Preemptive analgesia with butorphanol in psychotic patients following modified electroconvulsive therapy A randomized controlled trial

BACKGROUND： Preemptive .analgesia involves introducing an analgesic prior to the onset of pain stimulation to prevent sensitizing the nervous system to subsequent stimuli that could amplify pain. OBJECTIVE： To treat psychiatric patients with intravenous （i.v.） injection of butorphanol prior to modified electroconvulsive therapy, and to observe its effect on alleviating myalgia after treatment and adverse reactions. DESIGN： A randomized controlled observation. SETTING： Renmin Hospital of Wuhan University. PARTICIPANTS： A total of 120 psychiatric patients, who accepted modified electroconvulsive therapy, were selected from the Mental Health Center of Wuhan University from June to September in 2006. All patients corresponded to the Chinese Classification and Diagnostic Criteria of Mental Disorders, and those with diseases of heart, liver, lung and kidney, glaucoma, intracranial hypertension, hyperthyreosis, and hyperkalemia were excluded. The patients were randomly divided into a control group （n = 60） and treatment group （n = 60）. In the control group, there were 42 males and 18 females, aged 17-50 years, with a mean age of （34 ± 11） years. The patients weighed 50-70 kg, with a mean body mass of （63 ± 18） kg. In the treatment group, there were 40 males and 20 females, aged 20-54 years, with a mean age of （36 ± 13） years. The patients weighed 48-72 kg, with a mean body mass of （64 ± 16） kg. Approval was obtained from the Hospital＇s Ethics Committee. Informed consents were obtained from the patients＇ relatives. A SPECTRUM5000Q multifunctional mobile electroconvulsive therapy apparatus （CORPERATION, USA） was used. METHODS： （1） Treatments： In the control group, the patients were anesthetized by i.v. injection of propofol （AstraZeneca, Italy, No.CN309） containing 0.075% efedrina, and then modified electroconvulsive therapy was performed. Circulation, respiration, and firing of brain electrical activity were continuously monitored. In the treatment group, the patients were i.v. injected with 1 mg of butorphanol tartrate parenteral solution （Jiangsu Hengrui Medicine Co., Ltd., No.05100732） 5 minutes prior to anesthesia; the remaining treatments were the same as in the control group. （2） Evaluations： myalgia conditions were assessed 6 hours after the patients opened their eyes. The patients were evaluated by a visual analogue scale and Ramsay sedation scale immediately, and at 3 minutes and 6 hours after they opened their eyes. MAIN OUTCOME MEASURES： （1） Conditions of myalgia. （2） Scores of visual analogue scale and Ramsay sedation scale. RESULTS： All 120 psychiatric patients were involved in the final analysis. （1） Conditions of myalgia： 6 hours after modified electroconvulsive therapy, 22 patients in the control group and 1 patient in the treatment group complained of myalgia, which resulted in a significant difference between the two groups （P 〈 0.05）. （2） Scores of visual analogue scale and Ramsay sedation scale： the scores of visual analogue scale at 30 minutes and 6 hours after opening eyes were significantly lower in the treatment group than the control group （P 〈 0.05）, and the scores of Ramsay sedation scale were not significantly different between the two groups （P 〉 0.05）. CONCLUSION： Preemptive analgesia by butorphanol can effectively alleviate modified electroconvulsive therapy-induced myalgia, without adverse reactions.

Study on the value of parecoxib sodium preemptive analgesia for laparoscopic surgery based on postoperative pain and stress mediator secretion

Objective:To investigate the effect of parecoxib sodium preemptive analgesia on postoperative pain and stress response in patients with laparoscopic surgery.Methods:118 patients with asymptomatic gallbladder polyps who underwent elective laparoscopic surgery in our hospital between January 2018 and January 2019 were divided into the control group(n=59)and the preemptive analgesia group(n=59)by random number table.Control group received routine total intravenous anesthesia,and preemptive analgesia group received intravenous injection of parecoxib sodium 0.7mg/kg during anesthesia induction.The differences in serum levels of pain mediators[prostaglandin E2(PGE2),substance P(SP)and neuropeptide Y(NPY)],inflammatory factors[interleukin-1β(IL-1β),interleukin-6(IL-6)and interleukin-12(IL-12)]as well as stress mediators[cortisol(Cor),norepinephrine(NE)and epinephrine(E)]at before surgery(T0),30min after extubation(T1),6h after surgery(T2)and 24h after surgery(T3)were compared between the two groups of patients.Results:At T0,there was no significant difference in VAS score as well as inflammatory factor or stress mediator levels between the two groups(P>0.05).At T1,T2 and T3,VAS scores of the preemptive analgesia group were lower than those of the control group;serum IL-1β,IL-6,IL-12 and TNF-αlevels were lower than those of the control group;serum Cor,NE and E levels were lower than those of the control group(P<0.05).Conclusion:Parecoxib sodium preemptive analgesia has a positive effect on reducing postoperative pain and systemic stress in patients with laparoscopic cholecystectomy.

Research Status of Preemptive Analgesia and its Application in Clinical Anesthesia

The most effective treatment for postoperative pain is to reduce it by preventing or reducing the sensitivity and sensory disturbance on the central nervous system during the operation,prolonging the pain-relief time and reducing the use of analgesics.Preemptive analgesia refers to the intervention of central neuraxis sensitization and peripheral sensitization to prevent the expansion and spread of pain,so as to achieve postoperative pain-relief.In postoperative patient-controlled analgesia,preemptive analgesia has become a common treatment method for anesthesiologists.However,the clinical specifications for advanced analgesia are still lacking.Based on this,this paper reviews the use of advanced analgesia drugs and their clinical applications.

Effects of Preemptive Analgesia with Flurbiprofen Axetil Injection on Analgesia, Inflammatory Response, Stress Response and Immune Response in Patients Undergoing Thoracoscopic Lobectomy

Objective:To investigate the effect of preemptive analgesia withflurbiprofen axetil injection on the analgesic effect,inflammatory response,stress response and immune response in patients undergoing thoracoscopic lobectomy.Methods:92 patients with early non-small cell lung cancer who underwent thoracoscopic lobectomy from January 2016 to March 2018 in our hospital were divided into observation group and control group according to the method of random digital table,46 cases in each group.The control group was given routine perioperative analgesia,the observation group was given advanced analgesia mode,and the visual simulation scoring method(visual)was used to observe the patients in the two groups at 4,12,24 and 48 h after operation The results showed that the level of inflammation factor,stress response factor and immune response were significantly higher than that of before operation(T0),when anesthesia woke up(T1),12 hours after operation(T2),24 h after operation(T3)and 48 h after operation(T4).Results:(1)The VAS score of the observation group was significantly lower than that of the control group(P<0.05)at 4,12,24 and 48 h after operation;(2)The levels of IL-6,IL-10,SP-A and TNF-αin the two groups were significantly lower than that of the control group(P<0.05)The level of factor-α,TNF-α)was higher than that of to time point,and showed an upward trend;the level of IL-6,IL-10,TNF-α,SP-A decreased gradually at T3,T4 time points,the level of IL-6,TNF-α,SP-A in T1,T2,T3,T4 time points in the observation group was lower than that of the control group,and the level of IL-10 was higher than that of the control group(P<0.05);(3)Compared with T0 time point,the epinephrine(EPIPH)at T1,T2,T3,T4 time points in the two groups The levels of rine,e,noradrenaline,NE and cortisol in the observation group increased first and then decreased;the levels of E,NE and cor in the observation group were lower than those in the control group at T1,T2,T3 and T4 time points(P<0.05);and(4)Compared with T0 time point,the serum IgG,IgM and IgA levels in the two groups decreased gradually at T1,T2,T3 and T4 time points,but the observation group The levels of IgG,IgM and IgA in serum of group A were higher than those of group B(P<0.05).Conclusion:Preemptive analgesia with flurbiprofen axetil injection can significantly improve the postoperative pain,reduce the level of ;inflammation,reduce the stress response and increase the level of immune response.

Effect of Preemptive Ketamine Administration on Postoperative Visceral Pain after Gynecological Laparoscopic Surgery

The pain following gynecological laparoscopic surgery is less intense than that following open surgery; however, patients often experience visceral pain after the former surgery. The aim of this study was to determine the effects of preemptive ketamine on visceral pain in patients undergoing gynecological laparoscopic surgery. Ninety patients undergoing gynecological laparoscopic surgery were randomly assigned to one of three groups. Group 1 received placebo. Group 2 was intravenously injected with preincisional saline and local infiltration with 20 m L ropivacaine（4 mg/m L） at the end of surgery. Group 3 was intravenously injected with preincisional ketamine（0.3 mg/kg） and local infiltration with 20 m L ropivacaine（4 mg/m L） at the end of surgery. A standard anesthetic was used for all patients, and meperidine was used for postoperative analgesia. The visual analogue scale（VAS） scores for incisional and visceral pain at 2, 6, 12, and 24 h, cumulative analgesic consumption and time until first analgesic medication request, and adverse effects were recorded postoperatively. The VAS scores of visceral pain in group 3 were significantly lower than those in group 2 and group 1 at 2 h and 6 h postoperatively（P〈0.05 and P〈0.01, respectively）. At 2 h and 6 h, the VAS scores of incisional pain did not differ significantly between groups 2 and 3, but they were significantly lower than those in group 1（P〈0.01）. Groups 1 and 2 did not show any differences in visceral pain scores at 2 h and 6 h postoperatively. Moreover, the three groups showed no statistically significant differences in visceral and incisional pain scores at 12 h and 24 h postoperatively. The consumption of analgesics was significantly greater in group 1 than in groups 2 and 3, and the time to first request for analgesics was significantly longer in groups 2 and 3 than in group 1, with no statistically significant difference between groups 2 and 3. However, the three groups showed no significant difference in the incidence of shoulder pain or adverse effects. Preemptive ketamine may reduce visceral pain in patients undergoing gynecological laparoscopic surgery.

Preemptive analgesic effects of flurbiprofen axetil in patients undergoing radical resection of esophageal carcinoma via the left thoracic approach

Background Systemic non-steroidal anti-inflammatory drugs have been evaluated for their possible preemptive analgesic effects.The efficacy of flurbiprofen axetil for preemptive analgesia in patients undergoing radical resection of esophageal carcinoma via the left thoracic approach needs further investigation.The aim of this study was to research the preemptive analgesic effects of flurbiprofen axetil in thoracic surgery,and the influence of preoperative administration on postoperative respiratory function.Methods This randomized,double-blind,controlled trial enrolled 60 patients undergoing radical resection of esophageal carcinoma via the left thoracic approach.Anesthesia management was standardized.Each patient was randomly assigned to receive either 100 mg flurbiprofen axetil intravenously 15 minutes before incision （PA group） or intravenous normal saline as a control （C group）.Postoperative analgesia was with sufentanil delivered by patient-controlled analgesia pump.Postoperative sufentanil consumption,visual analog scale pain scores,plasma levels of interleukin-8,and oxygenation index were measured.Results Compared with the preoperative baseline,postoperative patients in the PA group had no obvious increase in pain scores （P 〉0.05）,but patients in the C group had significantly increased pain scores （P〈0.05）.Pain scores in the C group were significantly higher at 24 hours postoperatively than preoperatively.Intergroup comparisons showed lower visual analog scale scores at 2-24 hours postoperatively in the PA group than the C group （P 〈0.05）.Sufentanil consumption and plasma interleukin-8 levels at 2 and 12 hours postoperatively were significantly lower in the PA group than the C group （P 〈0.05）.The oxygenation index at 2 and 12 hours postoperatively was significantly higher in the PA group than the C group （P〈0.05）.Conclusions Intravenous flurbiprofen axetil appears to have a preemptive analgesic effect in patients undergoing radical resection of esophageal carcinoma via the left thoracic approach,and appears to contribute to recovery of respiratorv function and to reduction of the postoperative inflammatory reaction.

Effects of preoperative ketamine on the endocrine-metabolic and inflammatory response to laparoscopic surgery

Background Ketamine is hypothesized to reduce perioperative endocrine-metabolic and inflammatory responses in cardiac surgery patients. This randomized, placebo-controlled, double-blind study was performed to determine whether perioperative endocrine-metabolic and inflammatory responses are attenuated by preoperative administration of ketamine to healthy females receiving elective laparoscopic surgery. Methods Forty female patients with American Society of Anesthesiologist classification Ⅰ or Ⅱwho elected to receive gynecological laparoscopic surgery were randomly assigned to the ketamine-treated （group K; n = 20） or control （group C n = 20） group. At 2 minutes prior to induction patients in group K received ketamine （0.25 mg/kg） whereas those in group C received normal saline. All patients received standardized general anesthesia. Serum glucose and cortisol values were measured before ketamine administration （TO）, 2 minutes after tracheal intubation （T1）, 30 minutes after skin incision （T2）, 2 minutes after tracheal extubation （T3） and 1 hour postoperatively （T4）. Serum interleukin-6 and tumor necrosis factor-α values were determined at TO and T4. Postoperative analgesic efficacy, side effects of administered drugs, and time to discharge were recorded. Results Compared with subjects in group C, those in group K had lower serum glucose values at T1, T2, T3 and T4 and lower serum cortisol values at T4 （P 〈0.05）. Postoperative interleukin-6 and tumor necrosis factor-α concentrations for group K were lower than those for group C （P 〈0.05）. Postoperative visual analog scale scores at rest, cumulative fentanyl consumption, and time to discharge were lower in group K as compared to group C （P 〈0.05）. No significant differences in drug side effects were observed postoperatively between the two groups. Conclusion Endocrine-metabolic and inflammatory responses to laparoscopic surgery are attenuated in part by Dre-incisienal administration of ketamine.