Effect of different anesthetic modalities with multimodal analgesia on postoperative pain level in colorectal tumor patients

BACKGROUND According to clinical data,a significant percentage of patients experience pain after surgery,highlighting the importance of alleviating postoperative pain.The current approach involves intravenous self-control analgesia,often utilizing opioid analgesics such as morphine,sufentanil,and fentanyl.Surgery for colo-rectal cancer typically involves general anesthesia.Therefore,optimizing anes-thetic management and postoperative analgesic programs can effectively reduce perioperative stress and enhance postoperative recovery.The study aims to analyze the impact of different anesthesia modalities with multimodal analgesia on patients'postoperative pain.AIM To explore the effects of different anesthesia methods coupled with multi-mode analgesia on postoperative pain in patients with colorectal cancer.METHODS Following the inclusion criteria and exclusion criteria,a total of 126 patients with colorectal cancer admitted to our hospital from January 2020 to December 2022 were included,of which 63 received general anesthesia coupled with multi-mode labor pain and were set as the control group,and 63 received general anesthesia associated with epidural anesthesia coupled with multi-mode labor pain and were set as the research group.After data collection,the effects of postoperative analgesia,sedation,and recovery were compared.RESULTS Compared to the control group,the research group had shorter recovery times for orientation,extubation,eye-opening,and spontaneous respiration(P<0.05).The research group also showed lower Visual analog scale scores at 24 h and 48 h,higher Ramany scores at 6 h and 12 h,and improved cognitive function at 24 h,48 h,and 72 h(P<0.05).Additionally,interleukin-6 and interleukin-10 levels were significantly reduced at various time points in the research group compared to the control group(P<0.05).Levels of CD3+,CD4+,and CD4+/CD8+were also lower in the research group at multiple time points(P<0.05).CONCLUSION For patients with colorectal cancer,general anesthesia coupled with epidural anesthesia and multi-mode analgesia can achieve better postoperative analgesia and sedation effects,promote postoperative rehabilitation of patients,improve inflammatory stress and immune status,and have higher safety.

Medicinal cannabis products for the treatment of acute pain

For thousands of years,medicinal cannabis has been used for pain treatment,but its use for pain management is still controversial.Meta-analysis of the literature has shown contrasting results on the addition of cannabinoids to opioids compared with placebo/other active agents to reduce pain.Clinical studies are mainly focused on medicinal cannabis use in chronic pain management,for which the analgesic effect has been proven in many studies.This review focuses on the potential use of medical cannabis for acute pain management in preclinical studies,studies on healthy subjects and the few pioneering studies in the clinical setting.

Effectiveness and safety of continuous wound infiltrationfor postoperative pain management after open gastrectomy

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.

Early and Late Postoperative Pain and Side Effects after Mastectomy: A Comparison of Ketamine and Thiamylal Administered for Anesthetic Induction

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.

Thoracic Epidural Morphine for Postoperative Analgesia after Hemiclamshell Incision in Castleman Disease

The hemiclamshell incision is a valid but infrequent surgical alternative for the resection of tumors from mediastinum. This point makes this approach impossible to be studied under a randomized controlled trial. The triple association of thoracotomy, sternotomy and cervicothomy makes the hemiclamshell approach a high intensity postoperative pain surgery. However, there is no published data on this topic, and the reviewed articles only mention the analgesic regimens as a secondary point. Indeed, no author defines the best epidural drugs mixture for the patients. Multimodal analgesic regimen based on regional anesthesia should be used. Based on the recent advances on spinal opioids, morphine could be a good choice as epidural coadjutant to local anesthetics for hemiclamshell incision.

Intrathecal morphine vs femoral nerve block for postoperative-analgesia after total knee arthroplasty:A two-year retrospective analysis

AIM To compare the efficacy of intrathecal morphine and single shot femoral nerve block for patients undergoing primary total knee arthroplasty.METHODS Data was extracted from electronic medical records and case-paper record files of patients who underwent unilateral primary total knee arthroplasty under spinal anesthesia using bupivacaine 12.5 mg with intrathecal morphine(ITM) 0.2 mg and under general anesthesia(GA) with single shot femoral nerve block(FNB) using 20 m L 0.5% bupivacaine at our hospital in 2013 and 2014.All patients had received peri-articular infiltration as per the hospital protocol.Data for gender,age,weight,American Society of Anesthesiologists status,total surgical time,postoperative pain score using visual analogue scale(VAS) from 1 to 10 at 6 h,12 h and 24 h postoperatively,24 h opioid consumption,use of oral multimodal analgesia,postoperative high dependency unit(HDU) admission and the time to discharge from the hospital was collected.The data was analyzed using Mann-Whitney U test for continuous variables and Fischer's exact-t-test for categorical variables.RESULTS Twenty-two patients in ITM group and 32 patients in FNB group were analyzed.Median pain scores using VAS in ITM group were significantly lower at 6 h(0.0 vs 2.0,P<0.001),12 h(0.0 vs 2.0,P<0.001) and 24 h(0.0 vs 2.0,P<0.001) postoperatively.Also,postoperative morphine consumption in ITM group was significantly lower(P<0.001).However,median of nonsteroid anti-inflammatory drug unit requirement in 24 h postoperatively was statistically significant higher in ITM compared to FNB group(2.0 vs 1.0,P=0.025).The difference in postoperative paracetamol consumption in 24 h was not statistically significant(P=0.147).There was no significant difference in the postoperative HDU admission or time to discharge from the hospital.No respiratory depression in either group was noticed.CONCLUSION The ITM group patients had much lower pain scores and morphine requirement in the first 24 hour postoperatively compared to FNB group.

Perioperative Adjunct Magnesium Decreases Postoperative Opioid Requirements—A Meta-Analysis

Objectives: Magnesium (Mg) is the fourth most common cation in the body and has numerous physiological activities and anti-nociceptive effects. The anti-nociceptive effects are primarily mediated by regulation of calcium influx into the cell and antagonism of the N-Methyl-D-aspartate glutamate receptors. Opioids are widely used as analgesics to minimize postoperative pain, but their use is associated with various side effects as well as the potential for addiction and tolerance. Systemic Mg has been proposed as an adjunct to minimize postoperative pain in numerous clinical studies. This meta-analysis aims to critically examine the ability of perioperative intravenous (IV) Mg to reduce opioid use and its’ side effects. Methods: A comprehensive literature search of Pub Med, Cochrane Central Registry of Controlled Trials, and Google Scholar (1966-2016) was performed to identify all randomized control trials (RCTs) assessing the use of perioperative IV Mg in the reduction of postoperative opioid consumption. Keywords searched included combinations of “magnesium”, “pain”, “postoperative”, “preoperative”, “analgesia” and “opioid”. Inclusion criteria included RCTs comparing the use of perioperative IV Mg with a control group in adult patients (>18 yrs) undergoing elective surgery. Cumulative opioid consumption within the first 24 hours (hrs) postoperative period and the incidence of nausea and vomiting were analyzed. Results: 14 RCTs involving 910 patients were identified (455 patients received Mg and 455 patients received placebo or no therapy). Opioid consumption was significantly decreased in the systemic Mg group (standard mean difference [SMD]: 1.39, 95% CI 1.83 to -0.96;p p p = 0.234). Systemic Mg adjunct had no significant effect on postoperative nausea and vomiting (RR = 0.63;95% CI 0.38 to 1.04;p = 0.07). Conclusion: Perioperative IV Mg administration reduces opioid use in the first 24 hours postoperatively without any serious adverse events. The decreased need for postoperative opioids in the Mg group was not associated with a decrease in opioid-related side effects such as nausea and vomiting. Mg is an efficacious adjunct for postoperative analgesia and should be considered in multimodal analgesic treatment plans. Additional studies are required to optimize the Mg dose and timing, and to address whether specific opioids display unique benefit or resistance to adjunct Mg therapy.

Pain management in acute musculoskeletal injury: Effect of opioid vs nonopioid medications

BACKGROUND The use of opioids for pain is linked to an increased risk of developing opioid use disorder,and has resulted in the emergence of the opioid crisis over the last few years.AIM The systematic review question is“How does the use of opioid medications in pain management,compared with non-opioid medications,affect pain intensity over the short,intermediate,and long-term in adults with acute traumatic pain?”.METHODS The protocol was prospectively registered on the International Prospective Re-gister of Systematic Reviews:CRD42021279639.Medline and Google Scholar were electronically searched for controlled peer-reviewed studies published in full,with the PICO framework:P:Adult patients with traumatic injuries,I:Opioid medications,C:Non-opioid medi-cations,O:A minimum clinically important difference(MCID)in pain.RESULTS After full-text screening,we included 14 studies in the qualitative synthesis.Of these 14 studies,12 were rando-mized clinical trials(RCTs)and 2 were pseudo-RCTs with a total of 2347 patients enrolled.There was heteroge-neity in both medication utilized and outcome in these studies;only two studies were homogeneous regarding the type of study conducted,the opioid used,its comparator,and the outcome explored.The MCID was evaluated in 8 studies,while in 6 studies,any measured pain reduction was considered as an outcome.In 11 cases,the setting of care was the Emergency Department;in 2 cases,care occurred out-of-hospital;and in one case,the setting was not well-specified.The included studies were found to have a low-moderate risk of bias.CONCLUSION Non-opioids can be considered an alternative to opioids for short-term pain management of acute musculoskeletal injury.Intravenous ketamine may cause more adverse events than other routes of administration.

术后患者自控镇痛:北京协和医院30年临床管理经验

术后疼痛严重影响患者的康复进程,从而导致住院时间延长,照护成本增加。合理应用患者自控镇痛装置可有效缓解围术期急性疼痛。北京协和医院于1994年引入患者自控镇痛技术,并于2004年成立了急性疼痛服务工作组,以麻醉医生为指导、手术室疼痛专科护士为基础,联合实施基于患者自控镇痛的全流程、规范化管理,并不断改进和创新工作方法,为术后疼痛管理的发展奠定了坚实基础。本文从临床工作重点、护理管理经验、疼痛治疗理念的推广与传播、新形势下急性疼痛服务模式的发展等方面对该项工作进行系统回顾与总结,以期为全面加强患者诊疗过程中的疼痛管理、提升患者围术期镇痛服务满意度提供有价值的参考。

Effectiveness of Auricular Acupressure for Acute Postoperative Pain after Surgery: A Systematic Review and Meta-Analysis

Objective: To identify the effectiveness of auricular acupressure(AA) in patients with acute postoperative pain after surgery by systematic review. Methods: A search of randomized controlled trials was conducted in 5 English medical electronic databases and 4 Chinese databases. Two reviewers independently retrieved related studies, assessed the methodological quality, and extracted data with a standardized data form. Meta-analyses were performed using all time-points meta-analysis. Results: A total of 26 studies with 1,682 participants were included. Results showed that compared with conventional therapy, AA significantly improved the total effective rate [risk ratio=1.25, 95% confidence interval(CI), 1.13 to 1.37, P<0.0001; heterogeneity: P<0.0001, I^2=85%]. In the subgroup analysis, the results changed in different follow-up time and surgery categories. The pain relief in the AA group might be the most significant at 72 h after surgery(mean difference=–0.85, 95% CI, –1.20 to –0.50, P<0.0001) and in abdominal surgery(mean difference=–1.15, 95% CI, –1.41 to –0.90, P<0.0001). Sensitivity analysis demonstrated that the results of this meta-analysis were stable. No serious adverse effects were recorded. Conclusions: It was recommended to provide AA to patients with acute postoperative pain. However, a more accurate estimate of the effect requires further rigorously designed large-scale and high-quality RCTs for improving acute postoperative pain after surgery.

不同时期腹腔镜胆囊切除术治疗轻度急性胆管炎的应用分析

目的:分析不同时期腹腔镜胆囊切除术治疗轻度急性胆管炎的应用效果。方法:选取2018年1月—2021年12月天津市公安医院收治的60例轻度急性胆管炎患者作为研究对象,按照手术时期分为早期组30例和延期组30例。早期组于入院后行腹腔镜胆囊切除术,延期组于炎症控制后行腹腔镜胆囊切除术。比较两组患者疗效相关指标;肝功能指标包括:丙氨酸氨基转移酶(ALT)、总胆红素(TBIL);术后视觉模拟疼痛(VAS)评分。结果:早期组患者首次排气时间、术后住院时间长于延期组,差异有统计学意义(χ^(2)=3.475,P<0.05;t=3.107,P<0.05);术后3 d,两组患者ALT、TBIL水平比较,差异无统计学意义(t=0.853、0.361,P>0.05);术后1 h、12 h,早期组患者VAS评分明显低于延期组,差异有统计学意义(t=3.417、5.068,P<0.05)。结论:与早期腹腔镜胆囊切除术比较,延期腹腔镜胆囊切除术更有利于轻度急性胆管炎患者术后恢复,但术后12 h内的疼痛更明显。

腕踝针疗法在股骨粗隆间骨折术后镇痛中的应用

目的 探究在股骨粗隆间骨折术后使用腕踝针疗法进行干预的效果。方法 选取南昌市洪都中医院收治的80例股骨粗隆间骨折患者作为研究对象,所处时间均在2019年3月—2021年3月,按镇痛方式的差异将其分为常规组和观察组,每组40例,其中常规组采用常规疼痛干预措施,观察组在常规组的基础上采用腕踝针疗法。对比2组患者麻醉消失后不同时间段的疼痛数字评价量表(NRS)分值变化情况,观察2组患者匹兹堡睡眠质量指数(PSQI)分值。结果 观察组在干预后各时间段的NRS分值、PSQI分值均低于常规组(P<0.05)。结论 在股骨粗隆间骨折术后使用腕踝针疗法进行干预,可有效改善患者的疼痛程度,改善其睡眠质量,起到较好的镇痛作用,利于患者术后恢复。

快速康复理念下剖宫产术后多模式镇痛的研究进展

为了减少产妇术后疼痛、促进产妇术后快速恢复以及保障婴儿健康,剖宫产术后的镇痛方案一直在不断完善。其中多模式镇痛是剖宫产术后快速康复(enhanced recovery after cesarean,ERAC)的重要组成部分,做好剖宫产术后的多模式镇痛是十分必要的。为尽量减少阿片类药物的不良反应,非阿片类药物与区域阻滞的应用逐渐增多,多模式镇痛方案也在逐步完善。然而,到目前为止,关于剖宫产术后的多模式镇痛方案仍存在争议,尚无最佳方案出现。本文总结了目前剖宫产术后的多模式镇痛方案,并为多模式镇痛方案的发展提供思路。

髋或膝关节置换术后急性疼痛的影响因素和预测模型

目的探讨髋或膝关节置换术患者术后急性疼痛(APP)的影响因素,建立并验证预测模型。方法收集行髋或膝关节置换术患者316例的临床资料,男111例,女205例,年龄≥18岁,ASAⅠ—Ⅲ级。根据是否发生APP将患者分为两组:非APP组和APP组。将患者按7∶3的比例随机分成训练集和验证集。通过LASSO回归和多因素Logistic回归分析训练集,筛选危险因素并构建预测模型,绘制受试者工作特征(ROC)曲线并计算曲线下面积(AUC)评估模型的预测效率。在验证集中,采用Bootstrap方法进行内部验证,采用临床决策曲线分析(DCA)评价预测模型的临床价值。结果有137例(43.4%)患者发生APP。多因素Logistic回归分析显示,高BMI、糖尿病史、手术时间延长、疼痛灾难化评分≥27分是髋或膝关节置换术患者发生APP的独立危险因素(P<0.05),放置引流管、术前药物预防性镇痛、术后使用镇痛泵、术后行神经阻滞镇痛是髋或膝关节置换术患者发生APP的保护因素(P<0.05)。纳入BMI、糖尿病史、放置引流管、手术时间、疼痛灾难化评分构建预测模型,训练集的AUC为0.879(95%CI 0.836~0.922),验证集的AUC为0.819(95%CI 0.730~0.907)。Bootstrap内部验证显示,校准曲线在预测值和实测值之间有很好的一致性;DCA曲线显示,该预测模型具有较高的临床应用价值。结论髋或膝关节置换术患者发生APP的危险因素为高BMI、糖尿病史、手术时间延长、疼痛灾难化评分≥27分,保护因素为放置引流管、术前药物预防性镇痛、术后使用镇痛泵、术后行神经阻滞。基于以上因素构建的预测模型具有良好的判别能力与临床应用性,可为预测髋或膝关节置换术患者APP提供参考。

腰方肌阻滞在髋关节术后镇痛中的应用

髋关节手术创伤大,患者术后往往伴随中重度疼痛。安全且有效的术后镇痛可以有效促进患者的康复活动,有利于髋关节手术后患者早期功能恢复。常规使用的静脉自控镇痛虽然镇痛效果确切,但可能引起恶心呕吐、过度镇静、肠麻痹,甚至呼吸抑制等不良反应。腰方肌阻滞(QLB)作为一种替代腹横肌平面阻滞(TAPB)的技术。近年来逐渐应用于髋关节手术。本文通过对QLB的解剖基础、作用特点及其在髋关节手术中的应用作一综述,为QLB在髋关节术后镇痛中的应用提供参考。

腹腔镜胃肠肿瘤手术患者急性术后疼痛与疼痛敏感性的相关性

目的探讨腹腔镜胃肠肿瘤手术患者急性术后疼痛与疼痛敏感性的相关性。方法选取择期行全身麻醉下腹腔镜胃肠肿瘤手术的患者50例,性别不限,年龄≥18岁,美国麻醉医师协会(ASA)分级Ⅰ~Ⅱ级。根据术前疼痛敏感性问卷(PSQ)评分结果分为疼痛高敏感性组(PSQ评分≥5.0分,n=19)和低敏感性组(PSQ评分<5.0分,n=31)。记录两组患者的一般情况、手术情况,术后24 h内镇痛泵按压次数、补救镇痛次数,以及术后恶心、呕吐、嗜睡、腹胀等并发症的发生情况。采用视觉模拟量表(VAS)评分评估患者外周静脉置管及术后24 h内疼痛程度。结果两组患者的年龄、性别、ASA分级、BMI、手术时间、全身麻醉苏醒时间、气管导管拔管时间、术后24 h镇痛泵按压次数、术后并发症发生率比较差异均无统计学意义(均P>0.05)。与低敏感性组比较,高敏感性组外周静脉置管及术后清醒即刻、1 h、2 h的VAS评分较高(均P<0.05)。术前PSQ评分与外周静脉置管VAS评分呈正相关(r=0.693,P<0.05),与术后清醒即刻、1 h、2 h的VAS评分呈正相关(r=0.917、0.901、0.841,均P<0.05)。高敏感性组术后2 h补救镇痛次数较低敏感性组多(P<0.05)。以术前PSQ评分为检验变量、是否发生急性术后疼痛为状态变量绘制ROC曲线,其AUC为0.909,通过约登指数计算出PSQ评分最佳临界值为4.85分,提示采用PSQ评分可预测腹腔镜胃肠肿瘤手术患者急性术后疼痛的发生。结论疼痛敏感性与腹腔镜胃肠肿瘤手术患者急性术后疼痛的发生有关,可能成为急性术后疼痛发生的预测指标,术前PSQ≥4.85分者发生急性术后疼痛的可能性更高。

术后早期疼痛轨迹对于乳腺癌术后持续性疼痛的预测价值研究

目的 探讨术后早期疼痛轨迹对于乳腺癌术后持续性疼痛的预测价值。方法 选取2019年1月至2021年12月在上海同济大学医学院附属东方医院治疗的乳腺癌患者临床资料进行回顾性分析。采用GBTM根据术后1~7d的疼痛强度进行组间轨迹建模分析,确定术后早期疼痛轨迹。采用Logistic回归模型分析术后早期疼痛轨迹与术后持续性疼痛的相关性。采用ROC曲线评价术后早期疼痛轨迹对乳腺癌术后持续性疼痛的预测价值。结果 3组模型(轻度、中度和重度疼痛)适用于分析术后早期疼痛轨迹。术后6个月持续性疼痛发生率为50.80%,其中有42.24%出现轻度疼痛,有8.55%出现重度疼痛。常见疼痛部位依次为胸部(39.57%)、腋窝(27.81%)、手臂(13.91%)和后背(7.49%)。术后早期疼痛中的重度疼痛轨迹与术后6个月持续性疼痛相关(P<0.001)。ROC曲线显示,重度疼痛轨迹预测乳腺癌术后持续性疼痛的AUC为0.865。结论 术后早期疼痛轨迹可用于预测乳腺癌术后持续性疼痛,临床中可根据术后早期疼痛轨迹对患者进行分类,并采取针对性干预措施。

基于国际“PAIN OUT”调查工具PDCA改进术后患者镇痛管理质量

目的探讨基于国际“PAIN OUT”过程、结果多维度质控调查工具,医护一体化采用PDCA循环法在提升患者术后疼痛管理质量的应用效果。方法随机选取2018年10~12月聊城市人民医院关节骨科、胸科、肝胆外科、胃肠外科和两腺外科5个科室的术后24 h患者共150例作为改进前组,每科室各30例,在前期成立急性疼痛服务组织的基础上,组建医护一体化多学科合作疼痛管理团队,采用PDCA通过计划、实施、检查和处理步骤对患者围术期疼痛管理实施改进,基于信息化对医务人员进行多模式疼痛知识培训教育,优化改进流程,根据手术类别,制定个体化镇痛管理方案,对患者实施多元化宣教管理和多模式镇痛管理。2019年10~12月实施改进后从改进前选取的5个科室再次随机选取术后24 h患者150例作为研究对象,采用国际“PAIN OUT”数据表,从过程、结果指标多维度进行改进后评价。结果改进前后患者术后24 h内中重度疼痛的发生率由40.00%降至10.00%;镇痛满意度由91.20%提升到98.00%;患者镇痛知识健康教育满意度由90.00%提升到98.00%;护士的疼痛评估次数(1.78±1.05)次提升至(4.02±1.03)次;疼痛非药物干预措施实施次数由0次(0,1)提升到3次(2,4),P<0.05均有统计学意义。患者疼痛最剧烈的疼痛评分从(6.49±1.02)分降至(4.02±2.01)分,患者的首次下床活动时间由术后(23.72±6.05)h降低到(17.42±3.92)h;患者术后24 h内阿片类药物的用量由(110.24±10.23)μg降低至(82.21±11.27)μg(P<0.05)。结论采用PDCA实施术后疼痛管理质量改进,并采用国际“PAIN OUT”过程和结果质控指标进行评价,不仅能提高术后患者的满意度、舒适度,提升就医体验,缩短患者首次下床活动时间;而且减少患者阿片类药物的用量,符合ERAS快速康复理念。

疼痛+睡眠多维度强化干预联合渐进性肌肉放松训练在急腹症术后睡眠障碍患者中的应用效果

目的:探讨分析疼痛+睡眠多维度强化干预联合渐进性肌肉放松训练在急腹症手术后睡眠障碍(PSD)患者中的应用效果。方法:选取2022年6月至2023年10月三明市第一医院急诊科行急腹症手术后出现PSD的患者120例作为研究对象,按照随机数字表法分为观察组与对照组,每组60例。对照组予以常规护理干预,观察组在其基础上予以疼痛+睡眠多维度强化干预联合渐进性肌肉放松训练,比较2组术后疼痛程度、睡眠质量、焦虑状态、预后恢复。结果:观察组术后疼痛评分、预后恢复时间均低于对照组,差异有统计学意义(P<0.05);干预5 d后观察组睡眠质量评分、焦虑状态评分均低于对照组,差异有统计学意义(P<0.05)。结论:疼痛+睡眠多维度强化干预联合渐进性肌肉放松训练应用于急腹症手术后PSD患者中临床效果良好,利于其PSD与焦虑状态改善,降低术后疼痛,缩短预后恢复时间。

Comparison of oxycodone and sufentanil in patient-controlled intravenous analgesia for postoperative patients:a meta-analysis of randomized controlled trials

Background:Managing acute postoperative pain is challenging for anesthesiologists,surgeons,and patients,leading to adverse events despite making significant progress.Patient-controlled intravenous analgesia(PCIA)is a recommended solution,where oxycodone has depicted unique advantages in recent years.However,controversy still exists in clinical practice and this study aimed to compare two drugs in PCIA.Methods:We performed a literature search in PubMed,Embase,the Cochrane Central Register of Controlled Trials,Web of Science,Chinese National Knowledge Infrastructure,Wanfang,and VIP databases up to December 2020 to select specific randomized controlled trials(RCTs)comparing the efficacy of oxycodone with sufentanil in PCIA.The analgesic effect was the primary outcome and the secondary outcome included PCIA consumption,the Ramsay sedation scale,patients’satisfaction and side effects.Results:Fifteen RCTs were included in the meta-analysis.Compared with sufentanil,oxycodone showed lower Numerical Rating Scale scores(mean difference[MD]=-0.71,95%confidence interval[CI]:-1.01 to-0.41;P<0.001;I^(2)=93%),demonstrated better relief from visceral pain(MD=-1.22,95%CI:-1.58 to-0.85;P<0.001;I^(2)=90%),promoted a deeper sedative level as confirmed by the Ramsay Score(MD=0.77,95%CI:0.35-1.19;P<0.001;I^(2)=97%),and resulted in fewer side effects(odds ratio[OR]=0.46,95%CI:0.35-0.60;P<0.001;I^(2)=11%).There was no statistical difference in the degree of patients'satisfaction(OR=1.13,95%CI:0.88-1.44;P=0.33;I^(2)=72%)and drug consumption(MD=-5.55,95%CI:-14.18 to 3.08;P=0.21;I^(2)=93%).Conclusion:Oxycodone improves postoperative analgesia and causes fewer adverse effects,and could be recommended for PCIA,especially after abdominal surgeries.Registration:PROSPERO;https://www.crd.york.ac.uk/PROSPERO/;CRD42021229973.