目的 观察酒石酸布托啡诺与芬太尼合用于术后静脉自控镇痛（PCIA）的效果及最佳混合比例。 方法 2010年8月－2011年1月100例妇科手术患者，随机分为5组，每组20例。均全身麻醉术后采用负荷量+持续背景剂量+PCIA方案镇痛。根据不同配方分为F组：芬太尼1 mg+生理盐水至100 mL；B组：酒石酸布托啡诺10 mg+生理盐水至100 mL；BFⅠ组：芬太尼0.6 mg+酒石酸布托啡诺3 mg+生理盐水至90 mL；BFⅡ组：芬太尼0.5 mg+酒石酸布托啡诺5 mg+生理盐水至100 mL；BFⅢ组：芬太尼0.3 mg+酒石酸布托啡诺6 mg+生理盐水至90 mL。观察术后各时点视觉模拟评分（VAS）及镇静评分，患者满意度以及不良反应情况。 结果 术后早期BFⅢ组和B组VAS评分大于F组；镇静评分B组大于F组；B组满意度优良率小于其余各组；恶心呕吐发生率F组高于BFⅠ组及BFⅡ组。 结论 酒石酸布托啡诺和芬太尼合用于PCIA，镇痛效果确切，不良反应发生率低。推荐配比：BFⅠ组和BFⅡ组。
ObjectiveTo investigate the effect and safety of subgluteal approach continous sciatic nerve block with 0.2% ropivacaine for postoperative analgesia in calcaneal fracture patients. MethodsForty calcaneal fracture patients treated from May 2012 to January 2013 were randomly assigned to two groups:20 patients in continuous sciatic nerve block group (group CSB) and 20 patients in self-controlled intravenous analgesia group (group PCIA).Patients in group CSB were given subgluteal approach continuous sciatic nerve block,and PCA pump was connected to give 0.2% ropivacaine via continuous nerve block catheter continuously for analgesia.Patients in group PCIA were given PCA pump directly for self-controlled intravenous analgesia.The movement/rest VAS scores and Ramsay scores at 2,8,24,48 hours after surgery,the dose of other analgesia drugs after surgery,the satisfaction of patients and surgeons,and side effects were recorded. ResultsThe movement and rest visual analogue scale (VSA) scores and the dose of analgesia drugs in group CSB were significantly lower than group PCIA at all time points (P<0.05).The satisfaction of patients and surgeons in group CSB was higher than group PCIA (P<0.05). ConclusionCompared with self-controlled intravenous analgesia,subgluteal approach continuous sciatic nerve block with 0.2% ropivacaine can provide better and safer postoperative analgesia for calcaneal fracture patients.
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.
ObjectiveTo systematically review the efficacy and safety of oxycodone versus morphine for postoperative intravenous self-control analgesia (PCIA). MethodsWe searched databases including PubMed, EMbase, The Cochrane Library (Issue 8, 2015), CBM, CNKI, VIP, WanFang Data from inception to August 2015, to collect randomized controlled trials (RCTs) about oxycodone versus morphine for postoperative PCIA. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.3 software.ResultsSeven RCTs involving 826 patients were included. The results of meta-analysis showed that: there were no significant differences in postoperative analgesia at the points of 2 h, 3 h, 4 h, 8 h, 12 h, 24 h, 36 h and 48 h after surgery (2 h: MD=0.20, 95%CI –0.18 to 0.58, P=0.30; 3 hresting state: MD=–0.51, 95%CI –2.27 to 1.26, P=0.57; 3 hdynamic state: MD=–0.46, 95%CI –2.23 to 1.40, P=0.63; 4 h: MD=0.00, 95%CI –0.25 to 0.25, P=0.99; 8 h: MD=0.10, 95%CI –0.16 to 0.36, P=0.46; 12 h: MD=–0.34, 95%CI –0.85 to 0.17, P=0.19; 24 h: MD=–0.13, 95%CI –0.43 to 0.17, P=0.41; 36 h: MD=0.10, 95%CI –0.28 to 0.48, P=0.60; 48 h: MD=–0.13, 95%CI –0.36 to 0.09, P=0.25). The incidences of postoperative vomiting (OR=0.23, 95%CI 0.08 to 0.63, P=0.005), nausea (OR=0.27, 95%CI 0.08 to 0.86, P=0.03), respiratory depression (OR=0.15, 95%CI 0.04 to 0.53, P=0.003) and skin pruritus (OR=0.19, 95%CI 0.05 to 0.66, P=0.009) in the oxycodone group were lower than those in the morphine group. In addition, there were no significant differences of the incidences of headache, dizzy and shiver between two groups.ConclusionCompared with morphine, oxycodone has the same analgesia effect for PCIA, however, the incidences of adverse reactions are lower. Due to the limited quality and quantity of included studies, the above results are needed to be validated by more high quality studies.
Objective To analyze the outcome of fast track surgery after intercostal nerve block (INB) during thoracoscopic resection of lung bullae. Methods We recuited 76 patients who accepted thoracoscopic resection of lung bullae from February 2013 to March 2015. They were randomly divided into two groups: an intercostal nerve block and intravenous patient-controlled analgesia (INB+IPCA) group, in which 38 patients (30 males, 8 females, with a mean age of 23.63±4.10 years) received INB intraoperatively and IPCA postoperatively, and a postoperative intravenous patient-controlled analgesia (IPCA) group, in which 38 patients (33 males, 5 females, with a mean age of 24.93±6.34 years) only received IPCA postoperatively. Their general clinical data and the postoperative pain visual analogue scale (VAS) were recorded. Analgesia-associated side effects, rate of the pulmonary infection were observed. Expenses associated with analgesia during hospital were calculated. Results The score of VAS, the incidence of nausea and vomiting, fatigue and other side effects, pulmonary atelectasis and the infection rate in the INB+IPCA group were significantly lower than those in the IPCA group. Postoperative use of analgesic drugs was significantly less than that in the IPCA group. Medical expenses did not significantly increase. Conclusion INB+IPCA is beneficial for fast track surgery after thoracoscopic resection of lung bullae.