BACKGROUND:Pain in the emergency department(ED)is common but undertreated.The objective of this study was to examine the efficacy and safety of intranasal(IN)ketamine used as an analgesic for patients with acute injur...BACKGROUND:Pain in the emergency department(ED)is common but undertreated.The objective of this study was to examine the efficacy and safety of intranasal(IN)ketamine used as an analgesic for patients with acute injury with moderate to severe pain.METHODS:This study was a cross sectional,observational study of patients more than 8 years old experiencing moderate to severe pain[visual analog score(VAS)>50 mm].The initial dose of IN ketamine was 0.7 mg/kg with an additional dose of 0.3 mg/kg if VAS was more than 50 mm after 15minutes.Pain scores and vital signs were recorded at 0,15,30 and 60 minutes.Side-effects,sedation level and patient's satisfaction were also recorded.The primary outcome was the number of patients achieving≥20 mm reductions in VAS at 15 minutes.Other secondary outcome measures were median reduction in VAS at 15,30 and 60 minutes,changes of vital signs,adverse events,satisfaction of patients,and need for additional ketamine.RESULTS:Thirty-four patients with a median age of 29.5 years(IQR 17.5–38)were enrolled,and they had an initial median VAS of 80 mm(IQR 67–90).The VAS decreased more than 20 mm at15 minutes in 27(80%)patients.The reduction of VAS from baseline to 40 mm(IQR 20–40),20 mm(IQR 14–20)and 20 mm(IQR 10–20)respectively at 15,30 and 60 minutes(P<0.001).No critical changes of vital signs were noted and adverse effects were mild and transient.CONCLUSION:This study showed that IN ketamine is an analgesic choice for patients with acute injury in moderate to severe pain in an overcrowded and resource limited ED.展开更多
目的:探讨超声引导下收肌管阻滞联合膝关节后方浸润在膝关节镜下前交叉韧带重建术术后的镇痛作用和早期的康复作用。方法:行膝关节镜下前交叉韧带重建术患者60例,随机均分为收肌管阻滞联合膝关节后方浸润组(A组,0.375%罗哌卡因30 m L进...目的:探讨超声引导下收肌管阻滞联合膝关节后方浸润在膝关节镜下前交叉韧带重建术术后的镇痛作用和早期的康复作用。方法:行膝关节镜下前交叉韧带重建术患者60例,随机均分为收肌管阻滞联合膝关节后方浸润组(A组,0.375%罗哌卡因30 m L进行收肌管阻滞、0.2%罗哌卡因50 m L进行膝关节后方浸润)和对照组(B组,0.9%生理盐水30 m L进行收肌管阻滞、0.9%生理盐水50 m L膝关节后方浸润),观察2组患者术后2、4、8、24及48 h膝关节的静息时和活动时视觉模拟疼痛评分(VAS),比较2组患者术后24 h和48 h的膝关节活动度及患肢首次行主动直腿抬高时间及术后使用镇痛药物的不良反应。结果:术后2、4、8、24及48 h,A组患者的静息痛、活动痛VAS评分低于B组、主动膝关节活动度优于B组(P<0.05或P<0.01);2组患者均在术后早期能够进行直腿抬高锻炼,但首次直腿抬高时间比较,差异无统计学意义(P=0.077)。结论:超声引导下收肌管阻滞联合膝关节后方浸润可以为膝关节镜前交叉韧带手术患者提供良好的术后镇痛效果及术后康复。展开更多
文摘BACKGROUND:Pain in the emergency department(ED)is common but undertreated.The objective of this study was to examine the efficacy and safety of intranasal(IN)ketamine used as an analgesic for patients with acute injury with moderate to severe pain.METHODS:This study was a cross sectional,observational study of patients more than 8 years old experiencing moderate to severe pain[visual analog score(VAS)>50 mm].The initial dose of IN ketamine was 0.7 mg/kg with an additional dose of 0.3 mg/kg if VAS was more than 50 mm after 15minutes.Pain scores and vital signs were recorded at 0,15,30 and 60 minutes.Side-effects,sedation level and patient's satisfaction were also recorded.The primary outcome was the number of patients achieving≥20 mm reductions in VAS at 15 minutes.Other secondary outcome measures were median reduction in VAS at 15,30 and 60 minutes,changes of vital signs,adverse events,satisfaction of patients,and need for additional ketamine.RESULTS:Thirty-four patients with a median age of 29.5 years(IQR 17.5–38)were enrolled,and they had an initial median VAS of 80 mm(IQR 67–90).The VAS decreased more than 20 mm at15 minutes in 27(80%)patients.The reduction of VAS from baseline to 40 mm(IQR 20–40),20 mm(IQR 14–20)and 20 mm(IQR 10–20)respectively at 15,30 and 60 minutes(P<0.001).No critical changes of vital signs were noted and adverse effects were mild and transient.CONCLUSION:This study showed that IN ketamine is an analgesic choice for patients with acute injury in moderate to severe pain in an overcrowded and resource limited ED.
文摘目的:探讨超声引导下收肌管阻滞联合膝关节后方浸润在膝关节镜下前交叉韧带重建术术后的镇痛作用和早期的康复作用。方法:行膝关节镜下前交叉韧带重建术患者60例,随机均分为收肌管阻滞联合膝关节后方浸润组(A组,0.375%罗哌卡因30 m L进行收肌管阻滞、0.2%罗哌卡因50 m L进行膝关节后方浸润)和对照组(B组,0.9%生理盐水30 m L进行收肌管阻滞、0.9%生理盐水50 m L膝关节后方浸润),观察2组患者术后2、4、8、24及48 h膝关节的静息时和活动时视觉模拟疼痛评分(VAS),比较2组患者术后24 h和48 h的膝关节活动度及患肢首次行主动直腿抬高时间及术后使用镇痛药物的不良反应。结果:术后2、4、8、24及48 h,A组患者的静息痛、活动痛VAS评分低于B组、主动膝关节活动度优于B组(P<0.05或P<0.01);2组患者均在术后早期能够进行直腿抬高锻炼,但首次直腿抬高时间比较,差异无统计学意义(P=0.077)。结论:超声引导下收肌管阻滞联合膝关节后方浸润可以为膝关节镜前交叉韧带手术患者提供良好的术后镇痛效果及术后康复。
