【摘要】 目的 比较单次股神经阻滞和关节腔内单次注射罗哌卡因对膝关节镜检术后镇痛效果，为临床应用提供试验依据。 方法 2009年1月-2010年7月，选择美国麻醉医师协会（ASA）Ⅰ～Ⅱ级、年龄18~65岁、拟行择期单侧下肢膝关节镜手术患者180例，随机分为股神经阻滞组和关节腔内用药组，每组90例，分别于术前1 h行股神经阻滞（0.15%罗哌卡因20 mL）和手术结束时在膝关节腔内注入0.6%罗哌卡因20 mL。于术后4、8、24 h采用视觉模拟评分法（visual analog scale，VAS）行静止和运动时疼痛评分，记录术后患者满意度、不良反应发生率，术后使用镇痛药物情况。 结果 关节腔内用药组术后镇痛药物使用率（41.11%）明显高于股神经阻滞组（20.00%）（Plt;0.005）。两组患者术后24 h静止时及术后8、24 h运动时的VAS评分关节腔内用药组均明显高于股神经阻滞组（Plt;0.001），其余各时点差异无统计学意义（Pgt;0.05）。 结论 股神经阻滞可提供更加有效的术后镇痛效果，并且用药量小，安全系数高，值得临床推广。【Abstract】 Objective To compare the effect of single-injection femoral nerve block and local anesthetic intraarticular injection for analgesia after knee arthroscopy, in order to provide the experimental base for clinical application. Methods From January 2009 to July 2010, 180 American Society of Anesthesiologists (ASA) physical status I-II patients, aged from 18 to 65 years old, and scheduled for elective single knee arthroscopy were randomly divided into two groups: femoral nerve block group and local anesthetic intraarticular injection group with 90 patients in each group. For the patients in the former group, 20 mL of 0.15% ropivacaine was injected 1 hour before operation. For the latter group, 20 mL of 0.6% ropivacaine was injected into the articular cavity after operation. Pain intension scores at rest and in motion were measured 4, 8, and 24 hours after operation by visual analog scale (VAS). The degree of patients’ satisfaction, adverse reaction incidence rate and information of taking pain-killers were also recorded. Results The rate of using pain-killers in the intraarticular injection group (41.11%) was dramatically higher than the femoral nerve block group (20.00%) (Plt;0.005). The VAS scores of patients in the intraarticular injection group at rest 24 hours after operation and in motion 8 hours and 24 hours after operation were significantly higher than the femoral nerve block group (Plt;0.001), while there was no significant difference at other points between the two groups. Conclusions Femoral nerve block is more efficient for analgesia after knee arthroscopy compared with local anesthetic intraarticular injection. It is a safe procedure requiring only a relatively small dose of medicine, and is worth being popularized.
ObjectiveTo systematically review the efficacy of paravertebral block (PVB) versus thoracic epidural block (TEB) for post-thoracotomy analgesia. MethodsWe electronically searched databases including The Cochrane Library (Issue 9, 2013), PubMed, EMbase, Springer, CNKI, CBM, VIP and WanFang Data from 1980 to September 2013, to collect randomized controlled trials (RCTs) of PVB versus TEB for post-thoracotomy pain management. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data and assessed the methodological quality of included studies. Then, meta-analysis was performed using RevMan 5.2 software. ResultsThirteen RCTs involving 608 patients were included. The results of meta-analysis showed that:the PVB group got higher VAS score at 48 h than the TEB group (WMD=-0.36, 95%CI -0.54 to -0.71), but more patients of the PVB group chosen remedial method to release pain in epidural than in paravertebral. In addition, there were no differences in VAS scores at 6 h and 24 h between two groups. As for the analgesia related complication:compared with the TEB group, the PVB group has lower rate of hypotension (RR=0.18, 95%CI 0.08 to 0.41), urinary retention (RR=0.24, 95%CI 0.11 to 0.54), nausea and vomiting (RR=0.42, 95%CI 0.25 to 0.70). There were no significant differences between two groups in postoperative pulmonary complication (RR=0.52, 95%CI 0.10 to 2.76), postoperative FEV1 level (WMD=2.93, 95%CI -4.52 to 10.38) and duration of hospital stay (WMD=-0.19, 95%CI -0.89 to 0.50). The PVB group had lower risk of chronic pain than that of the TEB group (RD=-0.12, 95%CI -0.23 to -0.01). ConclusionCurrent evidence shows PVB has the similar efficacy as TEB in post-thoracotomy pain management, with lower risk of analgesia related complication and lower risk of post-thoracotomy chronic pain. Due to limited quality and quantity of the included studies, more high quality and large-scale RCTs are needed to verify the above conclusion.
ObjectivesTo systematically evaluate the efficacy and safety of dezocine combine with sufentanil (DS) versus sufentanil (S) for postoperative analgesia.MethodsCNKI, WanFang Data, VIP, PubMed, Wiley Online Library and ScienceDirect databases were searched online to collect randomized controlled trials (RCTs) of DS versus S for postoperative analgesia from January 2011 to July 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using Stata13.0 software.ResultsA total of 39 RCTs were included. The results of meta-analysis showed that: DS group had higher scores on VAS at 2 h, 6 h, 12 h, 24 h and 48 h points than S group at the dezocine level of 0.2 mg/kg. At the dezocine level of 0.3 mg/kg, there were no significant differences in scores on VAS at 2 h and 4 h. However, DS group had higher scores at 6 h, 12 h, 24 h and 48 h points. At the dezocine level of 10 mg/kg, there were no significant differences in scores on VAS at each time point in both groups. DS group was superior to S group in " excellent rate” and " good rate” of the analgesic satisfaction of patients. For safety, the incidence of postoperative nausea and vomiting of DS group was lower than S group.ConclusionsThe current evidence shows that dezocine combine with sufentanil have more effects of postoperative analgesia than sufentanil alone, and its incidence of adverse reactions is lower. Due to limited quality and quantity of the included studies, more high-quality studies are needed to verify above conclusions.
Objective To retrospectively analyze the analgesic effect and cost-effectiveness of combined analgesia versus intermittent analgesia for patients underwent retroperitoneal laparoscopic surgery. Methods We retrospectively collected clinical parameters and outcomes of analgesic effect from patients who underwent retroperitoneal laparoscopic surgery. Included patients were divided into two groups: local injection of ropivacaine combined with intermittent administration with analgesic via intravenous injection and intermittent administration with analgesic via intravenous injection only. Visual analogue scale (VAS) at different time points (2 h, 4 h, 6 h, 12 h, 24 h), usage of postoperative non-steroidal anti-inflammatory drugs (NSAIDs), adverse events, costs and other information were collected and assessed for further analysis of analgesic effect and cost-effectiveness. Results A total of 80 patients were enrolled in this study, each group consists of 40 patients. The results of this study found that VAS scores at 2 h and 4 h after operation in the combined analgesic group were significantly lower than that in the intermittent intravenous analgesia group (P<0.05), while there were no significant differences between the two groups in VAS scores at 6, 12 and 24 h after operation. The usage of NSAIDs were significantly lower in the combined group than intermittent group (P<0.05). The effective rate in the combined group was significantly higher than that in the intermittent group (P<0.05). The average cost of postoperative hospitalization and postoperative analgesic of the two groups were similar (allP values >0.05), and cost-effectiveness evaluation of the combined analgesia group was better than that of intermittent group. Conclusion Compared to intermittent administration with analgesic via intravenous injection, subcutaneous injection of ropivacaine hydrochloride combined with intermittent intravenous injection of parecoxib in patients underwent retroperitoneal laparoscopic surgery significantly could alleviate patients' painful complaints and reduce the postoperative usage of NSAIDs without increasing adverse events. Furthermore, the combination strategy has a lower cost-effectiveness ratio than intermittent group, which represents economic advantages.
Objective To evaluate the analgesic effect of intra-articular ropivacaine with lidocaine. Methods A double-blind randomized controlled trial was conducted. Ninety patients receiving selective knee arthroscopy were randomized into three groups of 30 patients. At the end of the operation, before the release of the tourniquet, an intra-articular injection was administered to each patient through arthroscope, in accordance with their random allocation: 0.9% normal saline (normal saline group); 100 mg ropivacaine (ropivacaine alone group) and 100 mg ropivacaine and 100 mg 2% lidocaine (ropivacaine with lidocaine group). Pain intensity was assessed after the operation using the 100-mm visual-analog scale (VAS), and the amount of supplemental analgesics used within the following 24 hours were recorded. Results The VAS scores of 2 hours postoperatively at rest, and 1, 2, 4, and 8 hours postoperatively at motion, were significantly higher in the normal saline group than in ropivacaine alone group (Plt;0.05). The VAS scores 0.5, 1 and 2 hours postoperatively at rest, and at the awaking moment, 0.5, 1, 4, 8, and 24 hours postoperatively at motion, were significantly higher in the normal saline group than in ropivacaine with lidocaine group (Plt;0.05). Conclusion Intra-articular ropivacaine can reduce a patient’s pain after operation. The combination of lidocaine with intra-articular ropivacaine can reduce the patient’s pain severity immediately after the operation and achieve an early analgesic effect.
【摘要】 目的 比较术后芬太尼皮下镇痛（PCSA）与硬膜外镇痛（PCEA）的临床效果，以及对胃肠功能的影响。 方法 2009年1-6月间观察择期硬膜外麻醉下经腹子宫切除术患者120例，术后分别实施PCSA与PCEA，观察术后第4、8、12、24、48 h的镇痛、镇静情况，呼吸循环、恶心呕吐及其他不良事件，记录术后首次肛门排气时间，测评术后镇痛满意度。 结果 术后两组患者镇痛优良率均在90%以上，各时点镇痛评分、镇静评分、恶心呕吐发生率、首次肛门排气时间以及患者镇痛优良率差异均无统计学意义（Pgt;0.05）。 结论 术后芬太尼PCSA与PCEA一样，效果确切，对术后胃肠功能无明显影响，患者满意，是一种安全、有效的镇痛方法。【Abstract】 Objective To compare clinical efficiency and gastrointestinal reaction of subcutaneous patient-controlled analgesia (PCSA) and epidural patient-controlled analgesia (PCEA) with fentanyl analgesic for patients after operation. Methods A total of 120 patients having undergone transabdominal hysterectomy under epidural anesthesia between January and June 2009 accepted PCSA or PCEA after operation. We evaluated the state of analgesia and sedation at the 4th, 8th, 12th, 24th and 48th hour after operation. We also looked into the respiration, blood circulation, nausea, vomiting and other abnormal events of the patients during the first 48 hours after operation. At the same time, we recorded the first time of anal exsufflation after operation and the degree of patients’ satisfaction. Results The analgesic effective rate was higher than 90% in both groups. There were no significant differences in analgesia and sedation scores at above-mentioned points after operation, incidence of nausea and vomiting, first time of anal exsufflation or analgesic effective rate between the two groups. Conclusion PCSA with fentanyl can be as effective in relieving postoperative pain as PCEA with fentanyl without obvious adverse effect in the gastrointestinal function. Therefore, PCSA is a safe and effective method to alleviate postoperative pain.
[Abstract]The number of lung transplantation is gradually increasing worldwide, which brings new challenges to the multi-disciplinary team of lung transplantation. The prognosis of lung transplant recipients is seriously affected by the pathophysiological state of specific lung diseases and perioperative risk factors. It is of great significance for these patients to optimize perioperative management according to these factors. Recently, several expert consensus have been published regarding anesthesia management of lung transplantation. Based on the current evidence and clinical practice of West China Hospital, this review summarizes the key points of anesthesia management for lung transplant recipients to guide anesthesiologists' clinical practice.
As a novel analgesic method, erector spinae plane block is increasingly widely used during perioperative period. This technique mainly injects local anesthetic drugs into the connective tissue between the deep fascia of the erector muscle and the transverse process of the vertebral body to achieve a blocking effect. Its role in postoperative analgesia in adult patients has been verified. Currently, case reports have shown that it also has a certain analgesic effect in pediatric patients, which can reduce postoperative pain scores and opioid consumption. Therefore, this article explores the application of erector spinae plane block in pediatric patients from various aspects, summarizes existing research results, and aims to provide more evidence for clinicians to reasonably use this block technique in the pediatric population.