Objective To explore the application of enhanced recovery after surgery (ERAS) in pain management after knee arthroplasty (TKA). Methods Doctor-nurse pain management team was established based on ERAS between June and July 2016, and the pain management was carried out after training the doctors and nurses. According to the formula of two-sample mean comparison and inclusion and exclusion criteria, 60 TKA patients admitted to the hospital from March to May 2016 were assigned into the control group (before intervention) and 60 TKA patients admitted from August to October 2016 were assigned into the trial group (after intervention). The patients in the control group received routine pain management. In the trial group, preventive analgesia was performed, pain health education paths were built and ISBAR communication mode was made preoperatively; anesthesia protocols were optimized intraoperatively; multimodal analgesia based on time-demand was used postoperatively; continuing analgesia program was provided at the discharge. The pain score, Hospital for Special Surgery (HSS) knee score, average length of stay (ALOS) and average hospitalization cost (excluding materials) were compared between the two groups. Results The pain scores between the two groups at the admission and 6 hours after surgery were not statistically different (P>0.05), and the pain scores in the trial group 24, 48, 72 hours after surgery were significantly lower than those in the control group (P<0.05). The HSS scores between the two groups at the admission were not statistically different (P>0.05), and the HSS scores in the trial group 3 days, 1 week, and 1 month after surgery were significantly higher than those in the control group (P<0.05). And ALOS and average hospitalization cost (excluding materials) in the trial group were significantly lower than those in the control group (P<0.05). Conclusion The application of ERAS in pain management after TKA can effectively alleviate the postoperative pain, improve the patients’ knee function, shorten the ALOS, and decrease the average hospitalization cost.
Objective To systematically evaluate the efficacy and safety of injected cyclooxygenase-2 inhibitor for acute postoperative pain. Methods We electronically searched PubMed, EBSCO, Springer, Ovid and CNKI databases from 1999 through Jan. 2009 to identify randomized controlled trials (RCTs) about cyclooxygenase-2 inhibitor or parecoxib sodium for acute postoperative pain. The methodological quality of included RCTs were assessed, and the data was extracted by two reviewers independently according to the Cochrane Handbook. The homogeneous RCTs were pooled using RevMan software, and the non-homogeneous studies evaluted using descriptive qualitative analysis. Results Seven RCTs involving 1939 patients met the inclusion criteria. The results of meta-analyses showed that: ① Efficacy: The comparison of PCA combined parecoxib sodium (successively injected less than 3 days) i.v. with PCA alone: after 24, 48, and 72 hours of the initial dose of parecoxib 40 mg i.v., the percentage of the patients’ global evaluation of study medication (PGESM) described effective (excellent and good) was higher than that of the control group [RR (95%CI) were 1.41 (1.13, 1.75), 1.25 (1.15, 1.35), and 1.30 (1.21, 1.40) respectively]; the percentage of the PGESM described ineffective (fair and poor) was lower than that of the control group [RR (95%CI) were 0.43 (0.26, 0.72), 0.44 (0.34, 0.57), and 0.33 (0.23, 0.48) respectively]. ② Safety: Combination of PCA with parecoxib sodium could lessen the incidence of postoperative fever (RR=0.34, 95%CI 0.22 to 0.53) and nausea and vomiting (RR=0.69, 95%CI 0.57 to 0.83), but not statistically decrease of respiratory depression (RR=0.84, 95%CI 0.38 to 1.83), pruritus (RR=0.91, 95%CI 0.54 to 1.52), and headache (RR=0.77, 95%CI 0.47 to 1.28). Conclusion The combination of PCA with parecoxib sodium successively injected less than 3 days can significantly increase the scores of PGESM, and does not increase the incidence of adverse effects or postoperative complications, and also has the advantage of decreasing postoperative fever, nausea and vomiting.
ObjectiveTo observe the influence of three postoperative analgesia methods on the survival rate of replanted finger by flat digital subtraction angiography (DSA) medical imaging detection system. MethodFrom July 2014 to July 2015, 342 patients were classified into gradeⅠ and gradeⅡ replantation in accordance with their physical condition and they were randomly divided into routine oral group, muscle injection group and analgesia group with 144 patients in each. Flat DSA was used to dynamically observe replantation after revascularization. Then we compared the three different analgesia methods in terms of psychological status of the patients, incidence of vascular crisis, occlusion rate, survival rate of replanted fingers. The function score of replanted fingers was evaluated for clinical efficacy. ResultsCompared with the conventional oral group and muscle injection group, the incidence of vascular crisis in replanted fingers and thrombosis rate were significantly lower in the analgesia group which had a replanted finger survival rate of 96.69% and a normal mental condition rate of 78.07%. Six months after surgery, the rate of excellent and good follow-up was significantly higher than the conventional oral group and muscle injection group (P<0.017) . ConclusionsThe 3-D technology of flat DSA can provide clear and reliable pictures of vessel revascularization status for replanted fingers. The use of continuous brachial plexus analgesia performs better than other methods of analgesia. Good analgesia can stabilize patients' anxiety and negative emotions, which is helpful to avoid excessive fluctuations in blood pressure induced by small artery spasm caused by blood clots and vascular crisis, thereby increasing the survival rate of replanted fingers and facilitating early rehabilitation of their function.
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.
ObjectiveTo study the tolerance of Ice Gardenia Pain Aerosol with single and multiple dosing in healthy Chinese volunteers, evaluate the safe dosing range and the highest tolerance dose of human body, and supply proof for the dose amount in Phase-Ⅱ study. MethodsForty subjects enrolled in Ward I of a national medicine clinical experiment institute between May and September 2014 were included in this study. For single dosing experiment, 28 eligible subjects were enrolled and assigned into 5 groups to receive a single dose of 2, 6, 10, 14 and 18 puffs per time, respectively. The patient number for each group was 4, 6, 6, 6 and 6, respectively with equal number of male and female patients in each group. For the multiple dosing treatment, 12 eligible subjects were enrolled and assigned into 2 groups to receive multiple dosing of 6 and 10 puffs per time per day, respectively, for 14 days. Both the two groups had 6 male and female patients. Tolerability was evaluated by monitoring adverse events, physical examinations, laboratory tests and electrocardiogram. ResultsTotally, 40 subjects were enrolled and all of them completed the study. No adverse events or severe adverse events were observed or reported. No abnormal laboratory test was reported 1 hour, 2, 4, 8, 12 and 24 hours after the treatment of single dosing, and multiple dosing group had no abnormal indexes or adverse events, either. The maximum single tolerance dose was 18 puffs per time, and a single dose of 2-18 puffs per time was well tolerated; Multiple dosing of 6 and 10 puffs per day, once a day for 14 days was well tolerated. ConclusionsSingle and multiple dosing of Ice Gardenia Pain Aerosol are considered to be well tolerated by healthy Chinese volunteers. The maximum single tolerance dose is 18 puffs per time; multiple dosing of 6 and 10 puffs per day, once a day for 14 days is well tolerated. We suggest that the above dosing range can be chosen in the following Phase-Ⅱ study.
Objective To identify the perception of pain among breast cancer patients and their quality of life, and to assess the influence of pain on their quality of life. Methods We did a cross-sectional study. A face-to-face survey was administered to 200 breast cancer patients, using two scales: Chinese Cancer Pain Assessment Tool (CCPAT) and European Organization for Research and Treatment of Cancer Core Quality-of-Life Questionnaire (Version 3) [EORTIC QLQ-C30]. Results Among the 200 breast cancer patients, 84 suffered from pain, while 116 did not. In regard to quality of life, the scores of physical function, role function and social function were higher among women without pain than among those in the pain group (Plt;0.05). There were no significant differences in scores of emotional function, cognitive function and global quality of life between the two groups (Pgt;0.05). There was a significant negative correlation between pain and quality of life in the pain group, the non-pain group and the whole sample (r=–0.731, Plt;0.001). Conclusion Pain has negative effects on physical function, role function and social function of breast cancer patients. The exacerbation of pain is associated with a decreased global quality of life for breast cancer patients.
Mirror therapy is a rehabilitation therapy in which a mirror is placed between the arms or legs so that the image of a moving non-affected limb gives the illusion of normal movement in the affected limb. As a simple, safe, and low-cost treatment, mirror therapy has been widely used. By summarizing and analyzing the literature about mirror therapy at home and abroad, this article summarizes its mechanism and clinical application in pain, stroke, cerebral palsy and so on, so as to provide reference for research and application on mirror therapy.
ObjectiveTo observe the clinical efficacy of non-nutritional sucking and 10% glucose water plus non-nutritional sucking in relieving the venipuncture pain for premature infants. MethodA total of 167 premature infants between April and December 2014 were selected as our study subjects, and they were randomly divided into three groups:intervention group Ⅰ (n=53), intervention group Ⅱ (n=58), and the control group (without any intervention, n=56). Two minutes before venous indwelling needle puncture, blood oxygen saturation and heart rate of the infants were recorded during their quiet state. In the process of venipuncture, the intervention group Ⅰ was given non-nutritional sucking, intervention group Ⅱ was given 10% glucose water plus non-nutritional sucking, and the control group did not accept any intervention. Premature pain rating scale (PIPP) was used to compare the three groups of infants in terms of pain score, heart rate and blood oxygen saturation 1 minute and 5 minutes after intravenous indwelling needle puncture. SPSS 17.0 software was applied for statistical analysis. ResultsOf the 167 premature infants, one-time puncture was successful in 152 infants, with 46 in intervention group Ⅰ, 54 in intervention group Ⅱ, and 52 in control group. One minute after intravenous indwelling needle puncture, PIPP score of intervention group Ⅰ and Ⅱ was significantly lower than that of the control group (P<0.05). The PIPP score of intervention group Ⅱ was significantly lower than that of intervention group Ⅰ (P<0.05). One minute and 5 minutes after intravenous indwelling needle puncture, heart rate in the intervention groups was significantly lower than that in the control group (P<0.05), blood oxygen saturation in the intervention groups was signficantly higher than that in the control group (P<0.05), and they were significantly lower in intervention group Ⅱ than in intervention group Ⅰ (P<0.05). ConclusionsNon-nutritional sucking is effective in alleviating venipuncture pain for premature infants, especially when it is used together with 10% glucose water. The method is worthy of clinical promotion.
The scientific understanding of pain has stayed on a traditional classic “pain pathway” for many years. However, with the continuous progress of clinical diagnosis, this pathway obviously cannot explain all pain phenomena, and the understanding and interpretation of pain needs to be updated. Based on the influence of comprehensive medicine based on philosophy and the continuous summary and research of clinical cases of somatic symptoms, this paper takes the biological defense mechanism as the basic starting point, analyzes the position of pain in the biological defense mechanism, and reinterprets and defines pain from the new point of view of comprehensive medicine with the new perspective of biological defense mechanism. In addition, this paper also presents the new treatment principles of pain according to the occurrence mechanism through the perspective of biological defense and psychosomatic mechanism, and puts forward new principles of treatment and the view that “defense” is the fundamental purpose of all biology, aiming to provide a reference for the reinterpretation of more diseases and the research on the nature of biological behavior.
Pain is one of the common complications of most diseases. Due to the unknown mechanism of pain, its treatment has been controversial. Repeated peripheral magnetic stimulation for pain has the advantages of non-invasiveness, painlessness, and well-targeted. However, the parameters of repeated peripheral magnetic stimulation for pain are not uniform due to various factors such as frequency, location of action, and coil type. In this paper, the parameters and efficacy of repeated peripheral magnetic stimulation for various kinds of pain such as acute and chronic low back pain, myofascial pain, migraine, peripheral neuralgia and post-traumatic pain are described, in order to providea theoretical basis for future research. In addition, the mechanism of repeated peripheral magnetic stimulation for pain has not been known, and this article will briefly summarize and explain on this.