Analysis of the Effect of Applying Ultrasound-Guided Nerve Block Anesthesia to Fracture Patients in the Context of Internet-Based Blockchain

Qiang Cai; Yi Han; Meiling Gao; Shuqin Ni

doi:10.1155/2022/6324009

Analysis of the Effect of Applying Ultrasound-Guided Nerve Block Anesthesia to Fracture Patients in the Context of Internet-Based Blockchain

Cai, Qiang;Han, Yi;Gao, Meiling;Ni, Shuqin 2022-04-14 00:00:00 Hindawi Journal of Healthcare Engineering Volume 2022, Article ID 6324009, 11 pages https://doi.org/10.1155/2022/6324009 Research Article Analysisofthe Effect ofApplyingUltrasound-Guided NerveBlock Anesthesia to Fracture Patients in the Context of Internet-Based Blockchain 1 2 3 4 Qiang Cai, Yi Han, Meiling Gao , and Shuqin Ni Department of Orthopedics, Xiangyang Central Hospital, Aﬃliated Hospital of Hubei University of Arts and Science, Xiangyang 441000, Hubei, China Department of Anesthesiology, $e Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China Department of Anesthesiology, Taihe Hospital, Hubei University of Medicine, Shiyan 442000, Hubei, China Department of Anesthesiology, Yantaishan Hospital, Yantai 264003, Shandong, China Correspondence should be addressed to Meiling Gao; 20201110325@nxmu.edu.cn and Shuqin Ni; ni518866@163.com Received 14 February 2022; Revised 27 February 2022; Accepted 28 February 2022; Published 14 April 2022 Academic Editor: Liaqat Ali Copyright © 2022 Qiang Cai et al. /is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. In the process of surgical treatment, the introduction of ultrasound technology to implement nerve block anesthesia can make the operations of patients with fractures under visualization and it can also signiﬁcantly improve the anesthesia eﬀect. With this technology, it is possible to minimize the anesthesia operation causing accidental injury and lay a good foundation for the smooth operation of surgical treatment.Blockchain technologyis a new decentralized infrastructureand distributed computing paradigm. /is technology has great development opportunities in the medical ﬁeld and is expected to play an important role in the construction of Internet medical ecology. /is study aims to investigate the eﬀect of ultrasound-guided nerve block anesthesia on fracture treatment in the context of blockchain. /is method has high application value and potential in medical data sharing, reducing treatment costs, improving the medical claims system, strengthening medical management, and optimizing medical decision-making using blockchain technology. /is study also addresses the uniqueness and complexity of ultrasound-guided nerve block anesthesia itself and analyzes the eﬀect of the proposed method. /e analysis shows that using the internet-based blockchain ultrasound-guided subacromial nerve block anesthesia for fracture patients is eﬀective, and the patient’s vital signs are stable, and the block is eﬀective. opioids and NSAIDs should be used with caution in high- 1. Introduction risk groups and that regional nerve block anesthesia may be Anesthesiologists play an important role in the treatment of used to minimize drug-related complications. Once a patient fractures by providing preoperative nerve block analgesia to is diagnosed with a hip fracture [1–3], preoperative analgesia help reduce pain, relieve fear, and help improve prognosis. should be administered by an experienced anesthesiologist, An eﬀective preoperative analgesic regimen is essential usually with an iliac fascia gap block or a femoral nerve because of the tremendous pain caused by fractures. Opioid block. Iliofascial gap blocks and femoral nerve blocks can be analgesics may produce adverse eﬀects such as perioperative administered by injection alone or in combination with an delirium, which increases the risk of surgery and increases infusion pump for continuous analgesia, but the risk of perioperative mortality, while nonsteroidal anti-inﬂamma- infection is higher with the combination, with a local in- tory drugs (NSAIDs) may produce adverse eﬀects on the fection rate of 0.3% to 2%. Anesthesia for fracture surgery cardiovascular system. /e Association of Anesthesiologists includes general anesthesia and intralesional anesthesia, of Great Britain and Ireland (AAGBI) recommends that which is more beneﬁcial to reduce postoperative 2 Journal of Healthcare Engineering direction of ultrasound emission was not easily visualized, complications and reduce perioperative mortality, so the appropriate anesthesia should be selected according to the while the nerve in the same direction as the emission could be clearly visualized with “low internal and high external.” /e patient’s own situation. For elderly patients with poor cardiopulmonary function, intralesional anesthesia is pre- nerves in the same direction as the emission direction can be ferred, which can help reduce the occurrence of postoper- clearly shown as “low inside and high outside” with a halo- ative delirium and the risk of deep vein thrombosis, with like shape [8]. Peripheral nerves are associated with other soft relative contraindications for aortic stenosis and coagulation tissue organs, such as blood vessels or ligaments, and un- abnormalities [2–5]. Among them, epidural anesthesia has a derstanding these soft tissue ultrasound images can help slower onset than subarachnoid anesthesia and is more detect peripheral nerves quickly and correctly. In clinical practice, diﬀerent tissues are identiﬁed based on their suitable for patients with cardiovascular disease. Regardless of the type of anesthesia chosen, intraoperative hypotension echogenic characteristics, in which substantial tissues tend to show homogeneous echogenicity, the presence of gas tissues should be avoided. It has been found that intraoperative hypotension increases mortality within 30 days after surgery, tends to be bright and strongly echogenic, and the presence of ﬂuid tissues tends to be hypoechoic or nonechogenic. Ul- and the incidence of intraoperative hypotension is signiﬁ- cantly higher with general anesthesia than with intralesional trasound-guided technique in clinical practice is mainly anesthesia, and the risk of hypotension is higher when performed in two ways: /e ﬁrst one is body marker tech- general anesthesia is combined with intralesional anesthesia. nique, which is simple and easy to perform. In this method, /e localization technique of peripheral nerve block anes- nerves located in the superﬁcial plexus with clear tissue are thesia is important for accurate anesthetic injection. At identiﬁed ﬁrst and then marked and blocked by puncture in present, the clinical application of localization techniques the usual way. Another method is ultrasound-guided real- time localization, which is performed by a skilled physician includes blind exploration of peripheral nerve anatomy, nerve stimulator, and ultrasound-guided localization. Be- who holds an ultrasound probe in his left hand and accurately locates the target nerve using in-plane techniques. When the cause ultrasound guidance has the characteristics of sim- plicity, ease of use, and excellent image quality, it has been block needle isclose to thenerve, the local anesthetic drug can be slowly injected. If there is a wrong injection site, it is increasingly used in peripheral nerve block anesthesia. Figure 1 illustrates the physical characteristics and visuali- necessary to adjust the position of the block needle in time, zation of the ultrasound guidance technique. and when the nerve can be observed to form a typical “donut Ultrasound mainly uses acoustic wave penetration and sign” with the anesthetic drug, the block is successful and the resolution for imaging. Wavelength and frequency speciﬁc block is eﬀective. When performing a block, multiple blocks waves have unique penetration and resolution, and the longer can be performed around the peripheral nerve to avoid poor the acoustic wave of the wave, the better the penetration and diﬀusion of anesthetic drugs in a single block [9–12]. Figure 2 illustrates the healthcare blockchain architecture. the better the penetration ability. At present, the frequency of ultrasound commonly used in clinical practice is mostly Blockchain, also known as distributed ledger technology, is a technical solution that collectively maintains a reliable 2.0∼50.0MHz; with the increase in frequency, the acoustic resolution rises, image clarity increases [6, 7], and penetration database through decentralization and detrust. /is tech- decreases; that is, its penetration and resolution are inversely nical solution mainly allows any number of nodes partici- proportional. Because ultrasound will be attenuated when pating in the system to pass a string of data blocks (blocks) encountering obstacles, for the application of ultrasound for associated with each other using cryptographic methods. peripheral nerve examination, ultrasound frequency needs to Each data block contains all the information exchange data be selected according to the anatomical structure of the nerve, of the system within a certain period of time and generates a as well as more superﬁcial nerves with higher frequency data ﬁngerprint for verifying the validity of its information ultrasound; deep nerves are selected with lower frequency and linking (Chain) to the next database block [13–16]. At present, the concept of blockchain technology is recognized ultrasound. Ultrasound images are divided into transverse and longitudinal sections according to the speciﬁc shape of as explained in the White Paper on the Development of Blockchain Technology and Applications in China, which the nerve. Transverse ultrasound images show a hypoechoic pattern with a circular shape surrounded by high echoge- deﬁnes it as a new Internet application model with dis- nicity, while longitudinal sections show a distribution of high tributed data storage, peer-to-peer transmission, consensus echogenicity and low echogenicity, mostly in the form of mechanism, cryptographic algorithms, and other computer parallel strips. In clinical practice, the use of ultrasound for technologies. /e unique features of blockchain include peripheral nerve examination can obtain clear ultrasound decentralization, being autonomous, security and trust- imagesofperipheral nervesatfrequencies higherthan5MHz. worthiness, and openness and transparency [14]. Clinical experimental research requires demanding When using 6–15MHz ultrasound to investigate peripheral nerve injury, it was found that normal peripheral nerve records of experimental results, and blockchain technology can provide researchers with traceable records of experi- longitudinal sections were mostly hypoechoic parallel to each other, and these hypoechoic bands were interspersed with mental results and clinical reports, which plays an important role in preserving experimental results and reducing falsi- linear hyper echoes, while transverse sections were mostly moderate echogenic with dotted hypoechogenicity inside, ﬁcation of clinical experimental records. According to sta- mostly showing a “sieve hole” shape. /e study also found tistics, half of the current experimental studies have that the peripheral nerve in the direction perpendicular to the unreported experimental results, and blockchain technology Journal of Healthcare Engineering 3 Visualization Physical Characteristics Echo-free: gallbladder, blood, gastric juice, urine. Isoechoic: e.g. liver and spleen, thyroid gland. Ultrasound-guided technology Hypoechoic: e.g. renal parenchyma, sternocleidomastoid muscle. High (strong) echogenicity: renal sinuses; gas- containing lung tissue, calciﬁcations or gas, the Nerves, stones hyperechoic with posterior acoustic shadowing. Figure 1: Ultrasound guidance technology features and visualization. Chronic Disease Insurance Medical Medical Application Drug Traceability Layer Screening fraud analysis Audit Open Service Layer Public Cloud Proprietary Cloud Hybrid Cloud Data Sharing and Co-creation Platform User Management Blockchain Management Smart Contracts Basic Service Layer System Management Data Standardization Operation Monitoring Management, research and product development soware Operating Environment Consensus Account Management Contract Templates Management Figure 2: Medical blockchain architecture. can address the selective reporting and untrue results in execution rights are cryptographically veriﬁed by a network clinical experiments, thus reducing the occurrence of aca- key to demonstrate how trust in clinical experiments can be demic misconduct. Blockchain-based research data would better enforced and how data tampering can be eliminated. It is demonstrated that the cryptographic guarantees pro- be time-stamped and publicly transparent, and all plans, consents, protocols, and possible outcomes could be stored vided by modern protocols can go beyond “proof of exis- on the blockchain even before clinical trials begin [14]. /e tence” and be used in complex clinical settings. Blockchain blockchain could also link the several phases of a clinical trial technology could signiﬁcantly improve surgical outcomes together, and the trial would only move to the next phase if research and experimental design, change the way we think all steps were followed and the methods used were properly about experimental design, and potentially produce truly validated, thus ensuring transparency and credibility of the veriﬁable and immutable data. Of course, it is still too early clinical trial. /is idea is extended by using smart contracts for blockchain technology to enter surgical outcomes re- that reside at a speciﬁc address in the blockchain and whose search, but its fundamental property as a public 4 Journal of Healthcare Engineering cryptographically controlled data store cannot be denied and in children and adolescents that ultrasound-guided lateral could improve the authenticity of experimental data [17]. imaging of the transverse process, vertebral body, and psoas muscle allows the surgeon to quickly locate the lumbar With the widespread use of ultrasound devices and the great development of ultrasound guidance technology, ultra- plexus nerve and perform a successful nerve block. Ultra- sound-guided peripheral nerve blocks have been gradually sound imaging of the sciatic nerve at the popliteal fossa is applied to various clinical procedures. Relevant studies have more obvious, so its ultrasound-guided nerve block is easier conﬁrmed that the application of ultrasound guidance to perform with accurate localization. A 4–7MHz probe is technology can eﬀectively improve the success rate of an- applied to identify the sciatic nerve location in the transverse esthesia, reduce complications, and decrease the amount of direction, and the needle is inserted from the lateral side anesthesia [14]. perpendicular to the ultrasound direction at 1 to 2cm from /is paper proposes an internet-based blockchain the sciatic nerve location, so that the anesthetic drug completely wraps the nerve sheath [19, 20]. Ultrasound- technology for the application of ultrasound-guided nerve block anesthesia for fracture patients. /is can better solve guided distal approach to the knee sciatic nerve block an- esthesia in severely obese patients is more eﬀective and can the problems of Information Island, information exchange, and information security caused by diﬀerent manufacturers, eﬀectively reduce the pain perception of patients. It is more diﬀerent technologies, diﬀerent standards, and diﬀerent diﬃcult to apply ultrasound imaging to the femoral nerve. software system integration when applying ultrasound- Clinically, it is often used in combination with a nerve guided nerve block anesthesia for fracture patients by using stimulator to locate the femoral nerve, applying a probe with blockchain technology. /e eﬀectiveness of the proposed a straight shape and a frequency of 4–9MHz to clearly method is demonstrated by analyzing some relevant dataset. observe the femoral nerve and its nearby tissues in the transverse plane and then injecting anesthetic drugs at several points near the femoral nerve by entering the needle 2. Related Work in the perpendicular direction of the acoustic waves on the 2.1. Application of Ultrasound-Guided Nerve Block Anesthesia outside of the probe. In pediatric femoral nerve fracture surgery, ultrasound-guided femoral nerve block combined in Patients with Fractures. Surgical treatment is an impor- tant source of psychological and physiological stress, which with general anesthesia is used to stabilize the hemody- namics and reduce the pain perception of the child. Other can cause patients to experience anxiety, fear, depression, and other adverse psychological states, which severely re- types of peripheral nerve blocks include oblique angle in- strict the outcome of surgical treatment and postoperative terval brachial plexus block, axillary brachial plexus block, patient recovery. /e presence of extremely pronounced and transgluteal sciatic nerve block, all of which require the anxiety and depression in patients during anesthesia seri- selection of a suitable shape and frequency probe according ously interferes with the operation. In order to improve the to the relevant nerve anatomy. Compared with the blind surgical treatment eﬀect of nerve block patients and promote positioning method and nerve stimulator positioning method, ultrasound-guided peripheral nerve block has the the rehabilitation process of patients, nerve block anesthesia patients are given routine care and psychological care based advantages of simplicity, economy, convenience and safety, and good blocking eﬀect. /e use of ultrasound-guided on routine care, respectively. Ultrasound-guided peripheral nerve block anesthesia types of subclavian brachial plexus peripheral nerve block for lower extremity nerve block can block should be performed using a frequency of 4–7MHz eﬀectively improve the blocking eﬀect and fast onset of arc probe [18], and the probe is placed in the downward anesthesia and eﬀectively reduce anesthesia-related com- depressed position of the clavicle 1cm away from the rostral plications. Ultrasound-guided peripheral nerve block can prominence position of the patient. /e patient’s brachial clearly observe the diﬀusion of anesthetic drugs, and the plexus nerve is clearly observed to show a grape-like shape of number of anesthetic drugs used for block is 30% to 40% less low-density ring-shaped hyperechoic, and the phenomenon than that of conventional block, which can eﬀectively reduce of anesthetic drug wrapping the nerve is visible after per- the complications caused by the use of anesthetic drugs in patients. Although the advantages of ultrasound-guided forming the block. /e application of ultrasound-guided continuous subclavian brachial plexus block in patients with peripheral nerve block anesthesia are obvious, it also has some limitations, such as the adverse eﬀects on the tissues multiple upper extremity fractures not only eﬀectively im- proved analgesia but also eﬀectively reduced the inﬂam- near the nerve, thediﬃcultyof blocking nerveswithcomplex matory response and decreased the incidence of anatomical structures and deeper locations, which may lead postoperative related complications. Another researcher to poor blocking eﬀects, and whether the frequency and found that, by comparing the eﬀect of diﬀerent concen- examination time of diﬀerent peripheral nerve block ap- trations of ropivacaine in ultrasound-guided brachial plexus plication probes will increase peripheral nerve injury, vas- block, the blocking eﬀect was the same when the concen- cular injury and hematoma, and nerve ischemia. Whether diﬀerent peripheral nerve block application probe fre- tration of anesthetic drug was the same, independent of the drug dose. /e lumbar plexus nerve, because it is in the deep quencies and examination times may increase peripheral nerve injury, vascular injury, and peripheral nerve com- interstitial space of the psoas major muscle next to the lumbar spine, consists of multiple tiny nerves, and improper plications such as hematoma and nerve ischemia still needs to be further determined. /ese issues will be the focus of block is prone to phenomena such as renal hematoma. BORE has found in ultrasound-guided lumbar plexus blocks subsequent research on ultrasound-guided peripheral nerve Journal of Healthcare Engineering 5 blocks, and as these issues are gradually resolved, ultra- prominent [14]. In 2017, a medical enterprise in the United sound-guided peripheral nerve blocks are expected to be- States caused about 47.5GB of data leakage due to system mismanagement, involving sensitive private information come a common mode of clinical nerve blocks. As regards anesthesia methods, the blind exploration group of brachial such as names, addresses, and case records of about 150,000 plexus nerve block methods includes three methods: patients. An individual’s medical records involve personal interosseous groove approach alone, axillary approach privacy and are personal data that can only be accessed by alone, and interosseous groove combined with axillary ap- authorized users. Traditional medical data adopts a cen- proach. In the ultrasound group, the brachial plexus nerve tralized storage strategy, and a large amount of medical data block methods included interosseous groove approach accumulates in hospital information centers or regional alone, supraclavicular approach alone, axillary approach health data centers. With the proliferation of medical data, alone, and combined interosseous groove axillary approach, the load carried by the centers continues to strengthen, and combined supraclavicular axillary approach, and combined security risks continue to increase. In response to the interosseous groove ulnar nerve block. In the blinded group, problems of medical data, blockchain technology provides a good solution for data storage and transmission with its the interosseous sulcus approach was performed with the patient lying ﬂat on the pillow, head turned to the opposite special technical architecture. Based on the current demand side, and arm to the side of the body, with the operator of medical data utilization and the technical characteristics standing in front of the patient’s head, ﬁrst having the of blockchain, a new medical data storage architecture based patient raise his head, revealing the sternal and clavicular on blockchain is proposed, as shown in Figure 3. /e ar- heads of the sternocleidomastoid muscle, identifying the chitecture is mainly divided into four layers: data layer, anterior and middle oblique muscle gaps [21], and entering communication layer, consensus layer, and application the needle vertically through the lateral edge of the inter- layer. In the data layer, patients’ medical records are stored osseous sulcus to ﬁnd the hypophysis. /e local anesthetic permanently in blocks, and the blocks are connected into chains by timestamps through the creation of mapping drug was pushed in after the sensation was detected. In blind exploration group axillary block method, the patient was pointers by hash functions to ensure the tamper-evident nature of medical records. /e transmission of medical data placed in a supine position with the head slightly tilted to the opposite side, the aﬀected upper limb was abducted by 90 , chain adopts asymmetric encryption algorithm [14]. After generating the data, the medical data generator (e.g., hos- the elbow was ﬂexed by 90 , the forearm was externally rotated, the most obvious place of axillary artery pulsation pital) encrypts the data using public key, and the patient was touched as the puncture point, and the needle was parses the data using private key to ensure the security of injected with the local anesthetic drug after encountering the data transmission. In addition, medical data blockchain can sense of breakthrough and the pulsation of the axillary also stipulate diﬀerent permissions for diﬀerent people by artery, and there was no return blood in the retraction. setting multiple private keys, single authorization, or mul- tiple authorizations in complex time and space and restrict them in time; for example, only the corresponding doctors 2.2. Internet Blockchain Medicine. As a decentralized, can access the data during a speciﬁc consultation time in- detrusted database technology solution with complete and terval. At the same time, each medical record must have the transparent information and privacy protection, blockchain digital signature of the corresponding medical personnel, can build an eﬃcient and reliable value transmission system which is also an important guarantee of the transparency of and promote the Internet as a network infrastructure for blockchain technology. In case of medical disputes, it is easy building social trust [14]. Blockchain has signiﬁcant ad- to trace the medical records. /e ability of medical data to be vantages in optimizing business processes, reducing oper- created, appended, and shared by multiple authorized ating costs, and improving collaboration eﬃciency in the parties will reshape the eﬃciency and transparency of the ﬁnancial industry, and its application in other industries is entire medical industry. In the communication layer, also rapidly developing. Focusing on the health sector, the medical data chain usually adopts P2P technology to or- construction of healthcare big data faces the dual challenge ganize each node, which is diﬀerent from the traditional of information security and privacy protection. Blockchain centralized network model. /e nodes in the P2P network is highly fault-tolerant, tamper-proof, and privacy-protec- are equal and there is no centralized server, which is a good tive and has important applications in medical, pharma- preventive eﬀect for the large-scale leakage of medical data. ceutical, health insurance, and genomics ﬁelds. In the ﬁeld of /e distributed data storage also improves the redundancy health services, patients’ medical data has been an asset. Due and stability of the whole system. /e consensus layer is a to the uneven progress of hospital informatization con- strategy and method for the nodes in the medical data chain struction, some hospitals cannot integrate their internal to reach agreement, which solves the problem of trans- information systems, poor interaction of information sys- mitting trusted information and transferring value over tems between hospitals, nonuniform data structure of untrustworthy channels and achieves a state of mutual trust medical records, and nonstandardized data standards of among nodes in a decentralized context. Traditional proof- electronic medical records, which makes medical data of-work requires mathematical operations to obtain book- sharing very diﬃcult. /ere are many problems with the keeping rights, which consumes higher resources and is less storage, transmission, and utilization of medical data, supervisee, and reaching consensus relies on the joint among which the problem of sensitive data leakage is very participation of the whole network [14]. /e main idea of 6 Journal of Healthcare Engineering Digital Copyright Identity Intellectual Property & Social Management Charity Authentication Securities Insurance Financial Electronic Medical Records Blockchain Application Ecology Credit Carbon Emissions Energy Gas Stations Power Trading Healthcare Payment Electronic Medical Records Medical Drug Traceability Figure 3: Blockchain application scenarios. proof-of-stake is that the ease of access to node bookkeeping 3.2. Analysis of Sequencing Mutual Information in rights is positively correlated with the beneﬁts held by nodes, Anesthesia. /e determination of the patient’s state of which reduces resource consumption and improves per- consciousness during anesthesia has been an important issue formance compared to proof-of-work. Smart contracts in for scientiﬁc research. /ere is still no monitor that can the application layer can meet the needs of healthcare demonstrate its ability to analyze the patient’s state of providers for healthcare data collection and exchange so- consciousness. Most monitors assess the state of sedation in lutions [22]. It is a multiuser participatory formulation, anesthesia only by analyzing changes in the Electroen- proliferation through P2P networks, and automatic execu- cephalography (EEG) signal of a single channel [27]. /e tion on the blockchain, which enables patients to deliver state of consciousness of the brain is importantly related to medical data to data researchers with conﬁdence and pro- the coupling of information in the brain domain as well as to synchronous oscillations, and, especially in recent years, motes the analysis and deeper utilization of healthcare big data [14]. many theories have supported the important hypothesis that Apart from the blockchain-based solutions, a large information coupling is an important condition for the number of artiﬁcial intelligence- and machine learning- existence of consciousness. For example, changes in cortical based clinical and healthcare systems have been developed in neural activity shifting from high to low frequencies with clinical and wellbeing setups for cancer [23], diabetes deepening anesthesia, enhancement of gamma waves during mellitus [24], and wellness recommendations [25, 26]. learning, and 40Hz oscillations were related to higher cognitive functions and consciousness. It is generally be- lieved that the “information coupling” between the allo- 3. Method cortex and the cortical cortex is one of the conditions for the 3.1. Model Architecture. /ere is currently no uniform emergence of consciousness. In anesthesia or sleep, the loss of consciousness is manifested by the decoupling and loss of deﬁnition of blockchain in the industry. Blockchain is a decentralized shared ledger that stores blocks of data in a connections between the functional areas of thalamocortical and cortical cortices. /e algorithm of mutual information cryptographic chain structure in chronological order and is maintained collectively and tamper-proof by consensus analysis based on sorting entropy is called sorting mutual algorithms. Blockchain technology provides a decentralized, information. Since the kinetic properties of EEG signals can open, Byzantine fault-tolerant transaction mechanism that is be viewed as changes in various modes on the time scale, the expected to be the foundational framework for the next sorting entropy theory can be a good way to calculate the generation of Internet transactions. /e basic framework of degree of mode changes in complex system motions. As a blockchain mainly consists of a data layer, a network layer, a time-varying signal, the amplitude and frequency of the EEG consensus layer, and an application layer, as shown in change over time include both rising and falling modes. Figure 4. Statistics of such pattern changes can be used to analyze Journal of Healthcare Engineering 7 Encrypted Ultrasound Medical Alliance DApp Application Layer Hybrid Proof Class PoX BFT Class Consensus Layer Propagation Protocol Node Discovery P2P networks Network Layer Encryption function components Ledger copy storage Hash Functions Data Packaging Aggregation Digital signatures Data Serialization Asymmetric encryption Atomic Data Recording Merkle tree Data layer Figure 4: Model structure. brain activity. Mutual information is used to measure the (6) Calculate the entropy of the joint probability dynamical coupling and information transfer of systems X distribution. and Y. H(X, Y) � − 􏽘 􏽘 p(x, y)logp(x|y). /e details of the PMI algorithm are described as follows: (4) x∈X y∈Y (1) Given a time series x (t � 1,2, . . .), map the time series to the vector X [x , x , . . . , x ] with (7) Obtain sorting mutual information based on sorting t t t+τ t+mτ entropy. embedding dimension of m and time delay of τ. (2) Arrange X in ascending order. I(X; Y) � H(X) + H(Y) − H(X, Y). (5) x t + j − 1 τ ≤ x t + j − 1 τ ≤ . . . ≤ x t + j − 1 τ . (1) 􏼂 􏼁 􏼁 􏼁 􏼁 􏼁 􏼁􏼃 1 2 m (3) Compute the probability distribution p , p , . . . , p 3.3. Analysis of Sequencing Mutual Information in Anesthesia. 1 2 k of the sequence of symbols, where k≤ m! For m- Not only does the emergence of Bitcoin solve the problem of dimensional numbers, there are m! kinds of order- value transfer in a detrusted peer-to-peer network, but also ing, and each vector X can be mapped to one of m! its proof-of-work (PoW) consensus algorithm combined with economic incentives and cryptography makes block- (4) Calculate the entropy of the ordering of the time chain cross the Byzantine fault-tolerance gap in distributed series x(t), t � 1,2, . . . . { } systems, bringing great innovations and breakthroughs in how to reach consensus in distributed scenarios. Since then, H(X) � − 􏽘 p logp . (2) j j many new Byzantine fault-tolerant consensus algorithms j�1 inspired by Bitcoin have emerged [14]. In its seminal paper on Bitcoin, the PoW consensus algorithm was adopted, (5) Meanwhile, compute the sorting entropy of another where one party submits a computational result that is time series y (t � 1,2, . . .), which is recorded syn- known to be diﬃcult to compute but easy to verify, and chronously with t . everyone else can verify this result by being conﬁdent that the submitting party has completed a signiﬁcant amount of H(Y) � − 􏽘 p logp . (3) computation to obtain the result. /e larger the number of j j j�1 possible hashes is, the smaller the chance that two values will 8 Journal of Healthcare Engineering create the same hash. /is made it uneconomical for e node collects unconﬁrmed transactions from across the network for the current time period, while adding a Coinbase transaction for issuing spammers to send large amounts of spam while still allowing new bitcoin rewards, forming a collection of transactions for the current users to send normal e-mail to other users when needed [14]. block body Bitcoin uses a similar system for the same purpose, where nodes compete against each other based on their computer’s Calculate the Merkle root of the block body transaction set into the computing power to solve a complex but easy-to-verify block header, ﬁll in the other metadata of the block header, where the random number Nonce is set to 0 SHA256 mathematical puzzle (a process known as mining), and the node that solves the puzzle the fastest receives the Add 1 to the random number Nonce, calculate the rightto keeptrackoftheblocks and thesystemautomatically double SHA256 hash of the current block header generates Bitcoin rewards and transaction fees within the blocks. /e Bitcoin system controls the average block False generation time of about ten minutes by ﬂexibly adjusting ≤ target hash value the diﬃculty of the random number search. In general, the PoW consensus algorithm’s random number search process True is shown in Figure 5. Successfully search for the appropriate random number, the section point gets the bookkeeping Suppose that an attacker opens another chain on the right of the block main chain, called the attack chain. /e probability that the attacker succeeds in ﬁlling a given gap can be approximated Figure 5: Consensus algorithm search process. as Gambler’s Ruin Problem [14]. According to the longest chain mechanism, the attacking chain has to catch up with the main chain to succeed; then its probability that the z k − λ n− k λ e q ⎡ ⎣ ⎤ ⎦ attacker opens another chain, called the attacking chain, on P � 1 − 􏽘 (9) 1 − 􏼠 􏼡 . k! p k�0 the main chain is assumed. /e probability that the attacker succeeds in ﬁlling a given gap can be approximated as It is calculated that in the case where the malicious Gambler’s Ruin Problem. attacking node has less than 50% of the computing power, its According to the longest chain mechanism, the attacking probability of successfully achieving an attack decreases chain must catch up with the main chain in order to succeed, exponentially as z increases [14]. In general, Bitcoin takes z and then its probability is to be 6, that is, a new block is created and followed by 6 1 q⩾p blocks before the transactions in that block are considered ⎧ ⎪ secure. To reduce the risk of forking and waiting for enough P � , (6) z z blocks to be conﬁrmed, blockchains with the PoW con- 􏼠 􏼡 q< p sensus algorithm are limited in throughput but are very scalable and nodes are free to join or exit. where p is the probability that the honest node makes the next block, q is the probability that the attacking node makes 4. Experimentation and Evaluation the next block, and P is the probability that the attacker 4.1. Dataset. Eighty-six patients with femoral neck fractures ﬁnally closes the gap of z blocks and overtakes the attacking who underwent surgical treatment in a hospital from July chain. If honest blocks will take the average expected time to 2016 to July 2018 were selected for the study, and they were produce a block, the potential progress of the attacker is a randomly divided into an observation group and a control Poisson distribution with the expected value of the group, with 43 cases in each group. /e patients in the distribution. observation group were aged 60 to 85 years, with an average λ � z . age of 63.52±1.29 years; 28 cases were males, and 15 cases (7) were females. /e patients in the control group were aged 61 to 84years, with a mean age of 63.19±1.18 years; 26 cases /erefore, to calculate the probability of the attacker were males, and 17 cases were females. /ere was no sta- catching up, the probability density of the Poisson distri- tistically signiﬁcant diﬀerence between the general data of bution of the number of progress blocks made by the at- the two groups of patients (P>0.05). /e study was ap- tacker needs to be multiplied by the probability of the proved by the hospital ethics committee, and the patients attacker still being able to catch up given that number to and their families gave informed consent. Inclusion criteria obtain the following equation: were as follows: meeting the indication for surgery; being (z− k) conﬁrmed as femoral neck fracture by MRI, CT, and X-ray; ⎧ ⎪ k − λ⎪ 􏼠 􏼡 , k⩽z normal mental status; performing internal ﬁxation treat- λ e (8) ment; and fracture time within 1 week. Exclusion criteria k! k�0 ⎪ were as follows: combination of other injuries; combination 1, k> z. of lower limb deformities; bilateral femoral neck fractures; To avoid summing over an inﬁnite series, Equation (8) is old fractures; pathological fractures; low cooperation; simpliﬁed to the following form: presence of cognitive and mental disorders; and Journal of Healthcare Engineering 9 Table 1: Comparison of analgesic eﬀects between the two groups of patients at diﬀerent time points (n �43, x± s). Group Preoperative 6h postoperatively 12h postoperatively 24h postoperatively 48h postoperatively Control group 6.52±1.23 7.42±1.85 10.85±1.43 12.52±1.32 14.89±2.62 Observation group 6.61±1.18 9.48±1.89 14.98±2.85 16.85±2.96 18.79±2.63 T 0.3462 5.1076 9.2558 6.1192 4.5268 P 0.7300 0.0000 0.0000 0.0000 0.0000 Table 2: Comparison of HR, SBP, and DBP at diﬀerent time points between the two groups of patients (n �43, x± s). 5 min Before 10min 20min 30min 60min Group Indicator after anesthesia after anesthesia after anesthesia afteranesthesia afteranesthesia anesthesia HR 80.02±15.02 90.02±14.52 80.36±1.52 90.29±2.15 85.03±0.96 78.96±1.26 (beats/min) Control group SBP (mmHg) 139.02±17.05 152.96±2.16 157.02±2.35 137.05±1.39 149.63±18.06 139.63±1.38 DBP (mmHg) 90.95±12.35 99.89±11.27 94.02±1.15 91.96±1.52 90.02±1.52 92.96±3.28 HR 80.12±14.93 82.96±15.16 83.56±12.16 84.15±13.13 84.02±14.15 80.12±1.01 Observation (beats/min) group SBP (mmHg) 138.37±17.15 140.15±16.39 142.34±15.05 139.86±17.85 139.98±18.69 137.96±15.39 DBP (mmHg) 89.63±13.02 92.96±0.32 93.93±12.15 92.25±10.26 93.36±15.02 92.25±14.26 combination of coronary heart disease, diabetes mellitus, patient’s nerve bundle was inﬁltrated with the drug solution and hypertension. as observed on the ultrasound image, and, for the nerve bundle that was not successfully inﬁltrated, the needle tip orientation was changed to be close to the nerve before the 4.2. Data Preprocessing. After the patients in both groups drug was injected until it was completely inﬁltrated with the were admitted to the room, cardiac monitoring was con- drug solution. nected, intravenous access was quickly established, and all vital signs such as pulse rate, oxygen saturation, heart rate (HR), and blood pressure were closely monitored. /e 4.3. Evaluation Metrics. /e analgesic eﬀects of the two control group analyzed the decentralized information of groups were compared. /e mechanical pain threshold of users using the algorithm based on Internet blockchain the skin around 2cm of the patient’s surgical incision was proposed in this paper, as well as parallel intravenous in- measured at 6, 12, 24, and 48h postoperatively using the halation compound anesthesia, and, at the induction of tactile measurement kit Nonfruit, respectively, and the anesthesia, patients were given intravenous injection of intensity of the measurement tool was increased from 0.4g 0.05mg/kg midazolam, 3 μg/kg fentanyl citrate injection with the ﬁber tip in vertical contact with the skin, ensuring (0.8mg/kg cis-atracurium with 1.5mg/kg propofol), and that the ﬁber tip was in a bent state for at least 2s. /e inhalation of sevoﬂurane, and, after completing tracheal corresponding intensity value of the ﬁber at the time of the intubation, the patients were given 4∼6mg/(kg-h) propofol patient’s tingling sensation (Xf) was recorded as the ﬁnal by micropump, and the EEG dual frequency index was measured intensity value. /e HR, systolic blood pressure maintained at 40∼60, with additional fentanyl and cis- (SBP), and diastolic blood pressure (DBP) before and 5, 10, atracurium if necessary. In the observation group, ultra- 20, 30, and 60min after anesthesia were compared between sound-guided nerve block anesthesia was performed, and the two groups. /e onset and maintenance time of sensory the patients were given 0.5mg of atropine sulfate injection block and the duration and maintenance time of motor intramuscularly before surgery. After admission, the pe- block were compared between the two groups. SPSS 19.0 ripheral veins were opened, HR and blood pressure were statistical software was used to process the data, and the routinely monitored, and the patients were given 0.03mg/kg count data were expressed as n/% by x2 test, and the midazolam intravenously for proper sedation. /e posterior measurement data were expressed as x± s by t-test, and the unilateral sciatic and lumbar plexus nerve block was per- diﬀerence was considered statistically signiﬁcant at formed under ultrasound (GELOGIQE9 color Doppler ul- P<0.05. trasound) guidance, and, after the small articular prominence was detected, the ultrasound probe was con- tinued to move upward until the images of L4∼5 and L3∼4 4.4. Results. From the comparison of the analgesic eﬀects of lumbar transverse process were clearly displayed; the needle the two groups of patients at diﬀerent time points, there was tip was placed close to the probe, and the out-of-plane no statistically signiﬁcant diﬀerence between the preoper- method was used to enter the needle, which could be ob- ative mechanical pain thresholds of the two groups served under ultrasound. /e puncture needle was observed (P>0.05); the mechanical pain thresholds of the patients in to pass through the L3∼4 transverse process gap until it the observation group were higher than those in the control group at 6, 12, 24, and 48h after surgery, and the diﬀerence reached the posterior 2/3, and local anesthetic drugs were injected immediately after the nerve plexus was found; the was statistically signiﬁcant (P<0.05). See Table 1. 10 Journal of Healthcare Engineering Table 3: Comparison of blockage between the two groups (n �43, x± s, min). Group Sensory blockade takes eﬀect Sensory blockade maintenance Motor block onset Motor block maintenance Control group Time Time Time Time Observation group 7.12±1.85 325.63±40.02 8.15±1.28 152.02±32.85 T 5.36±1.62 426.96±45.63 9.86±1.56 189.63±43.02 P 25.6326 12.2285 9.6325 20.6324 /e HR, SBP, and DBP of the two groups at diﬀerent Data Availability times were not statistically signiﬁcant when comparing the /e datasets used during the current study are available from HR, SBP, and DBP of the observation group at 5, 10, 20, 30, the corresponding author upon reasonable request. and 60min after anesthesia with those before anesthesia (P>0.05); the amplitude of HR, SBP, and DBP ﬂuctuations of the observation group at each time point was smaller than Conflicts of Interest that of the control group. See Table 2. /e onset of sensory block was shorter in the observation /e authors declare that they have no conﬂicts of interest. group than in the control group, and the maintenance time of sensory block, the onset of motor block, and the main- Authors’ Contributions tenance time of motor block were longer in the observation group than in the control group, and the diﬀerences were Qiang Cai and Yi Han contributed equally to this work. statistically signiﬁcant (P<0.05, Table 3). References 5. Conclusion [1] T. Mori, O. Nomura, and T. Ihara, “Ultrasound-guided pe- In this paper, we proposed a method of applying ultra- ripheral forearm nerve block for digit fractures in a pediatric sound-guided nerve block anesthesia to fracture patients in emergency department,” $e American Journal of Emergency the context of Internet blockchain, and two groups of Medicine, vol. 37, no. 3, pp. 489–493, 2019. patients were given intravenous inhalation complex an- [2] M. D. Baker and J. P. 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Publisher: Hindawi Publishing Corporation
Copyright: Copyright © 2022 Qiang Cai et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
ISSN: 2040-2295
eISSN: 2040-2309
DOI: 10.1155/2022/6324009
Publisher site: See Article on Publisher Site

Abstract

Hindawi Journal of Healthcare Engineering Volume 2022, Article ID 6324009, 11 pages https://doi.org/10.1155/2022/6324009 Research Article Analysisofthe Effect ofApplyingUltrasound-Guided NerveBlock Anesthesia to Fracture Patients in the Context of Internet-Based Blockchain 1 2 3 4 Qiang Cai, Yi Han, Meiling Gao , and Shuqin Ni Department of Orthopedics, Xiangyang Central Hospital, Aﬃliated Hospital of Hubei University of Arts and Science, Xiangyang 441000, Hubei, China Department of Anesthesiology, $e Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China Department of Anesthesiology, Taihe Hospital, Hubei University of Medicine, Shiyan 442000, Hubei, China Department of Anesthesiology, Yantaishan Hospital, Yantai 264003, Shandong, China Correspondence should be addressed to Meiling Gao; 20201110325@nxmu.edu.cn and Shuqin Ni; ni518866@163.com Received 14 February 2022; Revised 27 February 2022; Accepted 28 February 2022; Published 14 April 2022 Academic Editor: Liaqat Ali Copyright © 2022 Qiang Cai et al. /is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. In the process of surgical treatment, the introduction of ultrasound technology to implement nerve block anesthesia can make the operations of patients with fractures under visualization and it can also signiﬁcantly improve the anesthesia eﬀect. With this technology, it is possible to minimize the anesthesia operation causing accidental injury and lay a good foundation for the smooth operation of surgical treatment.Blockchain technologyis a new decentralized infrastructureand distributed computing paradigm. /is technology has great development opportunities in the medical ﬁeld and is expected to play an important role in the construction of Internet medical ecology. /is study aims to investigate the eﬀect of ultrasound-guided nerve block anesthesia on fracture treatment in the context of blockchain. /is method has high application value and potential in medical data sharing, reducing treatment costs, improving the medical claims system, strengthening medical management, and optimizing medical decision-making using blockchain technology. /is study also addresses the uniqueness and complexity of ultrasound-guided nerve block anesthesia itself and analyzes the eﬀect of the proposed method. /e analysis shows that using the internet-based blockchain ultrasound-guided subacromial nerve block anesthesia for fracture patients is eﬀective, and the patient’s vital signs are stable, and the block is eﬀective. opioids and NSAIDs should be used with caution in high- 1. Introduction risk groups and that regional nerve block anesthesia may be Anesthesiologists play an important role in the treatment of used to minimize drug-related complications. Once a patient fractures by providing preoperative nerve block analgesia to is diagnosed with a hip fracture [1–3], preoperative analgesia help reduce pain, relieve fear, and help improve prognosis. should be administered by an experienced anesthesiologist, An eﬀective preoperative analgesic regimen is essential usually with an iliac fascia gap block or a femoral nerve because of the tremendous pain caused by fractures. Opioid block. Iliofascial gap blocks and femoral nerve blocks can be analgesics may produce adverse eﬀects such as perioperative administered by injection alone or in combination with an delirium, which increases the risk of surgery and increases infusion pump for continuous analgesia, but the risk of perioperative mortality, while nonsteroidal anti-inﬂamma- infection is higher with the combination, with a local in- tory drugs (NSAIDs) may produce adverse eﬀects on the fection rate of 0.3% to 2%. Anesthesia for fracture surgery cardiovascular system. /e Association of Anesthesiologists includes general anesthesia and intralesional anesthesia, of Great Britain and Ireland (AAGBI) recommends that which is more beneﬁcial to reduce postoperative 2 Journal of Healthcare Engineering direction of ultrasound emission was not easily visualized, complications and reduce perioperative mortality, so the appropriate anesthesia should be selected according to the while the nerve in the same direction as the emission could be clearly visualized with “low internal and high external.” /e patient’s own situation. For elderly patients with poor cardiopulmonary function, intralesional anesthesia is pre- nerves in the same direction as the emission direction can be ferred, which can help reduce the occurrence of postoper- clearly shown as “low inside and high outside” with a halo- ative delirium and the risk of deep vein thrombosis, with like shape [8]. Peripheral nerves are associated with other soft relative contraindications for aortic stenosis and coagulation tissue organs, such as blood vessels or ligaments, and un- abnormalities [2–5]. Among them, epidural anesthesia has a derstanding these soft tissue ultrasound images can help slower onset than subarachnoid anesthesia and is more detect peripheral nerves quickly and correctly. In clinical practice, diﬀerent tissues are identiﬁed based on their suitable for patients with cardiovascular disease. Regardless of the type of anesthesia chosen, intraoperative hypotension echogenic characteristics, in which substantial tissues tend to show homogeneous echogenicity, the presence of gas tissues should be avoided. It has been found that intraoperative hypotension increases mortality within 30 days after surgery, tends to be bright and strongly echogenic, and the presence of ﬂuid tissues tends to be hypoechoic or nonechogenic. Ul- and the incidence of intraoperative hypotension is signiﬁ- cantly higher with general anesthesia than with intralesional trasound-guided technique in clinical practice is mainly anesthesia, and the risk of hypotension is higher when performed in two ways: /e ﬁrst one is body marker tech- general anesthesia is combined with intralesional anesthesia. nique, which is simple and easy to perform. In this method, /e localization technique of peripheral nerve block anes- nerves located in the superﬁcial plexus with clear tissue are thesia is important for accurate anesthetic injection. At identiﬁed ﬁrst and then marked and blocked by puncture in present, the clinical application of localization techniques the usual way. Another method is ultrasound-guided real- time localization, which is performed by a skilled physician includes blind exploration of peripheral nerve anatomy, nerve stimulator, and ultrasound-guided localization. Be- who holds an ultrasound probe in his left hand and accurately locates the target nerve using in-plane techniques. When the cause ultrasound guidance has the characteristics of sim- plicity, ease of use, and excellent image quality, it has been block needle isclose to thenerve, the local anesthetic drug can be slowly injected. If there is a wrong injection site, it is increasingly used in peripheral nerve block anesthesia. Figure 1 illustrates the physical characteristics and visuali- necessary to adjust the position of the block needle in time, zation of the ultrasound guidance technique. and when the nerve can be observed to form a typical “donut Ultrasound mainly uses acoustic wave penetration and sign” with the anesthetic drug, the block is successful and the resolution for imaging. Wavelength and frequency speciﬁc block is eﬀective. When performing a block, multiple blocks waves have unique penetration and resolution, and the longer can be performed around the peripheral nerve to avoid poor the acoustic wave of the wave, the better the penetration and diﬀusion of anesthetic drugs in a single block [9–12]. Figure 2 illustrates the healthcare blockchain architecture. the better the penetration ability. At present, the frequency of ultrasound commonly used in clinical practice is mostly Blockchain, also known as distributed ledger technology, is a technical solution that collectively maintains a reliable 2.0∼50.0MHz; with the increase in frequency, the acoustic resolution rises, image clarity increases [6, 7], and penetration database through decentralization and detrust. /is tech- decreases; that is, its penetration and resolution are inversely nical solution mainly allows any number of nodes partici- proportional. Because ultrasound will be attenuated when pating in the system to pass a string of data blocks (blocks) encountering obstacles, for the application of ultrasound for associated with each other using cryptographic methods. peripheral nerve examination, ultrasound frequency needs to Each data block contains all the information exchange data be selected according to the anatomical structure of the nerve, of the system within a certain period of time and generates a as well as more superﬁcial nerves with higher frequency data ﬁngerprint for verifying the validity of its information ultrasound; deep nerves are selected with lower frequency and linking (Chain) to the next database block [13–16]. At present, the concept of blockchain technology is recognized ultrasound. Ultrasound images are divided into transverse and longitudinal sections according to the speciﬁc shape of as explained in the White Paper on the Development of Blockchain Technology and Applications in China, which the nerve. Transverse ultrasound images show a hypoechoic pattern with a circular shape surrounded by high echoge- deﬁnes it as a new Internet application model with dis- nicity, while longitudinal sections show a distribution of high tributed data storage, peer-to-peer transmission, consensus echogenicity and low echogenicity, mostly in the form of mechanism, cryptographic algorithms, and other computer parallel strips. In clinical practice, the use of ultrasound for technologies. /e unique features of blockchain include peripheral nerve examination can obtain clear ultrasound decentralization, being autonomous, security and trust- imagesofperipheral nervesatfrequencies higherthan5MHz. worthiness, and openness and transparency [14]. Clinical experimental research requires demanding When using 6–15MHz ultrasound to investigate peripheral nerve injury, it was found that normal peripheral nerve records of experimental results, and blockchain technology can provide researchers with traceable records of experi- longitudinal sections were mostly hypoechoic parallel to each other, and these hypoechoic bands were interspersed with mental results and clinical reports, which plays an important role in preserving experimental results and reducing falsi- linear hyper echoes, while transverse sections were mostly moderate echogenic with dotted hypoechogenicity inside, ﬁcation of clinical experimental records. According to sta- mostly showing a “sieve hole” shape. /e study also found tistics, half of the current experimental studies have that the peripheral nerve in the direction perpendicular to the unreported experimental results, and blockchain technology Journal of Healthcare Engineering 3 Visualization Physical Characteristics Echo-free: gallbladder, blood, gastric juice, urine. Isoechoic: e.g. liver and spleen, thyroid gland. Ultrasound-guided technology Hypoechoic: e.g. renal parenchyma, sternocleidomastoid muscle. High (strong) echogenicity: renal sinuses; gas- containing lung tissue, calciﬁcations or gas, the Nerves, stones hyperechoic with posterior acoustic shadowing. Figure 1: Ultrasound guidance technology features and visualization. Chronic Disease Insurance Medical Medical Application Drug Traceability Layer Screening fraud analysis Audit Open Service Layer Public Cloud Proprietary Cloud Hybrid Cloud Data Sharing and Co-creation Platform User Management Blockchain Management Smart Contracts Basic Service Layer System Management Data Standardization Operation Monitoring Management, research and product development soware Operating Environment Consensus Account Management Contract Templates Management Figure 2: Medical blockchain architecture. can address the selective reporting and untrue results in execution rights are cryptographically veriﬁed by a network clinical experiments, thus reducing the occurrence of aca- key to demonstrate how trust in clinical experiments can be demic misconduct. Blockchain-based research data would better enforced and how data tampering can be eliminated. It is demonstrated that the cryptographic guarantees pro- be time-stamped and publicly transparent, and all plans, consents, protocols, and possible outcomes could be stored vided by modern protocols can go beyond “proof of exis- on the blockchain even before clinical trials begin [14]. /e tence” and be used in complex clinical settings. Blockchain blockchain could also link the several phases of a clinical trial technology could signiﬁcantly improve surgical outcomes together, and the trial would only move to the next phase if research and experimental design, change the way we think all steps were followed and the methods used were properly about experimental design, and potentially produce truly validated, thus ensuring transparency and credibility of the veriﬁable and immutable data. Of course, it is still too early clinical trial. /is idea is extended by using smart contracts for blockchain technology to enter surgical outcomes re- that reside at a speciﬁc address in the blockchain and whose search, but its fundamental property as a public 4 Journal of Healthcare Engineering cryptographically controlled data store cannot be denied and in children and adolescents that ultrasound-guided lateral could improve the authenticity of experimental data [17]. imaging of the transverse process, vertebral body, and psoas muscle allows the surgeon to quickly locate the lumbar With the widespread use of ultrasound devices and the great development of ultrasound guidance technology, ultra- plexus nerve and perform a successful nerve block. Ultra- sound-guided peripheral nerve blocks have been gradually sound imaging of the sciatic nerve at the popliteal fossa is applied to various clinical procedures. Relevant studies have more obvious, so its ultrasound-guided nerve block is easier conﬁrmed that the application of ultrasound guidance to perform with accurate localization. A 4–7MHz probe is technology can eﬀectively improve the success rate of an- applied to identify the sciatic nerve location in the transverse esthesia, reduce complications, and decrease the amount of direction, and the needle is inserted from the lateral side anesthesia [14]. perpendicular to the ultrasound direction at 1 to 2cm from /is paper proposes an internet-based blockchain the sciatic nerve location, so that the anesthetic drug completely wraps the nerve sheath [19, 20]. Ultrasound- technology for the application of ultrasound-guided nerve block anesthesia for fracture patients. /is can better solve guided distal approach to the knee sciatic nerve block an- esthesia in severely obese patients is more eﬀective and can the problems of Information Island, information exchange, and information security caused by diﬀerent manufacturers, eﬀectively reduce the pain perception of patients. It is more diﬀerent technologies, diﬀerent standards, and diﬀerent diﬃcult to apply ultrasound imaging to the femoral nerve. software system integration when applying ultrasound- Clinically, it is often used in combination with a nerve guided nerve block anesthesia for fracture patients by using stimulator to locate the femoral nerve, applying a probe with blockchain technology. /e eﬀectiveness of the proposed a straight shape and a frequency of 4–9MHz to clearly method is demonstrated by analyzing some relevant dataset. observe the femoral nerve and its nearby tissues in the transverse plane and then injecting anesthetic drugs at several points near the femoral nerve by entering the needle 2. Related Work in the perpendicular direction of the acoustic waves on the 2.1. Application of Ultrasound-Guided Nerve Block Anesthesia outside of the probe. In pediatric femoral nerve fracture surgery, ultrasound-guided femoral nerve block combined in Patients with Fractures. Surgical treatment is an impor- tant source of psychological and physiological stress, which with general anesthesia is used to stabilize the hemody- namics and reduce the pain perception of the child. Other can cause patients to experience anxiety, fear, depression, and other adverse psychological states, which severely re- types of peripheral nerve blocks include oblique angle in- strict the outcome of surgical treatment and postoperative terval brachial plexus block, axillary brachial plexus block, patient recovery. /e presence of extremely pronounced and transgluteal sciatic nerve block, all of which require the anxiety and depression in patients during anesthesia seri- selection of a suitable shape and frequency probe according ously interferes with the operation. In order to improve the to the relevant nerve anatomy. Compared with the blind surgical treatment eﬀect of nerve block patients and promote positioning method and nerve stimulator positioning method, ultrasound-guided peripheral nerve block has the the rehabilitation process of patients, nerve block anesthesia patients are given routine care and psychological care based advantages of simplicity, economy, convenience and safety, and good blocking eﬀect. /e use of ultrasound-guided on routine care, respectively. Ultrasound-guided peripheral nerve block anesthesia types of subclavian brachial plexus peripheral nerve block for lower extremity nerve block can block should be performed using a frequency of 4–7MHz eﬀectively improve the blocking eﬀect and fast onset of arc probe [18], and the probe is placed in the downward anesthesia and eﬀectively reduce anesthesia-related com- depressed position of the clavicle 1cm away from the rostral plications. Ultrasound-guided peripheral nerve block can prominence position of the patient. /e patient’s brachial clearly observe the diﬀusion of anesthetic drugs, and the plexus nerve is clearly observed to show a grape-like shape of number of anesthetic drugs used for block is 30% to 40% less low-density ring-shaped hyperechoic, and the phenomenon than that of conventional block, which can eﬀectively reduce of anesthetic drug wrapping the nerve is visible after per- the complications caused by the use of anesthetic drugs in patients. Although the advantages of ultrasound-guided forming the block. /e application of ultrasound-guided continuous subclavian brachial plexus block in patients with peripheral nerve block anesthesia are obvious, it also has some limitations, such as the adverse eﬀects on the tissues multiple upper extremity fractures not only eﬀectively im- proved analgesia but also eﬀectively reduced the inﬂam- near the nerve, thediﬃcultyof blocking nerveswithcomplex matory response and decreased the incidence of anatomical structures and deeper locations, which may lead postoperative related complications. Another researcher to poor blocking eﬀects, and whether the frequency and found that, by comparing the eﬀect of diﬀerent concen- examination time of diﬀerent peripheral nerve block ap- trations of ropivacaine in ultrasound-guided brachial plexus plication probes will increase peripheral nerve injury, vas- block, the blocking eﬀect was the same when the concen- cular injury and hematoma, and nerve ischemia. Whether diﬀerent peripheral nerve block application probe fre- tration of anesthetic drug was the same, independent of the drug dose. /e lumbar plexus nerve, because it is in the deep quencies and examination times may increase peripheral nerve injury, vascular injury, and peripheral nerve com- interstitial space of the psoas major muscle next to the lumbar spine, consists of multiple tiny nerves, and improper plications such as hematoma and nerve ischemia still needs to be further determined. /ese issues will be the focus of block is prone to phenomena such as renal hematoma. BORE has found in ultrasound-guided lumbar plexus blocks subsequent research on ultrasound-guided peripheral nerve Journal of Healthcare Engineering 5 blocks, and as these issues are gradually resolved, ultra- prominent [14]. In 2017, a medical enterprise in the United sound-guided peripheral nerve blocks are expected to be- States caused about 47.5GB of data leakage due to system mismanagement, involving sensitive private information come a common mode of clinical nerve blocks. As regards anesthesia methods, the blind exploration group of brachial such as names, addresses, and case records of about 150,000 plexus nerve block methods includes three methods: patients. An individual’s medical records involve personal interosseous groove approach alone, axillary approach privacy and are personal data that can only be accessed by alone, and interosseous groove combined with axillary ap- authorized users. Traditional medical data adopts a cen- proach. In the ultrasound group, the brachial plexus nerve tralized storage strategy, and a large amount of medical data block methods included interosseous groove approach accumulates in hospital information centers or regional alone, supraclavicular approach alone, axillary approach health data centers. With the proliferation of medical data, alone, and combined interosseous groove axillary approach, the load carried by the centers continues to strengthen, and combined supraclavicular axillary approach, and combined security risks continue to increase. In response to the interosseous groove ulnar nerve block. In the blinded group, problems of medical data, blockchain technology provides a good solution for data storage and transmission with its the interosseous sulcus approach was performed with the patient lying ﬂat on the pillow, head turned to the opposite special technical architecture. Based on the current demand side, and arm to the side of the body, with the operator of medical data utilization and the technical characteristics standing in front of the patient’s head, ﬁrst having the of blockchain, a new medical data storage architecture based patient raise his head, revealing the sternal and clavicular on blockchain is proposed, as shown in Figure 3. /e ar- heads of the sternocleidomastoid muscle, identifying the chitecture is mainly divided into four layers: data layer, anterior and middle oblique muscle gaps [21], and entering communication layer, consensus layer, and application the needle vertically through the lateral edge of the inter- layer. In the data layer, patients’ medical records are stored osseous sulcus to ﬁnd the hypophysis. /e local anesthetic permanently in blocks, and the blocks are connected into chains by timestamps through the creation of mapping drug was pushed in after the sensation was detected. In blind exploration group axillary block method, the patient was pointers by hash functions to ensure the tamper-evident nature of medical records. /e transmission of medical data placed in a supine position with the head slightly tilted to the opposite side, the aﬀected upper limb was abducted by 90 , chain adopts asymmetric encryption algorithm [14]. After generating the data, the medical data generator (e.g., hos- the elbow was ﬂexed by 90 , the forearm was externally rotated, the most obvious place of axillary artery pulsation pital) encrypts the data using public key, and the patient was touched as the puncture point, and the needle was parses the data using private key to ensure the security of injected with the local anesthetic drug after encountering the data transmission. In addition, medical data blockchain can sense of breakthrough and the pulsation of the axillary also stipulate diﬀerent permissions for diﬀerent people by artery, and there was no return blood in the retraction. setting multiple private keys, single authorization, or mul- tiple authorizations in complex time and space and restrict them in time; for example, only the corresponding doctors 2.2. Internet Blockchain Medicine. As a decentralized, can access the data during a speciﬁc consultation time in- detrusted database technology solution with complete and terval. At the same time, each medical record must have the transparent information and privacy protection, blockchain digital signature of the corresponding medical personnel, can build an eﬃcient and reliable value transmission system which is also an important guarantee of the transparency of and promote the Internet as a network infrastructure for blockchain technology. In case of medical disputes, it is easy building social trust [14]. Blockchain has signiﬁcant ad- to trace the medical records. /e ability of medical data to be vantages in optimizing business processes, reducing oper- created, appended, and shared by multiple authorized ating costs, and improving collaboration eﬃciency in the parties will reshape the eﬃciency and transparency of the ﬁnancial industry, and its application in other industries is entire medical industry. In the communication layer, also rapidly developing. Focusing on the health sector, the medical data chain usually adopts P2P technology to or- construction of healthcare big data faces the dual challenge ganize each node, which is diﬀerent from the traditional of information security and privacy protection. Blockchain centralized network model. /e nodes in the P2P network is highly fault-tolerant, tamper-proof, and privacy-protec- are equal and there is no centralized server, which is a good tive and has important applications in medical, pharma- preventive eﬀect for the large-scale leakage of medical data. ceutical, health insurance, and genomics ﬁelds. In the ﬁeld of /e distributed data storage also improves the redundancy health services, patients’ medical data has been an asset. Due and stability of the whole system. /e consensus layer is a to the uneven progress of hospital informatization con- strategy and method for the nodes in the medical data chain struction, some hospitals cannot integrate their internal to reach agreement, which solves the problem of trans- information systems, poor interaction of information sys- mitting trusted information and transferring value over tems between hospitals, nonuniform data structure of untrustworthy channels and achieves a state of mutual trust medical records, and nonstandardized data standards of among nodes in a decentralized context. Traditional proof- electronic medical records, which makes medical data of-work requires mathematical operations to obtain book- sharing very diﬃcult. /ere are many problems with the keeping rights, which consumes higher resources and is less storage, transmission, and utilization of medical data, supervisee, and reaching consensus relies on the joint among which the problem of sensitive data leakage is very participation of the whole network [14]. /e main idea of 6 Journal of Healthcare Engineering Digital Copyright Identity Intellectual Property & Social Management Charity Authentication Securities Insurance Financial Electronic Medical Records Blockchain Application Ecology Credit Carbon Emissions Energy Gas Stations Power Trading Healthcare Payment Electronic Medical Records Medical Drug Traceability Figure 3: Blockchain application scenarios. proof-of-stake is that the ease of access to node bookkeeping 3.2. Analysis of Sequencing Mutual Information in rights is positively correlated with the beneﬁts held by nodes, Anesthesia. /e determination of the patient’s state of which reduces resource consumption and improves per- consciousness during anesthesia has been an important issue formance compared to proof-of-work. Smart contracts in for scientiﬁc research. /ere is still no monitor that can the application layer can meet the needs of healthcare demonstrate its ability to analyze the patient’s state of providers for healthcare data collection and exchange so- consciousness. Most monitors assess the state of sedation in lutions [22]. It is a multiuser participatory formulation, anesthesia only by analyzing changes in the Electroen- proliferation through P2P networks, and automatic execu- cephalography (EEG) signal of a single channel [27]. /e tion on the blockchain, which enables patients to deliver state of consciousness of the brain is importantly related to medical data to data researchers with conﬁdence and pro- the coupling of information in the brain domain as well as to synchronous oscillations, and, especially in recent years, motes the analysis and deeper utilization of healthcare big data [14]. many theories have supported the important hypothesis that Apart from the blockchain-based solutions, a large information coupling is an important condition for the number of artiﬁcial intelligence- and machine learning- existence of consciousness. For example, changes in cortical based clinical and healthcare systems have been developed in neural activity shifting from high to low frequencies with clinical and wellbeing setups for cancer [23], diabetes deepening anesthesia, enhancement of gamma waves during mellitus [24], and wellness recommendations [25, 26]. learning, and 40Hz oscillations were related to higher cognitive functions and consciousness. It is generally be- lieved that the “information coupling” between the allo- 3. Method cortex and the cortical cortex is one of the conditions for the 3.1. Model Architecture. /ere is currently no uniform emergence of consciousness. In anesthesia or sleep, the loss of consciousness is manifested by the decoupling and loss of deﬁnition of blockchain in the industry. Blockchain is a decentralized shared ledger that stores blocks of data in a connections between the functional areas of thalamocortical and cortical cortices. /e algorithm of mutual information cryptographic chain structure in chronological order and is maintained collectively and tamper-proof by consensus analysis based on sorting entropy is called sorting mutual algorithms. Blockchain technology provides a decentralized, information. Since the kinetic properties of EEG signals can open, Byzantine fault-tolerant transaction mechanism that is be viewed as changes in various modes on the time scale, the expected to be the foundational framework for the next sorting entropy theory can be a good way to calculate the generation of Internet transactions. /e basic framework of degree of mode changes in complex system motions. As a blockchain mainly consists of a data layer, a network layer, a time-varying signal, the amplitude and frequency of the EEG consensus layer, and an application layer, as shown in change over time include both rising and falling modes. Figure 4. Statistics of such pattern changes can be used to analyze Journal of Healthcare Engineering 7 Encrypted Ultrasound Medical Alliance DApp Application Layer Hybrid Proof Class PoX BFT Class Consensus Layer Propagation Protocol Node Discovery P2P networks Network Layer Encryption function components Ledger copy storage Hash Functions Data Packaging Aggregation Digital signatures Data Serialization Asymmetric encryption Atomic Data Recording Merkle tree Data layer Figure 4: Model structure. brain activity. Mutual information is used to measure the (6) Calculate the entropy of the joint probability dynamical coupling and information transfer of systems X distribution. and Y. H(X, Y) � − 􏽘 􏽘 p(x, y)logp(x|y). /e details of the PMI algorithm are described as follows: (4) x∈X y∈Y (1) Given a time series x (t � 1,2, . . .), map the time series to the vector X [x , x , . . . , x ] with (7) Obtain sorting mutual information based on sorting t t t+τ t+mτ entropy. embedding dimension of m and time delay of τ. (2) Arrange X in ascending order. I(X; Y) � H(X) + H(Y) − H(X, Y). (5) x t + j − 1 τ ≤ x t + j − 1 τ ≤ . . . ≤ x t + j − 1 τ . (1) 􏼂 􏼁 􏼁 􏼁 􏼁 􏼁 􏼁􏼃 1 2 m (3) Compute the probability distribution p , p , . . . , p 3.3. Analysis of Sequencing Mutual Information in Anesthesia. 1 2 k of the sequence of symbols, where k≤ m! For m- Not only does the emergence of Bitcoin solve the problem of dimensional numbers, there are m! kinds of order- value transfer in a detrusted peer-to-peer network, but also ing, and each vector X can be mapped to one of m! its proof-of-work (PoW) consensus algorithm combined with economic incentives and cryptography makes block- (4) Calculate the entropy of the ordering of the time chain cross the Byzantine fault-tolerance gap in distributed series x(t), t � 1,2, . . . . { } systems, bringing great innovations and breakthroughs in how to reach consensus in distributed scenarios. Since then, H(X) � − 􏽘 p logp . (2) j j many new Byzantine fault-tolerant consensus algorithms j�1 inspired by Bitcoin have emerged [14]. In its seminal paper on Bitcoin, the PoW consensus algorithm was adopted, (5) Meanwhile, compute the sorting entropy of another where one party submits a computational result that is time series y (t � 1,2, . . .), which is recorded syn- known to be diﬃcult to compute but easy to verify, and chronously with t . everyone else can verify this result by being conﬁdent that the submitting party has completed a signiﬁcant amount of H(Y) � − 􏽘 p logp . (3) computation to obtain the result. /e larger the number of j j j�1 possible hashes is, the smaller the chance that two values will 8 Journal of Healthcare Engineering create the same hash. /is made it uneconomical for e node collects unconﬁrmed transactions from across the network for the current time period, while adding a Coinbase transaction for issuing spammers to send large amounts of spam while still allowing new bitcoin rewards, forming a collection of transactions for the current users to send normal e-mail to other users when needed [14]. block body Bitcoin uses a similar system for the same purpose, where nodes compete against each other based on their computer’s Calculate the Merkle root of the block body transaction set into the computing power to solve a complex but easy-to-verify block header, ﬁll in the other metadata of the block header, where the random number Nonce is set to 0 SHA256 mathematical puzzle (a process known as mining), and the node that solves the puzzle the fastest receives the Add 1 to the random number Nonce, calculate the rightto keeptrackoftheblocks and thesystemautomatically double SHA256 hash of the current block header generates Bitcoin rewards and transaction fees within the blocks. /e Bitcoin system controls the average block False generation time of about ten minutes by ﬂexibly adjusting ≤ target hash value the diﬃculty of the random number search. In general, the PoW consensus algorithm’s random number search process True is shown in Figure 5. Successfully search for the appropriate random number, the section point gets the bookkeeping Suppose that an attacker opens another chain on the right of the block main chain, called the attack chain. /e probability that the attacker succeeds in ﬁlling a given gap can be approximated Figure 5: Consensus algorithm search process. as Gambler’s Ruin Problem [14]. According to the longest chain mechanism, the attacking chain has to catch up with the main chain to succeed; then its probability that the z k − λ n− k λ e q ⎡ ⎣ ⎤ ⎦ attacker opens another chain, called the attacking chain, on P � 1 − 􏽘 (9) 1 − 􏼠 􏼡 . k! p k�0 the main chain is assumed. /e probability that the attacker succeeds in ﬁlling a given gap can be approximated as It is calculated that in the case where the malicious Gambler’s Ruin Problem. attacking node has less than 50% of the computing power, its According to the longest chain mechanism, the attacking probability of successfully achieving an attack decreases chain must catch up with the main chain in order to succeed, exponentially as z increases [14]. In general, Bitcoin takes z and then its probability is to be 6, that is, a new block is created and followed by 6 1 q⩾p blocks before the transactions in that block are considered ⎧ ⎪ secure. To reduce the risk of forking and waiting for enough P � , (6) z z blocks to be conﬁrmed, blockchains with the PoW con- 􏼠 􏼡 q< p sensus algorithm are limited in throughput but are very scalable and nodes are free to join or exit. where p is the probability that the honest node makes the next block, q is the probability that the attacking node makes 4. Experimentation and Evaluation the next block, and P is the probability that the attacker 4.1. Dataset. Eighty-six patients with femoral neck fractures ﬁnally closes the gap of z blocks and overtakes the attacking who underwent surgical treatment in a hospital from July chain. If honest blocks will take the average expected time to 2016 to July 2018 were selected for the study, and they were produce a block, the potential progress of the attacker is a randomly divided into an observation group and a control Poisson distribution with the expected value of the group, with 43 cases in each group. /e patients in the distribution. observation group were aged 60 to 85 years, with an average λ � z . age of 63.52±1.29 years; 28 cases were males, and 15 cases (7) were females. /e patients in the control group were aged 61 to 84years, with a mean age of 63.19±1.18 years; 26 cases /erefore, to calculate the probability of the attacker were males, and 17 cases were females. /ere was no sta- catching up, the probability density of the Poisson distri- tistically signiﬁcant diﬀerence between the general data of bution of the number of progress blocks made by the at- the two groups of patients (P>0.05). /e study was ap- tacker needs to be multiplied by the probability of the proved by the hospital ethics committee, and the patients attacker still being able to catch up given that number to and their families gave informed consent. Inclusion criteria obtain the following equation: were as follows: meeting the indication for surgery; being (z− k) conﬁrmed as femoral neck fracture by MRI, CT, and X-ray; ⎧ ⎪ k − λ⎪ 􏼠 􏼡 , k⩽z normal mental status; performing internal ﬁxation treat- λ e (8) ment; and fracture time within 1 week. Exclusion criteria k! k�0 ⎪ were as follows: combination of other injuries; combination 1, k> z. of lower limb deformities; bilateral femoral neck fractures; To avoid summing over an inﬁnite series, Equation (8) is old fractures; pathological fractures; low cooperation; simpliﬁed to the following form: presence of cognitive and mental disorders; and Journal of Healthcare Engineering 9 Table 1: Comparison of analgesic eﬀects between the two groups of patients at diﬀerent time points (n �43, x± s). Group Preoperative 6h postoperatively 12h postoperatively 24h postoperatively 48h postoperatively Control group 6.52±1.23 7.42±1.85 10.85±1.43 12.52±1.32 14.89±2.62 Observation group 6.61±1.18 9.48±1.89 14.98±2.85 16.85±2.96 18.79±2.63 T 0.3462 5.1076 9.2558 6.1192 4.5268 P 0.7300 0.0000 0.0000 0.0000 0.0000 Table 2: Comparison of HR, SBP, and DBP at diﬀerent time points between the two groups of patients (n �43, x± s). 5 min Before 10min 20min 30min 60min Group Indicator after anesthesia after anesthesia after anesthesia afteranesthesia afteranesthesia anesthesia HR 80.02±15.02 90.02±14.52 80.36±1.52 90.29±2.15 85.03±0.96 78.96±1.26 (beats/min) Control group SBP (mmHg) 139.02±17.05 152.96±2.16 157.02±2.35 137.05±1.39 149.63±18.06 139.63±1.38 DBP (mmHg) 90.95±12.35 99.89±11.27 94.02±1.15 91.96±1.52 90.02±1.52 92.96±3.28 HR 80.12±14.93 82.96±15.16 83.56±12.16 84.15±13.13 84.02±14.15 80.12±1.01 Observation (beats/min) group SBP (mmHg) 138.37±17.15 140.15±16.39 142.34±15.05 139.86±17.85 139.98±18.69 137.96±15.39 DBP (mmHg) 89.63±13.02 92.96±0.32 93.93±12.15 92.25±10.26 93.36±15.02 92.25±14.26 combination of coronary heart disease, diabetes mellitus, patient’s nerve bundle was inﬁltrated with the drug solution and hypertension. as observed on the ultrasound image, and, for the nerve bundle that was not successfully inﬁltrated, the needle tip orientation was changed to be close to the nerve before the 4.2. Data Preprocessing. After the patients in both groups drug was injected until it was completely inﬁltrated with the were admitted to the room, cardiac monitoring was con- drug solution. nected, intravenous access was quickly established, and all vital signs such as pulse rate, oxygen saturation, heart rate (HR), and blood pressure were closely monitored. /e 4.3. Evaluation Metrics. /e analgesic eﬀects of the two control group analyzed the decentralized information of groups were compared. /e mechanical pain threshold of users using the algorithm based on Internet blockchain the skin around 2cm of the patient’s surgical incision was proposed in this paper, as well as parallel intravenous in- measured at 6, 12, 24, and 48h postoperatively using the halation compound anesthesia, and, at the induction of tactile measurement kit Nonfruit, respectively, and the anesthesia, patients were given intravenous injection of intensity of the measurement tool was increased from 0.4g 0.05mg/kg midazolam, 3 μg/kg fentanyl citrate injection with the ﬁber tip in vertical contact with the skin, ensuring (0.8mg/kg cis-atracurium with 1.5mg/kg propofol), and that the ﬁber tip was in a bent state for at least 2s. /e inhalation of sevoﬂurane, and, after completing tracheal corresponding intensity value of the ﬁber at the time of the intubation, the patients were given 4∼6mg/(kg-h) propofol patient’s tingling sensation (Xf) was recorded as the ﬁnal by micropump, and the EEG dual frequency index was measured intensity value. /e HR, systolic blood pressure maintained at 40∼60, with additional fentanyl and cis- (SBP), and diastolic blood pressure (DBP) before and 5, 10, atracurium if necessary. In the observation group, ultra- 20, 30, and 60min after anesthesia were compared between sound-guided nerve block anesthesia was performed, and the two groups. /e onset and maintenance time of sensory the patients were given 0.5mg of atropine sulfate injection block and the duration and maintenance time of motor intramuscularly before surgery. After admission, the pe- block were compared between the two groups. SPSS 19.0 ripheral veins were opened, HR and blood pressure were statistical software was used to process the data, and the routinely monitored, and the patients were given 0.03mg/kg count data were expressed as n/% by x2 test, and the midazolam intravenously for proper sedation. /e posterior measurement data were expressed as x± s by t-test, and the unilateral sciatic and lumbar plexus nerve block was per- diﬀerence was considered statistically signiﬁcant at formed under ultrasound (GELOGIQE9 color Doppler ul- P<0.05. trasound) guidance, and, after the small articular prominence was detected, the ultrasound probe was con- tinued to move upward until the images of L4∼5 and L3∼4 4.4. Results. From the comparison of the analgesic eﬀects of lumbar transverse process were clearly displayed; the needle the two groups of patients at diﬀerent time points, there was tip was placed close to the probe, and the out-of-plane no statistically signiﬁcant diﬀerence between the preoper- method was used to enter the needle, which could be ob- ative mechanical pain thresholds of the two groups served under ultrasound. /e puncture needle was observed (P>0.05); the mechanical pain thresholds of the patients in to pass through the L3∼4 transverse process gap until it the observation group were higher than those in the control group at 6, 12, 24, and 48h after surgery, and the diﬀerence reached the posterior 2/3, and local anesthetic drugs were injected immediately after the nerve plexus was found; the was statistically signiﬁcant (P<0.05). See Table 1. 10 Journal of Healthcare Engineering Table 3: Comparison of blockage between the two groups (n �43, x± s, min). Group Sensory blockade takes eﬀect Sensory blockade maintenance Motor block onset Motor block maintenance Control group Time Time Time Time Observation group 7.12±1.85 325.63±40.02 8.15±1.28 152.02±32.85 T 5.36±1.62 426.96±45.63 9.86±1.56 189.63±43.02 P 25.6326 12.2285 9.6325 20.6324 /e HR, SBP, and DBP of the two groups at diﬀerent Data Availability times were not statistically signiﬁcant when comparing the /e datasets used during the current study are available from HR, SBP, and DBP of the observation group at 5, 10, 20, 30, the corresponding author upon reasonable request. and 60min after anesthesia with those before anesthesia (P>0.05); the amplitude of HR, SBP, and DBP ﬂuctuations of the observation group at each time point was smaller than Conflicts of Interest that of the control group. See Table 2. /e onset of sensory block was shorter in the observation /e authors declare that they have no conﬂicts of interest. group than in the control group, and the maintenance time of sensory block, the onset of motor block, and the main- Authors’ Contributions tenance time of motor block were longer in the observation group than in the control group, and the diﬀerences were Qiang Cai and Yi Han contributed equally to this work. statistically signiﬁcant (P<0.05, Table 3). References 5. Conclusion [1] T. Mori, O. Nomura, and T. Ihara, “Ultrasound-guided pe- In this paper, we proposed a method of applying ultra- ripheral forearm nerve block for digit fractures in a pediatric sound-guided nerve block anesthesia to fracture patients in emergency department,” $e American Journal of Emergency the context of Internet blockchain, and two groups of Medicine, vol. 37, no. 3, pp. 489–493, 2019. patients were given intravenous inhalation complex an- [2] M. D. Baker and J. P. 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Analysis of the Effect of Applying Ultrasound-Guided Nerve Block Anesthesia to Fracture Patients in the Context of Internet-Based Blockchain

Analysis of the Effect of Applying Ultrasound-Guided Nerve Block Anesthesia to Fracture Patients in the Context of Internet-Based Blockchain

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Analysis of the Effect of Applying Ultrasound-Guided Nerve Block Anesthesia to Fracture Patients in the Context of Internet-Based Blockchain

Analysis of the Effect of Applying Ultrasound-Guided Nerve Block Anesthesia to Fracture Patients in the Context of Internet-Based Blockchain

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