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The selection of anesthesia methods for bone plate fixation surgery needs to comprehensively consider multiple factors such as the surgical site, the patient’s physical condition, the duration and complexity of the operation. The following are common anesthesia methods and their applicable situations:
Nerve block anesthesia
Principle: By injecting local anesthetics around the nerve trunk, plexus and ganglion, the conduction function of the nerve is temporarily blocked, causing an anesthetic effect in the area innervated by the nerve.
Applicable scenarios: For distal limb bone plate fixation surgeries, such as the fixation of fractures in fingers, wrists, ankles, etc., nerve block anesthesia is a relatively appropriate choice. For example, when performing bone plate fixation surgery for distal radius fractures, brachial plexus nerve block anesthesia can be adopted to anesthetize the corresponding area of the upper limb. The patient remains conscious during the operation, but there is no pain sensation at the surgical site.
Advantages: It has a minor impact on the patient’s overall health, a quick postoperative recovery, relatively few complications, and can provide good analgesic effects, reducing the use of general anesthetic drugs.
Disadvantage: The anesthetic effect may be affected by individual differences, anatomical variations and other factors, resulting in incomplete block. For surgeries that take a long time or involve a large scope of operation, it may be necessary to supplement with other anesthesia methods.
Intraspinal anesthesia
Principle: Local anesthetics are injected into the subarachnoid space or epidural space within the spinal canal to block the spinal nerve roots and produce anesthetic effects in the corresponding areas.
Applicable scenarios: It is commonly used for anesthesia in bone plate fixation surgeries of the lower extremities, lower abdomen and perineum, such as femoral shaft fractures, tibiofibular fractures, pelvic fractures, etc. For example, when performing bone plate fixation surgery for femoral shaft fractures, epidural anesthesia or lumbar anesthesia can be adopted to make the patient’s lower body painless and facilitate the surgical operation.
Advantages: Definite anesthetic effect, good muscle relaxation, which is conducive to the operation. The impact on the respiratory and circulatory systems is relatively small, and the postoperative analgesic effect is good.
Disadvantages: The operation has relatively high technical requirements and may cause some complications, such as hypotension, headache, nerve damage, etc. After the operation, the patient needs to lie flat for a period of time, which limits the patient’s activities.
General anesthesia
Principle: By inhaling anesthetic drugs through the respiratory tract or injecting them intravenously or intramuscularly, the patient’s central nervous system is inhibited, leading to a state of loss of consciousness and no pain sensation.
Applicable scenarios: It is suitable for bone plate fixation surgeries in various parts, especially when the operation time is long, the operation is complex, the patient is uncooperative, or there are contraindications for nerve block anesthesia and intraspinal anesthesia. For instance, for patients with multiple fractures, spinal fractures combined with paraplegia, and fractures in children, general anesthesia is a relatively safe and reliable option.
Advantages: It can provide excellent surgical conditions, causing patients to completely lose consciousness and pain sensation, with good muscle relaxation, which is convenient for surgical operations. It can control the patient’s respiratory and circulatory functions to ensure the safety of the surgery.
Disadvantages: It has a significant impact on the patient’s overall health and may cause some complications, such as respiratory tract obstruction, insufficient ventilation, hypotension, arrhythmia, etc. The postoperative recovery time is relatively long, and the vital signs of the patients need to be closely monitored.
Local anesthesia
Principle: Local anesthetics are directly injected into the tissues at the surgical site to block the local nerve endings and produce an anesthetic effect.
Applicable scenarios: Generally, it is only suitable for some very superficial and simple bone plate fixation surgeries, such as Kirschner’s needle fixation for distal phalangeal fractures of the fingers, etc. In this case, local anesthesia can meet the surgical requirements and have the least impact on the patient.
Advantages: Simple operation, minimal impact on the patient’s overall health, quick postoperative recovery, and almost no complications.
Disadvantages: The anesthetic range is limited, the analgesic effect may not be ideal, and it may be difficult for patients who are sensitive to pain to tolerate the surgery. For surgeries with long operation times or deep operations, local anesthesia is difficult to meet the requirements.