Objective To compare the analgesic effect, duration and incidence of adverse reactions of liposome bupivacaine (LB) and bupivacaine hydrochloride after intercostal nerve block in single-port thoracoscopic lung surgery. Methods In Department of Thoracic Surgery of the First Affiliated Hospital of Xinxiang Medical University between September 2023 and March 2024, 228 patients who needed to undergo thoracoscopic lung surgery were selected and divided into two groups by random number table method: a group B with bupivacaine hydrochloride (n=118), and a group LB with LB (n=110). Intraoperative intercostal nerve block was performed under endoscopy, and the time of first use of analgesic drugs after surgery, cumulative use of opioids 72 h after surgery, incidence of postoperative nausea and vomiting, length of stay and other indicators were evaluated and recorded. Results Visual analogue scale (VAS) scores at 4 h, 8 h, 12 h, 24 h, 48 h and 72 h in the LB group were significantly lower than those in the group B (P<0.05). The total number of activities within 48 h after surgery in the group B was significantly lower than that in the LB group (P<0.05), and the postoperative hospitalization stay in the LB group was shorter than that in the group B, but the difference was not statistically significant. There was no statistical difference between the two groups in postoperative adverse reactions. Conclusion Intercostal nerve block with LB during single-port thoracoscopic lung surgery can significantly reduce postoperative pain, improve quality of life, and promote recovery of the patients. It is worthy of clinical application.
Nevus flammeus is a skin disease caused by congenital skin capillary malformation. In recent years, photodynamic therapy (PDT) has been proved to be effective and safe for this disease, but significant pain in the treatment process is the biggest obstacle to the implementation of this therapy. This article reviews the current pain management strategies in PDT. The current pain management methods include topical anesthesia, cold air analgesia, nerve block and others. Topical anesthesia has weak analgesic effect and short duration in PDT. Cold air analgesia is simple and feasible, but there is potential risk of affecting the treatment effect. The analgesic effect of nerve block is accurate, but the application scenario is limited. For nevus flammeus patients who need PDT, individualized analgesia should be selected according to the patient’s age and treatment scenario.
Objective To overview the systematic reviews/meta-analyses of efficacy of FNB used as a postoperative analgesic technique among patients undergoing TKR. Methods We electronically searched databases including The Cochrane Library, PubMed, EMbase, CNKI, WanFang Data and VIP from inception to July, 2016. Two reviewers independently screened literature and extracted data. AMSTAR tool was used to assess the methodological quality of included studies. The primary outcome was pain scores and the consumption of opoid medicine to evaluate the effectiveness of FNB. Results A total of 16 systematic reviews/meta-analyses were included, involving the FNBvs. LIA, PMDI, EA, PCA and ACB, respectively. The results of quality assessment indicated medium scores with 3 to 9 scores. The overviews’ results showed that: at rest, FNB was not superior to LIA at 6h after TKR; it was superior to PMDI at 12h after TKR; it was also superior to PCA and LIA, but not superior to ACB at 24h after TKR. On movement, FNB was superior to PCA and LIA at 24h after TKR; it was also superior to PCA at 48h after TKR. As to the consumption of opoid medicine, the consumption in FNB group was more than LIA group at 12h after TKR. In addition, the consumption in FNB group was less than PCA and LIA at 24h after TKR, and it was also less than PCA and ACB at 48h. The satisfaction of patients who received FNB was better than ACB, EA and PCA. Conclusion The current overview shows that FNB is more effective than PCA and LIA, the patients’ satisfaction is better. Due to the limitations of the quantity and quality of included studies, the above conclusions are needed to be verified by more studies.
ObjectiveTo summarize the early postoperative pain management strategies for anterior cruciate ligament reconstruction (ACLR), and to select a reasonable and effective pain management plan to promote functional rehabilitation after ACLR. MethodsThe literature about the early postoperative pain management strategies of ACLR both domestically and internationally in recent years was extensiverly reviewed, and the effects of improving postoperative pain were reviewed. ResultsCurrently, physical therapy and oral medication have advantages such as economy and simplicity, but the effect of improving postoperative pain is not satisfactory, often requires a combination of intravenous injection or intravenous pump, which is also a common way to relieve pain. However, in order to meet the analgesic needs of patients, the amount of analgesic drugs used is often large, which increases the incidence of various adverse reactions. Local infiltration analgesia (LIA), including periarticular or intra-articular injection of drugs, can significantly improve the early postoperative pain of ACLR, and achieve similar postoperative effectiveness as nerve block. LIA can be used as an analgesic technique instead of nerve block, and avoid the corresponding weakness of innervated muscles caused by nerve block, which increases the risk of postoperative falls. Many studies have confirmed that LIA can alleviate postoperative early pain in ACLR, especially the analgesic effects of periarticular injection are more satisfactory. It can also avoid the risk of cartilage damage caused by intra-articular injection. However, the postoperative analgesic effect and timeliness still need to be improved. It is possible to consider combining multimodal mixed drug LIA (combined with intra-articular and periarticular) with other pain intervention methods to exert a synergistic effect, in order to avoid the side effects and risks brought by single drugs or single administration route. LIA is expected to become one of the most common methods for relieving postoperative early pain in ACLR. ConclusionEarly pain after arthroscopic ACLR still affects the further functional activities of patients, and all kinds of analgesic methods can achieve certain effectiveness, but there is no unified standard at present, and the advantages and disadvantages of various analgesic methods need further research.
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.
Objective To assess the efficacy and safety of nerve-stimulator-guide needle placement in the peripheral nerve blockade. Methods The Cochrane Library, MEDLINE, OVID, VIP, CNKI and CBM were searched. The quality of the included studies was evaluated by three reviewers, and meta-analysis was performed. Results Twenty studies involving 1 287 participants related to needle placement in the peripheral nerve blockade were included. There were only 2 studies that described a detailed randomization method and allocation concealment and blinding, and the others were inadequate. Meta-analysis based on the included studies showed that: ① Absolute success ratio: nerve-stimulator-guide was higher than eliciting paraesthesia (OR= 4.05, 95%CI 2.57 to 6.36, Plt;0.00001) and anatomy localization (OR=30.3, 95%CI 1.73 to 532.74, P=0.02), but lower than ultrasound-guide-localization (OR=0.27, 95%CI 0.10 to 0.74, P=0.01). ② Onset time of the block: nerve-stimulator-guide was similar to eliciting paraesthesia (WMD= –1.70, 95%CI –?4.50 to 0.95, P=0.08), faster than arteriopalmus localization (WMD= 8.38, 95%CI 0.72 to 16.04, Plt;0.000 01), but slower than ultrasound-guide-localization (WMD= 8.38, 95%CI 0.72 to 16.04, P=0.04). ③ Ratio of complication associated to block: nerve-stimulator-guide was similar to eliciting paraesthesia (OR= 1.01, 95%CI 0.55 to 1.86, P=0.97), anatomy localization (WMD= 0.06, 95%CI 0.00 to 1.21, P=0.07) and arteriopalmus localization (WMD= 8.82, 95%CI 0.10 to 4.11, P=0.65), but higher than ultrasound-guide-localization (OR= 5.03, 95%CI 1.74 to 14.49, P=0.003). ④ Time to block: nerve-stimulator-guide was similar to eliciting paraesthesia (WMD=0.02, 95%CI –0.46 to 0.51, P=0.92), shorter than arteriopalmus localization (WMD= –4.00, 95%CI –5.58 to –2.42, Plt;0.000 01) and longer than ultrasound-guide-localization (WMD= 1.90, 95%CI 0.47 to 3.33, P=0.009). ⑤ Patient-accepted ratio: nerve-stimulator-guide was higher than eliciting paraesthesia (OR=2.32, 95%CI 1.02 to 5.30, P=0.05), and similar to arteriopalmus localization (OR=8.14, 95%CI 0.88 to 75.48, P=0.06). Conclusion Nerve-stimulator-guide location is a precise, effective and safe localization method. Due to moderate risk of selection bias and detection bias of included studies, the evidence is not b. Our results suggest that well-designed double-blind randomized controlled and larger-scale trials on the use of nerve stimulator in the peripheral nerve block are needed.
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.
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.
Objectives To overview the systematic reviews/meta-analyses of safety of femoral nerve block (FNB) used as a postoperative analgesic technique in patients undergoing total knee arthroplasty (TKA). Methods We searched databases including The Cochrane Library, PubMed, EMbase, CNKI, WanFang Data, and VIP from inception to July, 2016. Two reviewers independently screened literature, extracted data and used AMSTAR to evaluate the methodological quality of the included studies. The major indexes used to evaluate the safety of FNB were the incidence rates of symptoms including nausea, vomiting, sedation, retention of urine, dizziness, pruritus, hypotension, falls, nenous thromboembolism and deep infection. Results A total of 12 systematic reviews/meta-analyses were included.They assessed the safety of FNB compared with local infiltration analgesia (LIA), periarticular multimodal drug injection (PMDI), epidural analgesia (EA), patient-controlled intravenous analgesia of opioids (PCA) and adductor canal block (ACB), respectively. The methodological quality of included studies were medium, with the scores between 3 to 10. The results of overview indicated that: FNB had lower incidence rates of nausea and vomiting compared with EA and PCA, but had higher than ACB. FNB had lower incidence rates of sedation and retention of urine compared with EA and PCA. FNB had lower incidence rates of dizziness compared with EA and PCA, and lower incidence rate of hypotension compared with EA. Conclusion Current evidence suggests that FNB is safer than EA and PCA. Due to the limited quantity and quality of the included studies, the above conclusions are needed to be verified by more high-quality studies.
ObjectiveTo systematically evaluate the analgesic efficacy of local infiltration analgesia versus femoral nerve block for total knee arthroplasty. MethodsDatabases including PubMed, EMbase, The Cochrane Library (Issue 4, 2016), WanFang Data, CBM, and CNKI were searched to collect randomized controlled trials (RCTs) about the analgesic efficacy of local infiltration analgesia versus femoral nerve block for total knee arthroplasty from inception to April 2016. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. The meta-analysis was conducted using RevMan 5.3 software. ResultsA total of 13 RCTs involving 1 001 patients were included. The results of meta-analysis showed that: There were no significant differences in pain scores at rest (SMD=0.02, 95%CI -0.23 to 0.27, P=0.86), morphine consumption on movement (MD=-1.85, 95%CI -4.67 to 0.97, P=0.20), incidence of post-operative nausea and vomiting (RD=0.02, 95%CI -0.03 to 0.08, P=0.41) and incidence of post-operative knee infection (RD=0.01, 95%CI -0.02 to 0.03, P=0.60) between the two groups, but he local infiltration analgesia group had lower length of stay than the femoral nerve block group with statistical difference (SMD=-0.24, 95%CI -0.41 to -0.07, P=0.005). ConclusionLocal infiltration analgesia provides similar postoperative analgesia after total knee arthroplasty to femoral nerve block. However, due to the limited quantity of the included studies, the above conclusion still need to be verified by more high quality studies.