Objective To compare the pain relief and rehabilitation effect of intercostal nerve block and conventional postoperative analgesia in patients undergoing thoracoscopic surgery. Methods China National Repository, Wanfang Database, VIP, China Biomedical Literature Database, Web of Science, Clinicaltrials.gov, Cochrane Library, EMbase and PubMed were searched from establishment of each database to 10 Febraray, 2022. Relevant randomized controlled trials (RCTs) of intercostal nerve block in thoracoscopic surgery were collected, and meta-analysis was conducted after data extraction and quality evaluation of the studies meeting the inclusion criteria. Results A total of 21 RCTs and one semi-randomized study were identified, including 1 542 patients. Performance bias was the main bias risk. Intercostal nerve block had a significant effect on postoperative analgesia in patients undergoing thoracoscopic surgery. The visual analogue scale (VAS) score at 12 h after surgery (MD=–1.45, 95%CI –1.88 to –1.02, P<0.000 01), VAS score at 24 h after surgery (MD=–1.28, 95%CI –1.67 to –0.89, P<0.000 01), and VAS score at 48 h after surgery significantly decreased (MD=–0.90, 95%CI –1.22 to –0.58, P<0.000 01). In exercise or cough state, VAS score at 24 h after surgery (MD=–2.40, 95%CI –2.66 to –2.14, P<0.000 01) and at 48 h after surgery decreased significantly (MD=–1.89, 95%CI –2.09 to –1.69, P<0.000 01). In the intercostal nerve block group, the number of compression of the intravenous analgesic automatic pump on the second day after surgery significantly reduced (SMD=–0.78, 95%CI –1.29 to –0.27, P=0.003). In addition to the analgesic pump, the amount of additional opioids significantly reduced (SMD=–2.05, 95%CI –3.65 to –0.45, P=0.01). Postoperative patient-controlled intravenous analgesia was reduced (SMD=–3.23, 95%CI –6.44 to –0.01, P=0.05). Patient satisfaction was significantly improved (RR=1.31, 95%CI 1.17 to 1.46, P<0.01). Chest tube indwelling time was significantly shortened (SMD=–0.64, 95%CI –0.84 to –0.45, P<0.001). The incidence of analgesia-related adverse reactions was significantly reduced (RR=0.43, 95%CI 0.33 to 0.56, P<0.000 01). Postoperative complications were significantly reduced (RR=0.28, 95%CI 0.18 to 0.44, P<0.000 01). Two studies showed that the length of hospital stay was significantly shortened in the intercostal nerve block group, which was statistically different (P≤0.05), and there was no statistical difference in one report. Conclusion The relief of acute postoperative pain and pain in the movement state is more prominent after intercostal nerve block. Intercostal nerve block is relatively safe and conforms to the concept of enhanced recovery after surgery, which can be extensively utilized in clinical practice.
ObjectiveTo explore the safety and efficacy of thoracoscopic guided thoracic paravertebral block (TPVB) in resection of lung, and to provide strategies for enhanced recovery after surgery of lung surgery. MethodsA total of 180 patients with thoracoscopic surgery of lung (including sublobar resection and lobectomy) hospitalized between May 2021 and June 2023 were included. There were 108 females and 72 males with an average age of (62.15±7.36) years. Patients were divided into 3 groups. Patients received subcutaneous injection of ropivacaine (concentration: 0.375%, dose: 2 mg/kg) on peripheral incision at chest closing were allocated into a group A. Patients received ultrasound-guided injection of ropivacaine (concentration: 0.375%, dose: 2 mg/kg) at the TPVB point after chest closing into a group B. Patients received thoracoscopic guided injection of ropivacaine (concentration: 0.375%, dose: 2 mg/kg) before chest closing at the TPVB point into a group C. The baseline data of each group were compared, and the effectiveness outcomes included perioperative adverse drug reactions, pain scores, postoperative analgesic drug use and postoperative hospital stay were compared among the 3 groups. ResultsThere were no statistical differences in the baseline data of three groups, including age, weight, gender, incidence of previous underlying diseases, operation time, number of surgical incisions, number of drainage tubes inserted, and dosage of sufentanil or propofol used during surgery (P>0.05). There were no adverse anesthesia events in the 3 groups during the operation, the frequency of self-controlled intravenous analgesia pump, the VAS score, the incidence of adverse reactions, and the rate of postoperative analgesic drug use in group C was less or lower than the other two groups (P<0.05). The hospital stay in the group C and group B were lower than that in the group A (P<0.05). ConclusionThoracoscopic guided TPVB can reduce postoperative pain without increasing postoperative side effects, which had accelerated the enhanced recovery after surgery of lung.
目的:观察在经尿道膀胱肿瘤电切术中采用闭孔神经阻滞减少闭孔反射的情况及远期疗效。方法:选取2005年1月～2006年5月期间我科收治的60例确诊膀胱肿瘤患者,严格按照手术适应症随机分为两组:对照组30例单纯硬膜外麻下行经尿道肿瘤电切术,治疗组30例在硬膜外麻醉基础上进行闭孔神经阻滞,观察两组闭孔反射发生率并进行术后随访,观察肿瘤的复发情况。结果:对照组闭孔反射发生率明显高于治疗组(Plt;0.05),经过随访治疗组30例患者3例出现了膀胱肿瘤复发,复发率为10.0%,对照组复发率为13.3%(4/30),两组复发率无明显差异(Pgt;0.05)。结论:在经尿道膀胱肿瘤电切术中采取闭孔神经阻滞能明显减少闭孔反射的发生,明显提高手术的效果,但是改善膀胱肿瘤近期和远期疗效还有待进一步探讨。
ObjectiveTo investigate the efficacy of sequential treatment with adductor canal nerve block (ACNB) and cyclooxygenase 2 (COX-2) selective inhibitor (parecoxib and celecoxib) after primary total knee arthroplasty (TKA). MethodsBetween January 2015 and December 2015, 90 osteoarthritis patients who met the inclusion criteria were treated, and randomly divided into 3 groups:ACNB+COX-2 group (group A, n=30), COX-2 group (group B, n=30), and control group (group C, n=30). There was no significant difference in gender, age, body mass index, side, and osteoarthritis duration between groups (P > 0.05), and the data were comparable. ACNB was used in group A at the end of TKA. Intravenous injection of parecoxib (40 mg per 12 hours) was administrated at the first three postoperative days, and followed by oral celecoxib (200 mg per 12 hours) until 6 weeks after operation in groups A and B; while placebo was given at the same time point in group C. Oral tramadol or intravenous morphine, as remedial measures, were introduced when patients had a visual analogue scale (VAS) score more than 4. The following indicators were compared between groups:the operative time, drainage volume at 24 hours after operation, length of hospital stay, and incidence of side effect; VAS pain scores, morphine consumption, range of motion (ROM) of the knee joint, and inflammatory cytokines levels at pre-operation and at 1 day, 2 days, 3 days, 1 week, 2 weeks, 4 weeks, and 6 weeks after operation; morphine consumption within first 24 hours and at 24 hours to 6 weeks after operation; the American Hospital for Special Surgery (HSS) score at 1, 2, 4, and 6 weeks after operation; and the serum coagulation parameters at pre-operation, and at 1, 3, and 14 days after operation. ResultsThe length of hospital stay was significantly shorter and the incidence of postoperative nausea and vomiting was significantly lower in groups A and B than group C (P < 0.05). The VAS scores at rest (VASR) of groups A and B were significantly lower than that of group C at 1, 2, and 3 days after operation (P < 0.05); difference in the VAS scores at walking (VASW) was significant between groups at 1 day after operation (P < 0.05), and group A had the lowest VASW; and the VASW of groups A and B were significantly lower than that of group C at 2 and 3 days and at 1, 2, 4, and 6 weeks after operation (P < 0.05). The difference in morphine consumption was significant between groups within the first 24 hours after operation (P < 0.05), and group A exhibited the lowest consumption; and the morphine consumption in groups A and B was significantly lower than that in group C at 24 hours to 6 weeks after operation (P < 0.05). Significant difference was found in HSS scores between groups at 1, 2, 4, and 6 weeks after operation, and group A showed the highest score (P < 0.05). At 1 and 2 days after operation, group A showed the highest ROM (P < 0.05), and ROM of groups A and B was significantly higher that of group C at 3 days, 1 week, 2 weeks, 4 weeks, and 6 weeks after operation (P < 0.05). Groups A and B were significantly lower than group C in the serum erythrocyte sedimentation rate at 2 days, 3 days, 1 week, 2 weeks, 4 weeks, and 6 weeks, in C-reactive protein levels at 1, 2, and 3 days, in interleukin 6 (IL-6) and TNF-α levels at 1 day to 6 weeks, and in IL-8 level at 2 and 3 days (P < 0.05). The drainage volume within the first 24 hours and the serum coagulation parameters within the 2 weeks after operation showed no significant difference between groups (P > 0.05). ConclusionSequential treatment with ACNB and COX-2 selective inhibitor is a safe and effective approach for postoperative pain management after primary TKA, and it can alleviate postoperative pain, promote the joint function recovery, and reduce the risk of adverse reactions.
Objective To compare the effect of sciatic nerve block (SNB) combined with continuted femoral nerve block (FNB) or continuted adductor canal block (ACB) on pain and motor function after total knee arthroplasty (TKA). Methods A total of 60 patients with TKA-treated osteoarthritis of the knee who met the selection criteria were enrolled between November 2020 and February 2021 and randomised allocated into the study group (SNB combined with continuted ACB) and the control group (SNB combined with continuted FNB), with 30 cases in each group. There was no significant difference in gender, age, body mass, height, body mass index, preoperative Hospital for Special Surgery (HSS) score, femoral tibial angle, and medial proximal tibial angle between the two groups (P>0.05). The operation time, the initial time to the ground, the initial walking distance, and the postoperative hospital stay were recorded. At 2, 4, 6, 12, 24, and 48 hours after operation, the numerical rating scale (NRS) score was used to evaluate the rest pain around the knee joint, the quadriceps femoris muscle strength was evaluated by the freehand muscle strength method, and the knee flexion and extension angles were measured. Results There was no significant difference in the operation time and initial walking distance between the two groups (P>0.05); the initial time to the ground and postoperative hospital stay of the study group were significantly shorter than those of the control group (P<0.05). Except for the 48-hour postoperative NRS score of the study group, which was significantly lower than that of the control group (P<0.05), there was no significant difference in the NRS scores between the two groups at the remaining time points (P>0.05). The quadriceps femoris muscle strength from 4 to 24 hours postoperatively and the knee extension angle from 2 to 6 hours postoperatively of the study group were significantly better than those of the control group (P<0.05); the differences in the quadriceps femoris muscle strength and knee extension and flexion angles between the two groups at the remaining time points were not significant (P>0.05). Conclusion SNB combined with either continuted ACB or continuted FNB can effectively relieve pain in patients after TKA, and compared with combined continuted FNB, combined continuted ACB has less effect on quadriceps femoris muscle strength, and patients have better recovery of knee flexion and extension mobility.
ObjectiveTo determine the effectiveness of continuous intercostal nerve block for pain relief after thoracotomy.MethodsFrom November 2017 to October 2018, 120 patients who received thoracotomy procedure in our hospital were collected, including 60 males and 60 females aged 40-77 (58.10±7.00) years. The patients were randomly allocated into three groups by digital table including a continuous intercostal nerve block group (group A, n=40), a single intercostal nerve block group (group B, n=40), and an epidural analgesia group (group C, n=40). All the groups received the same basic analgesia. The pain scores and rescue analgesic doses were compared.ResultsOn postoperative day (POD) 0, all groups achieved effective pain control, and the visual analogue score was 2.02±0.39 points in the group A, 2.13±0.75 points in the group B and 2.03±0.69 points in the group C (P>0.05). On POD 0-2 and POD 3-4 (without basement analgesia), there was no significant difference between the group A and group C in the pain scores (2.08±0.28 points vs. 1.93±0.53 points, 3.20±0.53 points vs. 3.46±0.47 points, P>0.05), however, the difference between POD 0-2 and POD 3-4 in each group was stastically different (group A, 2.08±0.28 points vs. 3.20±0.53 points; group B, 2.42±0.73 points vs. 5.45±0.99 points; group C 1.93±0.53 points vs. 3.46±0.47 points, P<0.05). In terms of the rescue analgesic doses, there was no significant difference between the group A and group C (220.00±64.08 mg vs. 225.38±78.85 mg, P>0.05); it was larger in the group B than that in the group A and group C (343.33±119.56 mg vs. 220.00±64.08 mg; 343.33±119.56 mg vs. 225.38±78.85 mg, P<0.05).ConclusionMultimodal analgesia is an optimal choice in the initial stage after thoracotomy surgery. Continuous intercostal nerve block is an effective way to pain management in patients with thoracotomy.
目的 探讨改良区域神经阻滞麻醉在腹股沟疝无张力修补术中的优势和应用价值。方法 回顾性总结和分析2008年2月至2010年3月期间张掖医学高等专科学校附属医院运用改良区域神经阻滞麻醉行腹股沟疝无张力修补59例患者的临床资料。结果 59例患者按照神经阻滞麻醉效果分级标准，Ⅰ级52例，Ⅱ级6例， Ⅲ级1例。7例Ⅱ、Ⅲ级患者在分离腹膜前间隙内侧时自诉疼痛，经静脉给予杜非合剂2 ml后完成手术，但均未更改麻醉方式。术后无皮疹、皮下硬结、精索水肿、阴囊血肿、尿潴留、切口感染等并发症发生。结论 改良区域神经阻滞麻醉下行腹股沟疝无张力修补术效果好、安全性高、操作简单、费用低。
【摘要】 目的 观察密集型银质针松解术结合臂丛神经阻滞麻醉治疗老年肩周炎的疗效。 方法 2007年4月-2008年6月，将120例老年肩周炎患者（gt;60岁）随机分为治疗组、对照组各60例；治疗组采用密集型银质针松解术结合臂丛神经阻滞麻醉治疗，对照组则用单纯密集型银质针松解术治疗。 结果 治疗组痊愈43例、显效15例、好转2例；对照组痊愈41例、显效16例、好转3例。总有效率均为100%。两组疗效差异无统计学意义（Pgt;0.05），治疗组心率血压变化值及疼痛评分均低于对照组，差异有统计学意义（Plt;0.05）。 结论 密集型银质针松解术结合臂丛神经阻滞为治疗老年肩周炎的安全、有效方法。【Abstract】 Objective To investigate the effect of dense silver needle acupuncture therapy combined with brachial plexus nerve block for old patients with shoulder periarthritis. Methods A total of 120 patients with shoulder periarthritis diagnosed in our hospital between April 2007 and June 2008 were randomly divided into treatment group and control group with 60 in each group. Patients in the treatment group were treated with dense silver needle acupuncture therapy combined with brachial plexus nerve block, while patients in the control group were only treated with dense silver needle acupuncture therapy. Results In the treatment group, 43 patients were cured, the treatment produced effect in 15 patients, and improvement could be found in two patients. For the control group, those three numbers were respectively 41, 16 and 3. The effectice rate was 100% in both groups. The difference of effect between the two groups was not statistically significant (Pgt;0.05), while the variation of blood pressure and heart rate and the visual analogue scales in the treatment group were significant lower than these in the control gvroup (Plt;0.05) Conclusion The dense silver needle acupuncture therapy combined with brachial plexus nerve block is safe and effective in treating old patients with shoulder periarthritis.
Objective To study the neural mechanism of hypotension or shock state in acute cholangitis in severe type (ACST) and its value of clinical application. Methods A technique of blocking abdominal splanchnic nervi via right adipose capsule of kidney was carried out on 28 patients by injecting 1% lidocaine before urgent operation. Results After blocking the relevant nervi, hypotension or shock state in 23 patients were improved significantly (Ｐ＜0.05). The death rate was lower (14.3%) after having performed biliary decompressions with laparotomy. Conclusion Patients′ hypotension or shock state at the early phase of ACST is the result of neural reflex in which the splanchnic nervi is its afferent pathway. Blocking the relevant nervi before urgent operation, the valuable opportunity of emergency treatment can be obtainded and the complication and death rate are reduced significantly.
Objective To systematically evaluate effectiveness and safety of nerve block therapy for neck pain. Methods Databases including CENTRAL, PubMed, Ovid, ISI, EBSCO, CBM and CNKI were searched from the date of their establishment to November 2011, and relevant references were also retrieved manually to collect both domestic and abroad randomized controlled trials (RCTs) about nerve block therapy for neck pain. According to the inclusion and exclusion criteria, two researchers independently screened literature, extracted data, and assessed the quality of the included studies. Then the meta-analysis was conducted using RevMan 5.0 software. Results A total of 10 studies involving 625 participants were included. The results of qualitative analysis showed that: a) The short-term effectiveness of the nerve block therapy group was markedly superior to the placebo group, the cognitive therapy group and the transcutaneous electric nerve stimulation (TENS) group; and b) The short-term effectiveness of the combined nerve block therapy was markedly superior to the single nerve block therapy. The results of meta-analysis demonstrated that: a) There was no significant difference between the greater occipital nerve (GON) block group and the C2/3 nerve block group in neither short-term (SMD=−0.13, 95%CI −0.58 to 0.32, P=0.58) nor medium-term effectiveness (SMD=−0.01, 95%CI −0.46 to 0.44, P=0.98); and b): There was no significant difference between the injection with steroids group and the injection without steroids group in both short-term (SMD=0.16, 95%CI −0.13 to 0.44, P=0.28) and long-term effectiveness (SMD=0.27, 95%CI −0.02 to 0.55, P=0.07). Conclusion Current evidence shows nerve block therapy for neck pain is safe and especially good in short-term effectiveness. The combined nerve block therapy is probably more effective, but the effectiveness is not obviously improved by injection with or without steroids, and by different block methods. Due to the limitation of quality, quantity and total sample size of the included studies, this conclusion still needs to be proved by conducting more high quality and large scale studies.