Uncle Wang, who is in his 60s, has been picking up junk for a living. However, for some reason, his arms became weaker and weaker. Not only that, but both arms would ache inexplicably at night. When he was in pain, he could only bite the quilt and endure it.
Until one day, the community found the problem. So, everyone advised him to go to the hospital for a check. However, Uncle Wang, whose survival was a problem, refused. Everyone also saw his difficulties and launched a donation.
With everyone’s efforts, we have collected more than 3,000 yuan in total.
In this way, Uncle Wang and his party came to the hospital.
After diagnosis by an orthopedic doctor, Uncle Wang is suffering from a disease called “ulnar nerve entrapment syndrome”. It is defined as the ulnar nerve in the course of its course, due to the influence of local anatomical factors or external factors, in the bone fiber channel or space composed of bones, muscles, fascia, ligaments and other tissues are stretched and compressed, appearing. Syndrome of loss of function in areas of compressed innervation.
Generally, the disease occurs in one upper extremity. Unfortunately, Uncle Wang suffered from both upper limbs. So, self-care has become a problem.
Surgery has become a must, but the cost of surgery has temporarily stumped Uncle Wang. Surgery on both sides is generally done under general anesthesia, and the anesthesia fee alone costs two or three thousand. Brachial plexus anesthesia is cheap, but in principle, only one side of the brachial plexus can be hit. One operation can only be done on one side, and the overall cost is not low.
As soon as the orthopaedic surgeon called the anesthesiologist, there was an immediate discussion.
In view of Uncle Wang’s special situation, the Department of Anesthesiology has developed a special anesthesia plan for him – bilateral brachial plexus anesthesia.
At this point, someone will definitely question: This is an illegal operation!
Actually, the “bilateral brachial plexus” of this anesthesia plan is not a brachial plexus in the traditional sense.
Brachial plexus anesthesia in the traditional sense is a plexus block anesthesia technique. A certain amount (about 30 ml) of local anesthetic is injected near the brachial plexus to temporarily block nerve conduction. This anesthesia is very suitable for small and medium surgeries on the upper limbs. However, this anesthesia carries the risk of local anesthetic toxicity and phrenic nerve block.
Local anaesthetic poisoning, the main one is the large amount of local anaesthetic used in a short period of time. Think about it, 30ml on one side and 60ml on both sides. Even a 1% local anesthetic can only be capped at 40ml. So the violation is here.
The main cause of phrenic nerve block is the spread of local anesthetic into the path of the phrenic nerve. To reduce the risk of phrenic nerve block, it is necessary to reduce the dose. However, with a reduced dose, the anesthetic effect may not be sufficient.
Among the contradictions, the Department of Anesthesiology proposed a theoretically feasible plan – ultrasound-guided bilateral axillary brachial plexus block. And, both sides of the brachial plexus were implemented successively. The time difference is used to reduce the amount of local anesthetic used in the patient’s body per unit time.
Considering Uncle Wang’s actual economic situation, the Department of Anesthesiology specifically stated that only one fee will be charged for two anesthesia.
After everyone reassured that the cost was sufficient, Uncle Wang lay down on the operating table with peace of mind.
During the operation, the anesthesiologist completed anesthesia of the brachial plexus of one side of the axillary plexus for Uncle Wang under the guidance of ultrasound. Due to the use of ultrasound guidance, it can be clearly seen on the ultrasound image that the local anesthetic wraps the target nerve firmly. Looking at the total amount of local anesthetic, it is only slightly more than half the amount used for traditional brachial plexus blocks. After the effect is perfect, the orthopaedic surgeon comes to the stage to start the operation.
When the operation on this side was nearly finished, the anesthesiologist started anesthesia for the other side of the axillary brachial plexus. Since there has been an interval of two hours, there is no need to worry about overdose of local anesthetic. Since the direction of the local anesthetic can be clearly seen, there is basically no possibility of the local anesthetic spreading to the vicinity of the phrenic nerve.
After another two hours, Uncle Wang’s surgery was completed.
The next day, Uncle Wang’s arm was obviously not so numb.
At this time, Uncle Wang said what he said in his heart: he had wanted to see a doctor for a long time, but when he thought of spending so much money, he delayed. If it weren’t for the kind community staff and medical staff, he really doesn’t know how he will live in the future.
[Warm reminder] Please pay attention, here are a lot of professional medical science, to reveal the secrets of surgical anesthesia for you~