Chapter 61 The finished bird! (PS: Please collect, recommend and read!)
Indications for femoral nerve block: 1. Knee arthroscopy. 2. Superficial surgery on the front of the thigh. 3. Quadriceps tendon repair surgery. 4. Patella fracture surgery. 5. Hip and knee replacement surgery.
of postoperative analgesia.
The anesthesia range of the femoral nerve block is actually at the intersection with the range of surgery this patient needs to do.
If the force and direction are not chosen correctly during reduction, the muscles in the non-anesthetized area will be cut.
It is equivalent to operating on a patient without anesthesia.
Even combined with a sciatic nerve block, it only temporarily paralyzes the feeling and touch below the knee joint. The feeling and touch above the knee joint can only be said to be uncertain.
Cutaneous nerve branch block is a good supplement to combined anesthesia with sciatic nerve and femoral nerve block.
However, this kind of cutaneous nerve branch block is extremely difficult to control, is a high-precision operation, and is not very applicable, so not many anesthesiologists will delve into this direction.
Zhou Cheng was quite surprised that Yang Yifeng could perform such anesthesia. However, considering that Yang Yifeng himself was a graduate student in orthopedics and had a deep understanding of basic anatomy knowledge, and he knew how to use bedside color ultrasound, it was not impossible to achieve it.
.
At least, Zhou Cheng couldn't do such a nerve block. He was just an orthopedic surgeon, not an anesthesiologist.
When Zhou Cheng arrived, the blockade was almost over.
Yang Yifeng then gently poked the skin near the patient's thigh with the tip of the needle and asked, "Does it still hurt?"
"It doesn't hurt anymore, I can't feel it anymore!"
"Oh, it feels much more comfortable."
"It doesn't hurt at all. Thank you, doctor." The patient's breathing gradually calmed down.
For him, as long as it doesn't hurt, the feeling is simply wonderful.
Yang Yifeng pulled out the blocking needle and said: "When the patient's fractured end is inserted into the muscle, the injured muscle is deformed and has a certain torque and tension. If any further force is applied at this time,
Side stress will produce greater cutting force and severe pain."
"The pain receptors in our muscles are extremely sensitive to the force of cutting."
"So if separate blocks of cutaneous nerve branches are used, this situation can be avoided to the greatest extent."
"But this is only a short-term blockage. I estimate it can only last for about 30 minutes at most. Teacher Cai, Professor Zhong, is this time enough?"
Hearing Yang Yifeng's words, Director Zeng, the director of the anesthesiology department on the side, said with a smile: "Enough, enough, it must be enough."
"I have gained a lot of experience today. I only heard about this kind of branch cutaneous nerve block at academic exchange meetings. Very few people know how to do it. I didn't expect, Xiao Yang, that you can perform such a block operation."
."
"I really hope you can come to our anesthesiology department!"
Cai Dongfan probably thought that the big problem of patient anesthesia had been solved now, so he joked: "Director Zeng, Xiao Yang is Professor Ding's precious student. If you fool him into the anesthesiology department."
"I guess Professor Ding wouldn't mind letting you see the fists of the old professor of orthopedics."
Director Zeng twitched the corner of his mouth, remembering that he couldn't even defeat Cai Dongfan in a duel, let alone Professor Ding and his large group of disciples...
He shook his head: "I was just joking."
After Yang Yifeng finished the anesthesia, he said: "Teacher Cai, Professor Zhong, I'm going to step down now that I'm done with the anesthesia."
After saying that, Yang Yifeng was about to take off his clothes.
"Xiao Yang, don't step down. This femoral repositioning technique requires a lot of strength. One more person will give you more strength." Cai Dongfan said a little stunned.
Yang Yifeng helped so much, but when the official operation started, he was not allowed to come. This is unreasonable.
Yang Yifeng took two steps back, shook his head and said with a smile: "I believe Professor Zhong and Teacher Cai can definitely complete the follow-up operations, I will just watch from the audience."
“I’ve never experienced manual repositioning before, so I can’t help much.”
After saying that, he reached out and took the collar. This was considered a violation of the principle of sterility and he passively stepped down.
Cai Dongfan didn't dare to pull it anymore.
Zhang Zhengquan frowned, as if he couldn't understand Yang Yifeng.
Not only Zhang Zhengquan, Zhou Cheng couldn't understand it either.
Zhong Hua and Cai Dongfan saw that Yang Yifeng was full of personality, so they stopped persuading him.
The manual reduction of fractures is actually similar to the manual reduction of joint dislocations.
First, sufficient traction must be performed. The prerequisite for sufficient traction is that there must be two countertensions. Otherwise, the patient will be pulled directly off the operating table.
Therefore, assistants are needed for fixation and the surgeon performs traction operations. This patient is special, so a lot of helpers are needed.
But this patient cannot start reduction directly yet. His fracture type is also special. We need to first explore the location of the broken end——
Zhong Hua immediately said to Cai Dongfan: "Director Cai, you may be able to do the investigation a little faster."
"Okay, Professor Zhong." Cai Dongfan also nodded. After asking the instrument nurse for a round knife, he immediately made two 4cm long incisions at the two broken ends, and then went inside to break open the skin layer by layer.
subcutaneous tissue.
With Cai Dongfan's many techniques, he found the proximal end of the fracture in about four minutes.
Cai Dongfan replied: "Sure enough, it is inserted into the muscle group, but it is the interosseous muscle. I checked and found that there are no blood vessels around it!"
"Then look at the far end." Cai Dongfan immediately began to explore the far end.
Then I saw that the location of the fracture was only 0.5 centimeters away from the femoral artery at the rear, and the sharp bone edge was only 0.4 centimeters away from the femoral artery! This is because the muscles are deformed, so the broken end of the fracture is displaced.
Very outrageous.
His face changed immediately!
"Professor Zhong, come and see!"
Of course Zhong Hua is also a surgeon. If an orthopedic surgeon does not perform surgery, then he will definitely not be able to survive. Could it be that all the patients with the indications for surgery will not be cured?
When he saw this artery, the expression on his face immediately froze!
My forehead started to be covered with sweat.
The previous reset that Yang Yifeng performed before performing a cutaneous nerve block was simply too dangerous. If someone didn't pay attention, he could directly 'kill' successfully.
Yes, before Yang Yifeng came to supplement the anesthesia, he and Cai Dongfan had already tried a reduction, but the patient was in too much pain during the operation and the level of anesthesia was not ideal.
Therefore, the operation was called off midway, and Yang Yifeng was asked to supplement the cutaneous nerve block anesthesia.
"This? Can it still be reset?" Cai Dongfan asked.
Zhong Hua's eyes were very tangled. He turned his head and motioned to Cai Dongfan to go away with his eyes, and then the two of them stayed in the corner of the operating room.
Zhong Huacai said: "Director Cai, please forget about it. In this situation, there can be no deviation at all."
"And during the process of traction and reduction, no one can guarantee that the distal end of the fracture will not slip. The patient's heart function is not good. If the artery is broken, heart failure and insufficient circulating blood volume will basically occur very quickly.
Condition."
"Go and talk to the patient's family." Zhong Hua wanted to stop the operation.
When Luo Yun and Du Yanjun saw this scene, their hearts sank.
It seems that this patient has really been in the department for a long time.
I can't move at all!
"Okay!" Cai Dongfan's expression changed for a while and he left the operating room directly. He wanted to talk to his family members. The current situation was the most complicated and dangerous.
Then almost five minutes later, Cai Dongfan walked in again.
Said: "Professor Zhong, I just had a conversation with my brother-in-law. He is quite an open-minded person. He feels that if he takes a risk and strives for it, the quality of his future life will be greatly improved. Otherwise, his father's future life will be completely lost.
quality."
Zhong Hua asked: "Ah? Are you sure? Make up your mind!"
Cai Dongfan took a deep breath and said, "I'm sure!"
Although it is better to die than to live, if you can't even move, and you are lying down and enduring the pain endlessly.
Such a survival!
It has really lost too much meaning, just living for the sake of living. It is estimated that after the old man found out about his situation, he talked with his children and wife.
"Okay then." Zhong Hua also took a deep breath.
"Luo Yun, Xiao Du, you two are responsible for fixing the pelvis. Let's try one last time. There is only one last chance." Zhong Hua said.
The four people took their seats one after another.
Zhong Hua squeezed his hand and said, "You two need to fix it firmly. A fractured femur will require continuous traction for a long time. And we don't have much time left."
"Let the muscles relax completely!"
"Just four people?" Zhong Hua frowned slightly. There were not many opportunities. To resist the thigh muscles, only he and Cai Dongfan took the initiative to pull, which might not be enough.
Luo Yun understood and immediately said: "Zhou Cheng, wash your hands and come to the stage to help."
Zhou Cheng nodded, turned around and went out. Since Luo Yun called his name, he would not retreat.
Zhang Zhengquan, who was standing nearby, was slightly startled: Teacher Luo, I was the one who came to the operating room first?
I am also very strong.
A little aggrieved.
But Zhang Zhengquan had no idea that it was Zhou Cheng who suggested this surgery, otherwise there would be nothing like today.
Yang Yifeng looked at Luo Yun thoughtfully and began to wonder why Luo Yun asked Zhou Cheng to come on stage instead of Zhang Zhengquan, who was also trained by Guipei. This was an excellent material for him to write into the novel.
Only stories that are based on reality but higher than reality will make readers more sticky...
Cai Dongfan and Zhong Hua waited for a while.
Zhou Cheng finally changed into surgical clothes.
When Zhou Cheng approached, he watched as Cai Dongfan and Zhong Hua stood on the left and right sides of the ankle, completely holding the ankle with their four hands, leaving no room for him.
I sighed in my heart.
Secretly: I knew Zhong Hua would choose a farther traction position.
The heel is one of the common locations for bone traction and is also a better focus point for manual reduction.
But in fact, for femoral fractures, it is better to apply traction from the tibial tubercle. When performing manual reduction, the choice of focus point is the same.
Moreover, the broken end of this patient's femur was interestingly inserted into two muscles with a very classic shape.
If Cai Dongfan and Zhong Hua don't go on stage, and Cai Dongfan and Zhong Hua exert force from the ankle joint, it's over. The knee joint will serve as a prying point, and the femoral artery will definitely be in danger!
Cai Dongfan and Zhong Huazheng started to pull the pelvis vertically, while Luo Yun and Du Yanjun pressed hard to fix the pelvis!
I saw Zhou Cheng put his hands behind the tibial tubercle, and then just used a little force to lift it up as if doing a drawer test.
It exerted a force perpendicular to Luo Yun, Du Yanjun, Cai Dongfan and Zhong Hua.
Suddenly, the patient's lower limbs started to bend.
this?
What is Zhou Cheng doing?
Seeing this scene, everyone's expressions immediately changed.
What is Zhou Cheng doing this week?
The traction must be vertical. Zhou Cheng suddenly added a vertical force into the air. According to the principle of force synthesis, Zhou Cheng's force had no antagonistic force!
But didn’t Zhou Cheng bend his knee joint just in time?
What will happen after the knee joint is bent is completely beyond the expectations of Zhong Hua, Cai Dongfan and others!
The scalps of both people became numb in an instant!
Then the heart seemed to be crushed by an invisible force, followed by a high sense of tension caused by all the muscles in the body being frightened, as if every muscle was being pulled by some invisible force.