ObjectiveTo compare the effect of da Vinci Surgical System and video-assisted mini-thoractomy (VAMT) on postoperative pain of patients with lungs or mediastinal tumor. MethodsWe retrospectively analyzed the clinical data of 88 patients with lung or mediastinal tumor who underwent surgical treatment in our hospital from January 2015 through April 2015. The patients were divided into two groups including a robot group and a VAMT group. There were 49 patients in the robot group with 23 males and 26 females at age of 55.14±13.03 years and 39 patients with 23 males and 16 females at age of 56.92±8.98 years in the VAMT group. ResultsCompared with the VAMT group, shorter operation time (t=-2.298, P=0.024) and shorter time of drainage (t=-2.421, P=0.018) were found in the robot group with statistical differences. There was a statistical difference in visual analogue scale (VAS) scores of postoperative 24 hours between the robot group and the VAMT group (1.00±0.74 vs. 2.33±1.64, t=-4.704, P=0.000). While no statistical difference was found in VAS scores of postoperative 48 hours (t=-0.244, P=0.808) between the two groups. ConclusionCompared with VAMT, da Vinci Surgical System can be used in the treatment of lung and mediastinal tumor with shorter operation time, shorter time of drainage, less pain, and less invasiveness.
Objective To investigate the effects of pain specialist nurse training (PSNT) on nurse’s pain management knowledge and attitude. Methods By distributing the “questionnaire of pain management knowledge and attitude”, 95 certified nurses, who were from 24 hospitals of different levels in Sichuan, Chongqing, Yunnan and Xinjiang, were investigated to survey their knowledge and attitude changes before and after PSNT. The data were analyzed by t-test. Results A total of 190 questionnaires were distributed to 95 nurses, and 190 returned, with a effective response rate of 100%. The result showed that, the total score after training (34.00±5.30) was significantly higher than that before training (17.58±4.00), with a significant difference (P=0.000). Conclusion The pain specialist nurse training can improve nurses’ knowledge and their attitudes on pain management.
Objective To systematically review the effects of lidocaine for preventing pain on injection of propofol. Methods Databases including The Cochrane Library (Issue 4, 2012), PubMed, MEDLINE, Ovid, HighWire, EMbase, CBM and CNKI were searched electronically to collect literature published from January, 1985 to December, 2012. Randomized controlled trials (RCTs) were indentified about lidocaine for preventing injection pain of propofol. References of the included studies were also retrieved. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assess the quality of the included studies. Then meta-analysis was performed using RevMan 5.1 software. Results Fifteen trials involved 1 332 patients were included. The results of meta-analysis indicated that, adding lidocaine into propofol lowered the incidence of pain on injection compared with blank control, with a significant difference (RR=0.36, 95%CI 0.30 to 0.44, Plt;0.000 01); using different doses of lidocaine before injection lowered the incidence of pain on injection compared with blank control, with a significant difference (RR=0.59, 95%CI 0.47 to 0.75, Plt;0.000 1); using different doses of lidocaine after venous occlusion lowered the incidence of pain on injection compared with blank control, with a significant difference (RR=0.44, 95%CI 0.37 to 0.52, Plt;0.000 01). Conclusion Lidocaine could reduce the pain on injection of propofol. Using lidocaine 40 mg after venous occlusion is a relatively effective method to lower the incidence of pain on injection which is more suitable for outpatient who receive intravenous anesthesia without preoperation medication.
Objective To evaluate the effects of a preoperative pain education program on patients’ knowledge of postoperative pain management, measures taken for such pain management and the actual postoperative pain. Methods A total of 84 patients undergoing abdominal surgery were non-randomly divided into two groups, 42 in each group. Patients in group A received routine preoperative care and 30 minutes of education about pain management, while patients in group B received routine preoperative care only. All patients completed the Postoperative Pain Management Questionnaire on the second postoperative day. Results Patients in group A achieved higher scores for their knowledge about postoperative pain management than those in group B (Plt;0.05). More patients in group A took non-medical pain relief methods after surgery (Plt;0.05); and patients in group A were able to use the PCA pump more correctly than those in group B (Plt;0.05). No significant differences were observed between the two groups in the frequency of asking for analgesics or their pain score when they requested analgesics (Pgt;0.05). The average score for postoperative pain was lower for group A compared to group B (Plt;0.05). Conclusions A program of preoperative pain education can improve patients’ knowledge of postoperative pain management and encourage them to participate actively in such pain management, so as to further relieve the postoperative pain.
Abstract： Objective To evaluate clinical outcomes of painless flexible fiberoptic bronchoscopy in the treatment for pulmonary complications in postoperative pediatric patients with congenital heart diseases. Methods We retrospectively analyzed clinical data of 58 patients who received fiberoptic bronchoscopy for pulmonary complications after surgical repair for atrial septal defect， ventricular septal defect， tetralogy of Fallot， double outlet right ventricle or transposition of the great arteries in First Affiliated Hospital of Harbin Medical University From August 2009 to February 2012. There were 26 male patients and 32 female patients with their age ranging from 20 days to 2 years. Olympus xp-60 fiberoptic bronchoscopy was used for removal of airway secretions and bronchial alveolar lavage under anesthesia with propofol， fentanyl and lidocaine. Pulse oximetry， respiratory sound and chest X-ray changes were observed. Results The examination time of painless fiberoptic bronchoscopy was 10-25 minutes in the 58 patients. After removal of airway secretions by fiberoptic bronchoscopy， their respiratory status improved significantly， pulse oxygen saturation increased by 5%-12%， and their pulmonary crackles were significantly reduced. In 29 patients with atelectasis， their pulmonary lobes demonstrated significant reexpansion in chest X-ray reviews on the next day after fiberoptic bronchoscopy， and 8 patients received another fiberoptic bronchoscopy treatment on the next day to achieve complete pulmonary reexpansion. One patient with severe pulmonary hypertension （PH） stayed in intensive care unit （ICU） for 6 days， 3 patients with transposition of the great arteries stayed in ICU for 5 days， 3 patients with double outlet of right ventricle and moderately high PH stayed in ICU for 4 days， and all the other patients were discharged from ICU within 48 hours after admission. There was no severe complication related to fiberoptic bronchoscopy， except 2 patients with minor nasal mucosa bleeding who were cured with hemostatic drugs and local compression. Conclusion Painless flexible fiberoptic bronchoscopy can significantly enhance clinical outcomes and shorten ICU stay for postoperative pediatric patients with congenital heart diseases.
Objective To analyze the causes of pain after total knee arthroplasty (TKA), and to review its diagnosis and treatment methods. Methods Domestic and abroad l iterature concerning pain after TKA was extensively reviewed and thoroughly analyzed. Results Pain after TKA was divided into intra-articular and extra-articular factors, systematic assessment, appropriate imaging, and laboratory tests were useful to confirm the diagnosis; targeted surgery could effectively rel ieve the pain. Conclusion The causes of pain after TKA are complex and diverse, the first step is to exclude intraarticular infection, for patients having a clear cause the appropriate surgery is effective. Otherwise revision should be carried outcautiously under condition of unexplained pain and conservative treatment can rel ieve pain to some degree.
Objective To investigate the effects of lycium barbarum polysaccharide (LBP) on the formation of traumatic neuroma and pain after transection of sciatic nerve in rats. Methods Forty Sprague-Dawley (SD) rats, weighing 200-220 g, half male and half female, were allocated into 2 groups randomly: LBP group and control group (n=20 per group). The right sciatic nerves were transected and 2 cm sciatic nerve were removed in all rats of the 2 groups. LBP were intraperitoneally injected in a volum of 10 mg/(kg·d) in the LBP group, while the same volum normal sal ine (NS) in the control group for 28 days. The deficiency of toenail and toe were observed to estimate the autophagy of the operated l imb. Light microscope and transmission electron microscope were used to observe the formation of traumatic neuroma aftertransection of sciatic nerve. Results Autophagy was observed in 5 rats (25%) of LBP group and in 12 rats (60%) of controlgroup at 4 weeks, showing significant difference (P lt; 0.05). Neuroma formed in 8 rats (40%) of LBP group and in 16 rats(80%) of control group, showing significant difference (P lt; 0.05). The observation of l ight microscope showed that there were unorganized growth cells in the neuroma, infiltrated muscle cells, the regeneration of axons and ensheathing cells to form small patch and funicular structure in the control group, while in the LBP group there were less prol iferation of nerve fibers with a regular arrangement. Transmission electron microscope showed that there were lots of axons in nerve tumour, more fusoid fibroblasts, more collagen fiber, and hyperplasia and degenerated myel in sheath in the control group, while in the LBP group there were less myel in sheath in the proximal end of injuring nerves, less Schwann cells and fibroblasts, and sparsed collagen fibers. Conclusion LBP can inhibit autophagy and the formation of traumatic neuroma after transection of sciatic nerve in rats.
【Abstract】 Objective To explore the correlation between pain grading, stage of necrosis and bone marrow edema(BME) in nontraumatic osteonecrosis of femoral head (NONFH) so as to strengthen understandings about cl inical significance of BME in NONFH. Methods From October 2004 to October 2006, 97 patients (149 hips) with NONFH were treated. There were 68 males and 29 femals with an average age of 38.8 years (19-62 years). The disease course was from 20 days to 4 years. BME was identified grade 0 to grade 2 according to MRI. Based on grading scale of pain, pain grading were divided into no pain (grade 0), mild pain (grade 1) and moderate or severe pain (grade 2). According to Association Research Circulation Osseous staging system, NONFH were divided into I-IV stages. The incidence rate of BME in each pain grading and stages of necrosis was analyzed respectively. Contingency table analyses and rank sum tests were used to compare the difference of pain grading and stages of necrosis among these groups. Results The total incidence rate of BME was 73.15% (109/149), the incidence rateswere 84.38% in pain groups (108 /128) and 94.12% in the grade 2 (32/34). Pain grading correlated with BME rating (P lt; 0.001).The results of rank sum tests for several independent samples showed significant difference in BME among pain groups(P lt; 0.001). With the advance of pain scale, the mean rank of BME increased gradually(28.19 for grade 0, 78.94 for grade 1 and 96.12 for grade 2). BME was more commonly and clearly seen in stage Ⅱ（77.05%）and stage Ⅲ（82.81%）of NONFH. Stage I-III of NONFH correlated with BME rating (P lt; 0.001). The results of rank sum tests showed significant difference in BME rating among three stages (P lt; 0.001). With the advance of disease, the rank of BME rating increased gradually (39.07 for grade 0, 60.16 for grade 1 and 86.15 for grade 2 ). Conclusion BME is a sign that is accompanied with NONFH. The probabil ity and extent of BME correlated well with the pain and stage of NONFH．The condition of BME can be used as a index for the appraisal of advancement of disease and the judgment of treatment result.
Objective To systematically evaluate the effects of magnesium sulfate on postoperative pain and complications after general anesthesia. Methods A literature search was conducted in following databases as The Cochrane Library, EMbase, PubMed, EBSCO, Springer, Ovid, CNKI and CBM from the date of establishment to September 2011 to identify randomized controlled trials (RCTs) about intravenous infusion of magnesium sulfate during general anesthesia. All included RCTs were assessed and the data were extracted according to the standard of Cochrane systematic review. The homogenous studies were pooled using RevMan 5.1 software. Results A total of 11 RCTs involving 905 patients were included. The results of meta-analyses showed that compared with the control group, intravenous infusion of magnesium sulfate during general anesthesia significantly reduced the visual analog scale (VAS) scores at the time-points of 2, 4, 6, 8, 16, and 24 hours, respectively, after surgery, the postoperative 24 hours morphine requirements, and the incidents of postoperative nausea and vomiting (RR=0.61, 95%CI 0.40 to 0.91, P=0.02) and chilling (RR=0.29, 95%CI 0.14 to 0.59, P=0.000 7). Although the incidents of bradycardia (RR=1.93, 95%CI 1.05 to 3.53, P=0.03) increased, there were no adverse events or significant differences in the incidents of hypotension and serum concentration changes of magnesium. Conclusion Intravenous infusion of magnesium sulfate during general anesthesia may obviously decrease the pain intensity, and the incidents of nausea and vomiting and chilling after surgery, without increasing cardiovascular adverse events and risk of hypermagnesemia. The results still need to be confirmed by more high-quality and large-sample RCTs.
Objectives To evaluate the effect of metrinidazole treatment after conventional hemorrhoidectomy pain in patients with third and fourth degree hemorrhoids. Methods We searched the Cochrane Library (Issue 1 2009), PubMed (1966 to March 2009), EMbase (1974 to March 2009), SCI (1974 to March 2009), CBM (1978 to March 2009), CNKI (1994 to March 2009), and VIP (1989 to March 2009) to identify randomized controlled trials or quasi- randomize controlled trials of metronidazole versus placebo for treating post hemorrhoidectomy pain. We evaluated the quality of the included studies by using the Handbook 4.2.6 recommend standards and analyzed data using the Cochrane Collaboration’s RevMan 4.2.10. Results We included seven randomized controlled trials or quais-randomized controlled trials (n=553). Meta-analyses showed that there were statistical differences between metronidazole and placebo in pain after hemorrhoidectomy and the use of an additional dose of analgesia. Conclusions The current evidence shows that metronidazole relieves the pain after conventional hemorrhoidectomy and reduces the additional used of analgesics. Further high quality, large sample randomized controlled trials should be carried out.