolysis. We performed most of the tenolysis procedure under general anesthesia and the final stage with an intraoperative assessment of active finger movement and dissection under local anesthesia. He regained his grip strength 2.5 years post-injury. General anesthesia is useful to treat a surgical site with extensive hard scars, whereas local anesthesia is useful for adjusting tension in an awake patient. The indication for wide-awake surgery is yet to be established; our method of combining general and local anesthesia in the tenolysis procedure illustrates the possibilities in expanding this method.
Adult ; Anesthesia, General ; Anesthesia, Local ; Brain Neoplasms ; Contracture/surgery* ; Dissection ; External Fixators ; Fracture Fixation ; Humans ; Male ; Wakefulness

Prostate biopsy is the gold standard for the diagnosis of prostate cancer. In order to successfully and effectively complete the biopsy, clinicians should not only select the correct puncture method, but also pay attention to the pain control of patients undergoing puncture. It is necessary to select a reasonable anesthetic method for biopsy. The pain during biopsy comes from the skin, muscle and other structures in the puncture approach, and also comes from the prostate capsule. Therefore, the anesthesia emphasis of transperineal and transrectal biopsy approaches will also be different. The use of appropriate anesthesia is of great significance to improve the patient's cooperation and ensure the success rate of biopsy. With the continuous maturity of the technology and concept of prostate biopsy, a single anesthesia method has been unable to meet the actual anesthetic needs of biopsy, and the use of multi-site and multi-phase combined anesthesia for different sources of pain has become the mainstream anesthetic option.
Anesthesia ; Anesthesia, Local ; Biopsy ; Humans ; Image-Guided Biopsy/methods* ; Male ; Pain/pathology* ; Prostate/pathology* ; Prostatic Neoplasms/pathology*

OBJECTIVES: This study aims to explore the clinical and pathological characteristics of congenital granular cell tumors and provide some references for clinical diagnosis, differential diagnosis, and treatment. METHODS: Nine ca-ses of congenital granular cell tumors who visited the Children's Hospital of Zhejiang University School of Medicine from February 2008 to March 2022 were retrospectively analyzed. Herein, its clinical characteristics, pathological characteristics, treatment, and prognosis were summarized and analyzed. RESULTS: We found that nine patients were all female, aged 1‑38 days when they saw the doctor. Three of them were attached in maxillary and the other six were attached in mandible. Meanwhile, six tumors were found during the mother's pregnancy at 28-39 weeks and three tumors were found at the baby's birth. One case was excised surgically under local anesthesia, and the other cases were excised surgically under general anesthesia. After 1 month to 12 years of follow-up, patients have no recurrence, however, two cases emerged new teeth from the tumor resection site. Histopathology of all excised lesions was congenital granular cell lesion. CONCLUSIONS Congenital granular cell tumor is a benign tumor and the prognosis is good. Therefore, surgical resection of the tumor can be done without extensive resection, and it generally does not relapse. Thus, ultrasonography during pregnancy is an important method for the early detection of congenital granular cell epulis.
Infant ; Child ; Pregnancy ; Humans ; Female ; Granular Cell Tumor/surgery* ; Retrospective Studies ; Neoplasm Recurrence, Local ; Anesthesia, General ; Diagnosis, Differential

Humans ; Lidocaine ; Anesthesia, Local ; Radius Fractures/surgery* ; Anesthetics, Local/adverse effects* ; Bone Plates ; Fracture Fixation, Internal

OBJECTIVE: To compare the clinical therapeutic effect of fire needling stripping after local anesthesia, simple fire needling and liquid nitrogen cryotherapy on verruca vulgaris. METHODS: A total of 900 patients with verruca vulgaris were randomized into a fire needling stripping group (300 cases, 2 cases dropped off), a fire needling group (300 cases, 4 cases dropped off) and a liquid nitrogen cryotherapy group (300 cases, 5 cases dropped off). After local anesthesia of compound lidocaine cream, fire needling therapy was adopted, and the necrotic tissue of verruca was stripped in the fire needling stripping group. Simple fire needling therapy was adopted in the fire needling group, without local anesthesia and stripping. Liquid nitrogen cryotherapy was adopted in the liquid nitrogen cryotherapy group. The treatment was given once a week, and totally 3 weeks were required in the 3 groups. The skin lesion scores of number, area, thickness, color, pruritus, isomorphism and the level of T lymphocyte (CD RESULTS: Compared before treatment, the skin lesion scores were decreased ( CONCLUSION Fire needling stripping after local anesthesia can effectively treat the verruca vulgaris, improve the skin lesion and immunity, its therapeutic effect is superior to simple fire needling and liquid nitrogen cryotherapy.
Anesthesia, Local ; Cryotherapy ; Humans ; Treatment Outcome ; Vascular Surgical Procedures ; Warts/therapy*

OBJECTIVE: To evaluate the clinical efficacy of local infiltration anesthesia of ropivacaine combined with compound betamethasone for postoperative analgesia in patients with hallux valgus. METHODS: From September 2019 to December 2020, 48 patients with hallux valgus were treated surgically. According to different postoperative analgesia methods, the patients were divided into combined local infiltration group and intravenous analgesia pump group. There were 24 cases, in the combined local infiltration group including 2 males and 22 females;the age ranged from 21 to 78 years old, with an average of (58.3±7.7) years old;soft tissue release and chevron osteotomy were performed in 15 cases and metatarsophalangeal joint fusion in 9 cases;immediately after operation, 20 ml of ropivacaine combined with compound betamethasone mixed diluent was used for local infiltration anesthesia once. There were 24 patients in intravenous analgesia pump group, including 3 males and 21 females;the age ranged from 23 to 81 years old, with an average of(56.8±8.3) years old;soft tissue release and Chevron osteotomy were performed in 17 cases and metatarsophalangeal joint fusion in 7 cases;immediately after operation, intravenous analgesia pump was used for analgesia. The basic flow was 2 ml / h;the self control dose was 0.5 ml;and the locking time was 15 min. Visual analogue scale (VAS) was recorded at 12, 24, 48 and 72 hours after operation;and the VAS was recorded at 24 hours after operation. The occurrence of adverse drug reactions at 0 to 12 hours, 12 to 24 hours and 24 to 48 hours after operation were recorded;and the healing of incision was recorded. RESULTS: All patients were followed up, and the duration ranged from 14 to 17 days, with a mean of (14.60±0.92) days. There was significantdifference in VAS at 12, 24 and 48 hours between the combined local infiltration group and the intravenous analgesia pump group( CONCLUSION Compared with intravenous analgesia pump group, ropivacaine combined with compound betamethasone can significantly reduce postoperative wound pain without increasing adverse drug reactions, and does not increase wound infection.
Adult ; Aged ; Aged, 80 and over ; Analgesia ; Anesthesia, Local ; Bunion ; Feasibility Studies ; Female ; Hallux Valgus/surgery* ; Humans ; Male ; Middle Aged ; Pain, Postoperative/drug therapy* ; Young Adult

OBJECTIVE: To explore the application and clinical effect of wide awake local anesthesia no tourniquet technique in the surgery of bilateral carpal tunnel syndrome. METHODS: From March 2016 to August 2018, 20 patients (40 sides) with bilateral carpal tunnel syndrome were treated by wide awake technique. All patients were female, aged from 32 to 56 (50.8±6.4) years old. The anesthetic, intraoperative and postoperative pain and anxiety were evaluated, operative field bleeding in operation were assessed, postoperative skin healing of surgical area and anesthetic complications were observed, and Kelly grading were used to evaluate recovery of function. RESULTS: Twenty patients were followed up from 6 to 9 months with an average of 7.8 months. There was light anxiety before injection (NRS score rangedfrom 1 to 3), slight pain occurred during injection on the first poke (NRS ranged from 2 to 3);no pain and anxiety during operation (NRS score was 0);mild or moderate pain (NRS score ranged from 1 to 6) without anxiety(NRS score was 0) after operation was occurred. Surgical skin healed well at the stageⅠwithout side effect of anesthetic. At final follow-up, according to Kelly grading, 30 sides got excellent results, 8 sides good and 2 sides fair. CONCLUSION Wide awake technique is safe and effective in treating neurolysis of bilateral carpal tunnel syndrome, and could receive good clinical effects.
Adult ; Anesthesia, Local ; Carpal Tunnel Syndrome ; Female ; Humans ; Middle Aged ; Pain, Postoperative ; Wakefulness

Alkalosis, Respiratory ; Anesthesia, Local ; Diskectomy, Percutaneous ; Endoscopy ; Humans ; Intervertebral Disc Displacement ; Lumbar Vertebrae ; Retrospective Studies ; Treatment Outcome