To establish an effective method of continuous quality control of acute pain service, a retrospective study on incident reporting during postoperative anal-gesia period was conducted. Incidents were reported and analy...To establish an effective method of continuous quality control of acute pain service, a retrospective study on incident reporting during postoperative anal-gesia period was conducted. Incidents were reported and analyzed in 1507 patients who received epidural postoperative analgesia, and the results of satisfaction of pain relief was compared with those of incident analysis. In this study, an incident was defined as any factor that might or had affected patient's safety during analgesia period. Our results showed that 1203 incidents were reported in 641 of 1507 patients, of which 122 incidents were critical. 78. 3 % of all incidents were detect-ed by acute pain service stuff. The most common incidents included complica-tions, insufficient analgesia and problems with delivery circuits. Human factors were involved in 28. 9 % of the incidents, most being associated with technical failure due to unskillfu1ness, poor communications between APS stuff and pa-tients and lack of cooperation with surgeons and nurses. The general satisfactionrate of the patients was 90. 8 %. There was a very significant difference between the satisfaction of the patients who suffered from incidents and who did not (P<t0.001). It is concluded that incidents affect the satisfaction of the patients who received postoperative pain relief. Incident reporting is a more effective method for quality control of acute pain service.展开更多
AIM: To prospectively evaluate the effectiveness and safety of continuous wound infiltration(CWI) for pain management after open gastrectomy. METHODS: Seventy-five adult patients with American Society of Anesthesiolog...AIM: To prospectively evaluate the effectiveness and safety of continuous wound infiltration(CWI) for pain management after open gastrectomy. METHODS: Seventy-five adult patients with American Society of Anesthesiologists(ASA) Physical Status Classification System(ASA) grade 1-3 undergoing open gastrectomy were randomized to three groups. Group 1 patients received CWI with 0.3% ropivacaine(group CWI). Group 2 patients received 0.5 mg/m L morphine intravenously by a patient-controlled analgesia pump(PCIA)(group PCIA). Group 3 patients received epidural analgesia(EA) with 0.12% ropivacaine and 20 μg/m L morphine with an infusion at 6-8 m L/h for 48 h(group EA). A standard general anesthetic technique was used for all three groups. Rescue analgesia(2 mg bolus of morphine, intravenous) was given when the visual analogue scale(VAS) score was ≥ 4. The outcomes measured over 48 h after the operation were VAS scores both at rest and during mobilization, total morphine consumption, relative side effects, and basic vital signs. Further results including time to extubation, recovery of bowel function, surgical wound healing,mean length of hospitalization after surgery, and the patient's satisfaction were also recorded.RESULTS: All three groups had similar VAS scores during the first 48 h after surgery. Group CWI and group EA, compared with group PCIA, had lower morphine consumption(P < 0.001), less postoperative nausea and vomiting(1.20 ± 0.41 vs 1.96 ± 0.67, 1.32 ± 0.56 vs 1.96 ± 0.67, respectively, P < 0.001), earlier extubation(16.56 ± 5.24 min vs 19.76 ± 5.75 min, P < 0.05, 15.48 ± 4.59 min vs 19.76 ± 5.75 min, P < 0.01), and earlier recovery of bowel function(2.96 ± 1.17 d vs 3.60 ± 1.04 d, 2.80 ± 1.38 d vs 3.60 ± 1.04 d, respectively, P < 0.05). The mean length of hospitalization after surgery was reduced in groups CWI(8.20 ± 2.58 d vs 10.08 ± 3.15 d, P < 0.05) and EA(7.96 ± 2.30 d vs 10.08 ± 3.15 d, P < 0.01) compared with group PCIA. All three groups had similar patient satisfaction and wound healing, but group PCIA was prone to higher sedation scores when compared with groups CWI and EA, especially during the first 12 h after surgery. Group EA had a lower mean arterial pressure within the first postoperative 12 h compared with the other two groups.CONCLUSION : CWI with ropivacaine yields a satisfactory analgesic effect within the first 48 h after open gastrectomy, with lower morphine consumption and accelerated recovery.展开更多
Objective: To compare acute and long-term postoperative pain and side effects in patients undergoing mastectomy for breast cancer under general anesthesia induced with ketamine or thiamylal. Methods: Twenty four ASA p...Objective: To compare acute and long-term postoperative pain and side effects in patients undergoing mastectomy for breast cancer under general anesthesia induced with ketamine or thiamylal. Methods: Twenty four ASA physical status I-III patients undergoing mastectomy were randomly assigned to one of two groups. Ketamine group received intravenous ketamine, 1 mg/kg, and thiamylal group received intravenous thiamylal, 4 mg/kg, at the induction of general anesthesia. Anesthesia was maintained with sevoflurane, N2O and fentanyl. The intensity of pain was assessed by using visual analog scale (VAS) 3 and 16 hr and 2, 3 and 4 weeks after surgery. Postoperative side effects, including nausea, vomiting and hallucination were also recorded. Results: At 16 hr after surgery, VAS in ketamine group was significantly lower than that in thiamylal group. However, there were no statistically significant differences between the two groups in the VAS at 3 hr and 2, 3 and 4 weeks after surgery. There were no differences in the incidence of side effects such as nausea, vomiting and hallucination between the two groups. Conclusion: Intravenous ketamine at the induction of anesthesia could reduce acute postoperative pain but not long-term pain after mastectomy.展开更多
Over the last decades,the number of total knee arthroplasty procedures performed in the United States has been increasing dramatically.This very successful intervention,however,is associated with significant postopera...Over the last decades,the number of total knee arthroplasty procedures performed in the United States has been increasing dramatically.This very successful intervention,however,is associated with significant postoperative pain,and adequate postoperative analgesia is mandatory in order to allow for successful rehabilitation and recovery.The use of regional anesthesia and peripheral nerve blocks has facilitated and improved this goal.Many different approaches and techniques for peripheral nerve blockades,either landmark or,more recently,ultrasound guided have been described over the last decades.This includes but is not restricted to techniques discussed in this review.The introduction of ultrasound has improved many approaches to peripheral nerves either in success rate and/or time to block.Moreover,ultrasound has enhanced the safety of peripheral nerve blocks due to immediate needle visualization and as consequence needle guidance during the block.In contrast to patient controlled analgesia using opioids,patients with a regional anesthetic technique suffer from fewer adverse events and show higher patient satisfaction;this is important as hospital rank-ings and advertisement have become more common worldwide and many patients use these factors in order to choose a certain institution for a specific procedure.This review provides a short overview of currently used regional anesthetic and analgesic techniques focusing on related implications,considerations and outcomes.展开更多
Background and Objectives: Pain control after hepatic resection presents unique challenges as subcostal incisions, rib retraction, and diaphragmatic irritation can lead to significant pain. Both epidural analgesia and...Background and Objectives: Pain control after hepatic resection presents unique challenges as subcostal incisions, rib retraction, and diaphragmatic irritation can lead to significant pain. Both epidural analgesia and ON-Q catheters have been used for postoperative pain management after hepatic surgery, but to our knowledge have not been directly compared. Methods: The records of 143 patient between the ages 18 and 70 were reviewed who underwent hepatic resection by a single surgeon. Patients were categorized according to method of postoperative pain control. Average pain scores for both study groups were collected until POD#3. Results: Demographic data and the length of surgery were similar between the groups (all P > 0.05). On the day of surgery and POD#1, average pain scores for the epidural group were lower than the ON-Q group (P 0.0001 and P = 0.0008 respectively). There was no difference in pain scores on POD #2 (P = 0.2369) or POD #3 (P = 0.2289). Conclusions: Epidural analgesia provides superior pain control on the day of surgery and POD#1 when compared to On-Q catheter with IV PCA. There was no difference in pain scores on POD#2 or POD#3. Future prospective randomized trials comparing these analgesic methods will be required to further evaluate enhanced recovery after hepatic surgery.展开更多
Background： We undertook a randomized controlled trial to ascertain if single-incision laparoscopic cholecystectomy （SILC） was more beneficial for reducing postoperative pain than traditional laparoscopic cholecyst...Background： We undertook a randomized controlled trial to ascertain if single-incision laparoscopic cholecystectomy （SILC） was more beneficial for reducing postoperative pain than traditional laparoscopic cholecystectomy （TLC）. Moreover, the influencing factors of SI LC were analyzed. Methods： A total of 552 patients with symptomatic gallstones or polyps were allocated randomly to undergo SILC （n = 138） or TLC （n - 414）. Data on postoperative pain score, operative time, complications, procedure conversion, and hospital costs were collected. After a 6-month follow-up, all data were analyzed using the intention-to-treat principle. Results： Among SILC group, 4 （2.9%） cases required conversion to TLC. Mean operative time of SILC was significantly longer than that of TLC （58.97 ± 21.56 vs. 43.38 ± 19.02 min, P 〈 0.001）. The two groups showed no significant differences in analgesic dose, duration of hospital stay, or cost. Median pain scores were similar between the two groups 7 days after surgery, but SILC-treated patients had a significantly lower median pain score 6 h after surgery （10-point scale： 3 [2, 4] vs. 4 [3, 5], P = 0.009）. Importantly, subgroup analyses of operative time for SILC showed that a longer operative time was associated with greater prevalence of pain score 〉5 （≥100 min： 5/7 patients vs. 〈40 min, 3/16 patients, P = 0.015）. Conclusions： The primary benefit of SILC appears to be slightly less pain immediately after surgery. Surgeon training seems to be important because the shorter operative time for SILC may elicit less pain immediately after surgery.展开更多
Purpose: Opioids are concerned as a major cause of postoperative respiratory depression. In the immediate postoperative period, however, other factors can produce instability of breathing such as pain, agitation, and ...Purpose: Opioids are concerned as a major cause of postoperative respiratory depression. In the immediate postoperative period, however, other factors can produce instability of breathing such as pain, agitation, and residual effects of anesthetics. Such factors might be overlooked masked by the fear for opioid-induced respiratory depression. We report a case who presented apnea immediately after emergence from anesthesia that we considered was produced by an interaction among such factors accompanied with fentanyl-induced respiratory depression. Clinical Features: A 31-year-old woman underwent ovarian cystectomy under general anesthesia with continuous infusions of propofol and remifentanil, and bolus doses of fentanyl. Transversus abdominis plane blocks with ropivacaine were given upon completion of surgery. She complained of severe wound pain and was agitated at the emergence from anesthesia. Fentanyl 50 μg was administered intravenously. In several minutes, she developed apnea, unconsciousness, and difficulty of mechanical ventilation via a face mask. The estimated effect site concentration at the onset of the episode (2.9 ng·ml-1) was approximately the same (3.0 ng·ml-1) as after 30 min when she regained consciousness and spontaneous breathing. It indicated that not only direct inhibition of the respiratory center by fentanyl but also other stimulatory and inhibitory factors contributed to respiratory arrest. Conclusion: In the immediate postoperative period, transient factors, such as pain, mental instability and anesthetic residues, which are indirectly-related with breathing, can interact each other and with opioids. The interaction would induce apnea through mechanisms combined among direct inhibition of the respiratory center, and modulation of chemical and cortical controls of breathing.展开更多
文摘To establish an effective method of continuous quality control of acute pain service, a retrospective study on incident reporting during postoperative anal-gesia period was conducted. Incidents were reported and analyzed in 1507 patients who received epidural postoperative analgesia, and the results of satisfaction of pain relief was compared with those of incident analysis. In this study, an incident was defined as any factor that might or had affected patient's safety during analgesia period. Our results showed that 1203 incidents were reported in 641 of 1507 patients, of which 122 incidents were critical. 78. 3 % of all incidents were detect-ed by acute pain service stuff. The most common incidents included complica-tions, insufficient analgesia and problems with delivery circuits. Human factors were involved in 28. 9 % of the incidents, most being associated with technical failure due to unskillfu1ness, poor communications between APS stuff and pa-tients and lack of cooperation with surgeons and nurses. The general satisfactionrate of the patients was 90. 8 %. There was a very significant difference between the satisfaction of the patients who suffered from incidents and who did not (P<t0.001). It is concluded that incidents affect the satisfaction of the patients who received postoperative pain relief. Incident reporting is a more effective method for quality control of acute pain service.
基金Supported by Foundation of Health Department of Zhejiang ProvinceChina+3 种基金No.2011RCA207Foundation of Education Department of Zhejiang ProvinceChinaNo.Y201431914
文摘AIM: To prospectively evaluate the effectiveness and safety of continuous wound infiltration(CWI) for pain management after open gastrectomy. METHODS: Seventy-five adult patients with American Society of Anesthesiologists(ASA) Physical Status Classification System(ASA) grade 1-3 undergoing open gastrectomy were randomized to three groups. Group 1 patients received CWI with 0.3% ropivacaine(group CWI). Group 2 patients received 0.5 mg/m L morphine intravenously by a patient-controlled analgesia pump(PCIA)(group PCIA). Group 3 patients received epidural analgesia(EA) with 0.12% ropivacaine and 20 μg/m L morphine with an infusion at 6-8 m L/h for 48 h(group EA). A standard general anesthetic technique was used for all three groups. Rescue analgesia(2 mg bolus of morphine, intravenous) was given when the visual analogue scale(VAS) score was ≥ 4. The outcomes measured over 48 h after the operation were VAS scores both at rest and during mobilization, total morphine consumption, relative side effects, and basic vital signs. Further results including time to extubation, recovery of bowel function, surgical wound healing,mean length of hospitalization after surgery, and the patient's satisfaction were also recorded.RESULTS: All three groups had similar VAS scores during the first 48 h after surgery. Group CWI and group EA, compared with group PCIA, had lower morphine consumption(P < 0.001), less postoperative nausea and vomiting(1.20 ± 0.41 vs 1.96 ± 0.67, 1.32 ± 0.56 vs 1.96 ± 0.67, respectively, P < 0.001), earlier extubation(16.56 ± 5.24 min vs 19.76 ± 5.75 min, P < 0.05, 15.48 ± 4.59 min vs 19.76 ± 5.75 min, P < 0.01), and earlier recovery of bowel function(2.96 ± 1.17 d vs 3.60 ± 1.04 d, 2.80 ± 1.38 d vs 3.60 ± 1.04 d, respectively, P < 0.05). The mean length of hospitalization after surgery was reduced in groups CWI(8.20 ± 2.58 d vs 10.08 ± 3.15 d, P < 0.05) and EA(7.96 ± 2.30 d vs 10.08 ± 3.15 d, P < 0.01) compared with group PCIA. All three groups had similar patient satisfaction and wound healing, but group PCIA was prone to higher sedation scores when compared with groups CWI and EA, especially during the first 12 h after surgery. Group EA had a lower mean arterial pressure within the first postoperative 12 h compared with the other two groups.CONCLUSION : CWI with ropivacaine yields a satisfactory analgesic effect within the first 48 h after open gastrectomy, with lower morphine consumption and accelerated recovery.
文摘Objective: To compare acute and long-term postoperative pain and side effects in patients undergoing mastectomy for breast cancer under general anesthesia induced with ketamine or thiamylal. Methods: Twenty four ASA physical status I-III patients undergoing mastectomy were randomly assigned to one of two groups. Ketamine group received intravenous ketamine, 1 mg/kg, and thiamylal group received intravenous thiamylal, 4 mg/kg, at the induction of general anesthesia. Anesthesia was maintained with sevoflurane, N2O and fentanyl. The intensity of pain was assessed by using visual analog scale (VAS) 3 and 16 hr and 2, 3 and 4 weeks after surgery. Postoperative side effects, including nausea, vomiting and hallucination were also recorded. Results: At 16 hr after surgery, VAS in ketamine group was significantly lower than that in thiamylal group. However, there were no statistically significant differences between the two groups in the VAS at 3 hr and 2, 3 and 4 weeks after surgery. There were no differences in the incidence of side effects such as nausea, vomiting and hallucination between the two groups. Conclusion: Intravenous ketamine at the induction of anesthesia could reduce acute postoperative pain but not long-term pain after mastectomy.
文摘Over the last decades,the number of total knee arthroplasty procedures performed in the United States has been increasing dramatically.This very successful intervention,however,is associated with significant postoperative pain,and adequate postoperative analgesia is mandatory in order to allow for successful rehabilitation and recovery.The use of regional anesthesia and peripheral nerve blocks has facilitated and improved this goal.Many different approaches and techniques for peripheral nerve blockades,either landmark or,more recently,ultrasound guided have been described over the last decades.This includes but is not restricted to techniques discussed in this review.The introduction of ultrasound has improved many approaches to peripheral nerves either in success rate and/or time to block.Moreover,ultrasound has enhanced the safety of peripheral nerve blocks due to immediate needle visualization and as consequence needle guidance during the block.In contrast to patient controlled analgesia using opioids,patients with a regional anesthetic technique suffer from fewer adverse events and show higher patient satisfaction;this is important as hospital rank-ings and advertisement have become more common worldwide and many patients use these factors in order to choose a certain institution for a specific procedure.This review provides a short overview of currently used regional anesthetic and analgesic techniques focusing on related implications,considerations and outcomes.
文摘Background and Objectives: Pain control after hepatic resection presents unique challenges as subcostal incisions, rib retraction, and diaphragmatic irritation can lead to significant pain. Both epidural analgesia and ON-Q catheters have been used for postoperative pain management after hepatic surgery, but to our knowledge have not been directly compared. Methods: The records of 143 patient between the ages 18 and 70 were reviewed who underwent hepatic resection by a single surgeon. Patients were categorized according to method of postoperative pain control. Average pain scores for both study groups were collected until POD#3. Results: Demographic data and the length of surgery were similar between the groups (all P > 0.05). On the day of surgery and POD#1, average pain scores for the epidural group were lower than the ON-Q group (P 0.0001 and P = 0.0008 respectively). There was no difference in pain scores on POD #2 (P = 0.2369) or POD #3 (P = 0.2289). Conclusions: Epidural analgesia provides superior pain control on the day of surgery and POD#1 when compared to On-Q catheter with IV PCA. There was no difference in pain scores on POD#2 or POD#3. Future prospective randomized trials comparing these analgesic methods will be required to further evaluate enhanced recovery after hepatic surgery.
文摘Background： We undertook a randomized controlled trial to ascertain if single-incision laparoscopic cholecystectomy （SILC） was more beneficial for reducing postoperative pain than traditional laparoscopic cholecystectomy （TLC）. Moreover, the influencing factors of SI LC were analyzed. Methods： A total of 552 patients with symptomatic gallstones or polyps were allocated randomly to undergo SILC （n = 138） or TLC （n - 414）. Data on postoperative pain score, operative time, complications, procedure conversion, and hospital costs were collected. After a 6-month follow-up, all data were analyzed using the intention-to-treat principle. Results： Among SILC group, 4 （2.9%） cases required conversion to TLC. Mean operative time of SILC was significantly longer than that of TLC （58.97 ± 21.56 vs. 43.38 ± 19.02 min, P 〈 0.001）. The two groups showed no significant differences in analgesic dose, duration of hospital stay, or cost. Median pain scores were similar between the two groups 7 days after surgery, but SILC-treated patients had a significantly lower median pain score 6 h after surgery （10-point scale： 3 [2, 4] vs. 4 [3, 5], P = 0.009）. Importantly, subgroup analyses of operative time for SILC showed that a longer operative time was associated with greater prevalence of pain score 〉5 （≥100 min： 5/7 patients vs. 〈40 min, 3/16 patients, P = 0.015）. Conclusions： The primary benefit of SILC appears to be slightly less pain immediately after surgery. Surgeon training seems to be important because the shorter operative time for SILC may elicit less pain immediately after surgery.
文摘Purpose: Opioids are concerned as a major cause of postoperative respiratory depression. In the immediate postoperative period, however, other factors can produce instability of breathing such as pain, agitation, and residual effects of anesthetics. Such factors might be overlooked masked by the fear for opioid-induced respiratory depression. We report a case who presented apnea immediately after emergence from anesthesia that we considered was produced by an interaction among such factors accompanied with fentanyl-induced respiratory depression. Clinical Features: A 31-year-old woman underwent ovarian cystectomy under general anesthesia with continuous infusions of propofol and remifentanil, and bolus doses of fentanyl. Transversus abdominis plane blocks with ropivacaine were given upon completion of surgery. She complained of severe wound pain and was agitated at the emergence from anesthesia. Fentanyl 50 μg was administered intravenously. In several minutes, she developed apnea, unconsciousness, and difficulty of mechanical ventilation via a face mask. The estimated effect site concentration at the onset of the episode (2.9 ng·ml-1) was approximately the same (3.0 ng·ml-1) as after 30 min when she regained consciousness and spontaneous breathing. It indicated that not only direct inhibition of the respiratory center by fentanyl but also other stimulatory and inhibitory factors contributed to respiratory arrest. Conclusion: In the immediate postoperative period, transient factors, such as pain, mental instability and anesthetic residues, which are indirectly-related with breathing, can interact each other and with opioids. The interaction would induce apnea through mechanisms combined among direct inhibition of the respiratory center, and modulation of chemical and cortical controls of breathing.
