ObjectiveTo discuss the clinical effects of intercostals nerve freezing technique for analgesia on post-operative chest. MethodsWe included 80 patients with thoracotomy in Zhongshan Hospital in Xiamen University between June 2013 and June 2014. The patients were divided into a trial group (30 males and 10 females at average age of 59.90± 10.62 years) and a control groups (28 males and 12 females at average age of 59.85± 10.52 years) by random digital table. The patients in the trial group were treated with frozen the intercostals nerve roots located in the incision and next intercostals before closing the chest by cryotherapy therapy apparatus (K520 type, Beijing Kulan Company). The patients in the control group were treated with self-control intravenous analgesia pump post-operation. We compared the postoperative incision pain and cough, sputum reflection score, and pulmonary complications between the two groups. ResultsThe pain degree in the trial group was significantly weaker than that in the control group on the first day, the second day and the seventh day after operation (t=-6.45, -4.95, -3.14, P < 0.05). Cough, sputum reflection score were significantly higher than those in the control group (P < 0.01). Pulmonary complications were significantly lower (t=3.023, P < 0.05). There were 4 patients with pneumonia and no pulmonary atelectasis in the trial group. While there were 8 patients with pneumonia in the control group and 1 patient with pulmonary atelectasis. ConclusionIntercostals nerve freezing technique can drastically reduce postoperative pain in the patients with open thoracic operation, effectively promote patient cough and expectoration, and reduce pulmonary complications rate.
Objective To evaluate the efficacy of intravertebral analgesia for external cephalic version. Methods We electronically searched The Cochrane Library (Issue 4, 2009), PubMed (1980 to 2009), Ovid MEDLINE (1950 to 2009), Ovid EBM Database (1991 to 2009), EMbase (1980 to 2009), CBM (1978 to 2009) and CNKI (1979 to 2009) to collect literature about intravertebral analgesia for external cephalic version. We screened randomized controlled trials (RCTs) according to the predefined inclusion and exclusion criteria, extracted data and evaluated the quality of the included studies, and then performed meta-analyses by using RevMan 5.0.13 software. Results Seven RCTs involving 620 women met the inclusion criteria. Five trials were of relatively high quality, and 1 of low quality and 2 not clear. The result of meta-analyses showed that intravertebral analgesia was superior in external cephalic version with a RR 1.53 and 95%CI 1.24 to 1.88. Conclusion Intravertebral analgesia can increase the successful rate of external cephalic version in the treatment of breech presentation compared with intravenous medicine for systematic use or no analgesia.
目的 评估术后亚麻醉剂量的氯胺酮提高布托啡诺自控静脉镇痛(patient sey-controlled intravenous analgesia， PCIA）效果的可行性及应用价值。 方法 将2008年6月-2009年5月收治的68例美国麻醉师协会（ASA）分级Ⅰ~Ⅱ级的择期外科手术患者随机分为B组(0.2 mg/mL布托啡诺组）和BK组(0.2 mg/mL布托啡诺和4 mg/mL氯胺酮混合液组），每组34例。患者于手术结束后连接自控镇痛泵行自控PCIA。观察并记录拔除气管导管后及PCIA后1、4、8、12、24 h患者疼痛评分视觉模拟评分（VAS）、镇静评分、血压、心率、血氧饱和度（SPO2）、按压次数和布托啡诺消耗量，以及呼吸抑制(SPO2≤92%）、恶心呕吐、尿潴留等并发症。 结果 BK组24 h布托啡诺用量减少40%，VAS评分降低，与B组比较差异均有统计学意义(Plt;0.05）。同时VASgt;3的发生率明显减少(Plt;0.05）。镇静评分和过度镇静发生率降低，但差异无统计学意义(Pgt;0.05）。恶心呕吐的发生率两组差异无统计学意义(Pgt;0.05）。 结论 布托啡诺配伍亚麻醉剂量的氯胺酮在术后患者PCIA中能增强布托啡诺的镇痛效果，不良反应无明显增加。
目的 探讨围手术期超前平衡镇痛在肛肠手术中止痛的临床效果。方法 回顾性分析2009年11月至2010年10月期间巴中市中医院肛肠科123例采用腰俞穴麻醉的肛肠手术患者的临床资料，患者被分成超前平衡镇痛组（60例）和传统镇痛组（63例）2组。2组术前准备相同，术后均口服布洛芬缓释胶囊300mg止痛，2次/d。对Ⅲ～Ⅳ度内痔及内括约肌痉挛的患者术中均常规行内括约肌松解术，对VAS评分6分以上的患者选择使用盐酸曲马多注射止痛。超前平衡镇痛组术前0.5h肌注安定10mg，口服布洛芬缓释胶囊300mg，术中采用2%盐酸利多卡因5ml、0.75%盐酸布比卡因5ml、芬太尼50 μg、地塞米松5mg用生理盐水稀释成20ml行腰俞穴麻醉并止痛，术毕肛内塞用双氯芬酸钠栓1枚。传统镇痛组术中采用2%盐酸利多卡因5ml、0.75%盐酸布比卡因5ml用生理盐水稀释成20ml行腰俞穴麻醉。比较2组术后4、6、8、12、24及48 h VAS评分、盐酸曲马多使用率及恶心、呕吐及尿潴留的发生率。结果 术后4、6、8、12、24及48 h VAS评分超前平衡镇痛组均明显低于传统镇痛组（P＜0.01），术后盐酸曲马多使用率超前平衡镇痛组明显低于传统镇痛组（P＜0.05），恶心、呕吐及尿潴留的发生率2组比较差异均无统计学意义（P＞0.05）。结论 围手术期超前平衡镇痛用于肛肠手术止痛是一种疗效肯定、安全、不良反应少而又简单易行的镇痛方法。
Objective To compare the analgesia effect and clinical rehabilitation between continuous adductor canal block (ACB) and single shot ACB in total knee arthroplasty (TKA)． Methods Between October 2016 and February 2017, 60 patients with severe knee osteoarthritis undergoing primary unilateral TKA were prospectively recruited in the study. All the patients were randomly allocated into 2 groups and received ultrasound-guided continuous ACB (group A, n=30) or single shot ACB (group B, n=30), respectively. There was no significant difference in gender, age, body mass index, nationality, American Society of Anesthesiology (ASA) grading, and preoperative knee range of motion and quadriceps strength between 2 groups (P>0.05). After operation, the tourniquet time, postoperative drainage volume, hospitalization time, and adverse events in 2 groups were recorded. Visual analogue scale (VAS) scores at rest and during activity, the quadriceps strength, the knee range of motion, and the time of 90° knee flexion in 2 groups were also recorded and compared. Results There was no significant difference in tourniquet time, postoperative drainage volume, and incidence of adverse events between 2 groups (P>0.05). But the hospitalization time was significant shorter in group A than in group B (P<0.05). VAS scores at rest and during activity were lower in group A than in group B, with significant differences in VAS score at rest after 12 hours and in VAS score during activity after 8 hours between 2 groups (P<0.05). The quadriceps strength was higher in group A than in group B, with significant difference at 24, 48, and 72 hours (P<0.05). The knee range of motion was significantly better in group A than in group B at 24, 48, 72 hours and on discharge (P<0.05). The time of 90° knee flexion was significantly shorter in group A than in group B (t=–2.951, P=0.016). There were 4 patients in group A and 7 patients in group B requiring meperidine hydrochloride (50 mg/time) within 24 hours, and 3 patients in group A and 7 patients in group B at 24 to 48 hours, and 1 patient in group A and 3 patients in group B at 48 to 72 hours. Effusion in the catheter site occurred in 2 cases of group A, but no catheter extrusion occurred. Conclusion Continuous ACB is superior in analgesia both at rest and during activity and opioid consumption compared with single shot ACB after TKA. And the quadriceps strength could be reserved better in continuous ACB group, which can perform benefits in early rehabilitation.
Objective To study the analgesic effect of intercostal nerve crush after thoracotomy. Methods Model of forceps crushing of intercostal nerve in 20 rabbits was made pathological changes and repairing process of the nerve were observed in order to identify the best forceps crushing degree that could be used clinically. Prospective double-blind randomized trial in 210 patients who had undergone thoracotomy was carried out from February 1996 to June 2002,and were divided into three groups. Intercostal nerve forceps crushing group (group A):before closing chest,4 routes of costal nerves(incision,above and below incision, and one for inserting drainage tube)were dissected and squeezed with forceps. Intercostal nerve forceps crushing with anaesthetic drugs infiltration group (group B):based on intercostal nerve forceps crush, the intercostal nerve in the chest tube location was infiltrated with bupivacaine hydrochloride 5ml, and control group. Postoperative incisional pain was recorded by visual analogue scales (VAS) including recording the dosage of dolantin needed, arterial oxygen saturation (SaO2) on 3,7,15,and 30 d after operation. Results Pathological changes of the axons and myelin sheaths progressed by the degree of crushing, but recovered in 4-6 weeks. The blood vessel microhemostat was locked to the third teeth and lasting for 30 seconds, the effective analgesia and quick recovery were provided. The clinical use of nerve crush was made with the same procedure which showed b analgesic effect in both group A and group B. The total effective rate in 3 d after operation was 97.1%,98.6% and 0% in group A, B, and the control group respectively, and group A, B was significantly higher than that in contral group (Plt;0.001, 0.001); dosage of dolantin administration in group A,B and control group was 40.20±4.12mg, 35.42±3.31mg and 135.10± 8.17mg respectively (Plt;0.01). There was no statistically difference in SaO2 for three groups (P=0.475). Conclusion The intercostal nerve crush is an available and lasting analgesic procedure to relieve postoperative pain of thoracotomy. The technique is simple and can improve respiratory function and accelerate sputum to be coughed up. It can also decrease the opportunity of pulmonary infection. Intercostal nerve may regenerate and recover its function although if it is temporary contused.
Objective To investigate the applied significance of adjustable low-concentration of mixed oxygenand nitrous oxide inhalation sedation combined with lidocaine local anesthesia in anorectal surgery. Methods Three hundreds patients underwent anorectal surgery in our hospital were divided into control group （n=154） and observation group （n=146）. Patients of control group underwent pure lidocaine local anesthesia， and patients of observation group underwent mixed oxygen and nitrous oxide sedation analgesia combined with lidocaine local anesthesia. Vital signs before and after operation as well as results of sedation and analgesia were compared between the 2 groups. Results Anorectal surgeries of all patients were performed successfully. There were no significant differences on change of heart rate， blood pressure， and oxygen saturation between the 2 groups before and after operation （P＞0.05）. The operation time between the control group 〔（36.3±6.8） min〕 and observation group 〔（35.4±6.5） min〕 had no statistically significant difference（t=-0.607， P=0.544）. The analgesic effects （Z=-6.859， P=0.000） and sedative effects （Z=-5.275， P=0.000） of obser-vation group were both better than those of control group. Conclusions Low-concentration of mixed oxygen and nitrous oxide inhalation sedation combined with lidocaine local anesthesia can relieve the discomfort of fear and pain， no side-impacts on vital sign before and after operation were observed，and it has better effects of sedation and analgesia， therefore it can be recommended to clinical application.
ObjectiveTo systematically evaluate the effectiveness and safety of dezocine versus fentanyl for postoperative patient-controlled intravenous analgesia (PCIA). MethodsWe electronically searched the specialized trials registered in The Cochrane Library (Issue 2, 2013), the Cochrane anesthesia group, MEDLINE, EMbase, CBM, CNKI, VIP and WanFang Data from inception to February, 2013. Randomized controlled trials (RCTs) on dezocine versus Fentanyl for postoperative PCIA were included. RevMan 5.0 software was used for meta-analysis after critically literature screening, data extracting and assessing of methodological quality independently by two reviewers. ResultsA total of 15 RCTs involving 1 116 patients were finally included. The results of meta-analysis showed that there was no significant difference in postoperative analgesia and sedation at the hour-points of 2 h, 4 h, 6 h, 8 h, 12 h, 24 h, and 48 h after surgery. As for safety, the incidences of postoperative nausea, vomiting, skin pruritus, respiratory depression and uroschesis in the dezocine group were lower than those in the fentanyl group. ConclusionCompared with fentanyl, dezocine has the same effects of analgesia and sedation for PCIA; its incidence of adverse reactions is lower, so dezocine is safer in clinic.