AIM To prospectively evaluate the effect of local wound infiltration with ropivacaine on postoperative pain relief and stress response reduction after open hepatectomy.METHODS A total of 56 patients undergoing open he...AIM To prospectively evaluate the effect of local wound infiltration with ropivacaine on postoperative pain relief and stress response reduction after open hepatectomy.METHODS A total of 56 patients undergoing open hepatectomy were randomly divided into two groups:a ropivacaine group(wound infiltration with ropivacaine solution)and a control group(infiltration with isotonic saline solution).A visual analog scale(VAS)at rest and on movement was used to measure postoperative pain for the first 48 h after surgery.Mean arterial pressure(MAP),heart rate(HR),time to bowel recovery,length of hospitalization after surgery,cumulative sufentanil consumption,and incidence of nausea and vomiting were compared between the two groups.Surgical stress hormones(epinephrine,norepinephrine,and cortisol)were detected using enzyme-linked immunosorbent assay,and the results were compared. RESULTS VAS scores both at rest and on movement at 24 h and48 h were similar between the two groups.Significantly lower VAS scores were detected at 0,6,and 12 h in the ropivacaine group compared with the control group(P<0.05 for all).MAP was significantly lower at 6,12,and 24 h(P<0.05 for all);HR was significantly lower at 0,6,12,and 24 h(P<0.05 for all);time to bowel recovery and length of hospitalization after surgery(P<0.05 for both)were significantly shortened;and cumulative sufentanil consumption was significantly lower at 6,12,24,and 36 h(P<0.05 for all)in the ropivacaine group than in the control group,although the incidence of nausea and vomiting showed no significant difference between the two groups.The levels of epinephrine,norepinephrine,and cortisol were significantly lower in the ropivacaine group than in the control group at 24 and 48 h(P<0.01 for all). CONCLUSION Local wound infiltration with ropivacaine after open hepatectomy can improve postoperative pain relief,reduce surgical stress response,and accelerate postoperative recovery.展开更多
Patients who suffer a Fractured Neck of Femur (NOF) have a high mortality and morbidity rate with up to 20% needing long term care post fracture and a further 30% not returning to their pre fracture functioning. Hip f...Patients who suffer a Fractured Neck of Femur (NOF) have a high mortality and morbidity rate with up to 20% needing long term care post fracture and a further 30% not returning to their pre fracture functioning. Hip fracture accounts for 87% of total fragility fractures. We describe an anaesthetic technique of fixation of fracture of the femoral neck under direct infiltration local anaesthesia;that can be performed on the sick elderly patient. Twenty-eight NOF fractures were included in this series (24 DHS, 4 Hemiarthroplasty);twenty-three procedures were completed (82.14%);no patient required conversion to another form of anaesthesia either general or spinal;five patients required some degree of light sedation due to agitation (17.8%). This method presents itself as an option in managing patient with high comorbidities which can also be implemented in impoverished areas with limited access to operating surgical facilities.展开更多
Background: Ketamine or dexmedetomidine as an adjuvant to bupivacaine in local wound infiltration attenuated postoperative stress response, especially with ketamine in patients undergoing total abdominal hysterectomy....Background: Ketamine or dexmedetomidine as an adjuvant to bupivacaine in local wound infiltration attenuated postoperative stress response, especially with ketamine in patients undergoing total abdominal hysterectomy. Objectives: Compare effect of local wound infiltration with ketamine or dexmedetomidine added to bupivacaine to bupivacaine alone on inflammatory cytokine response after total abdominal hysterectomy. Methods: Sixty female patients with endometrial carcinoma underwent total abdominal hysterectomy and scheduled to receive local wound infiltration before wound closure either with one of three;40 ml of 0.25% bupivacaine alone (C Group) or with the addition of 2 mg/kg ketamine (K Group) or 2 μg/kg dexmedetomidine (D Group). After extubation, they were followed up for postoperative interleukin 6 (IL6), IL1β, IL10, and TNF-α levels were assessed at baseline, pre-infiltration, 6, and 24 h by blood samples obtained from each patient, hemodynamic variables, analgesic profile and side effects. Results: Inflammatory cytokines response was attenuated in K and D groups, evidenced by decreased mean pro-inflammatory cytokines IL6, TNF-α, and increased anti-inflammatory IL10 at 6 and 24 h postoperatively compared to pre-infiltration levels (p ≤ 0.01) with preservation of IL1β at its preoperative level (p > 0.05). Attenuation was more in K and D groups than in the C group and was highest in the K group with decreased 1<sup>st</sup> request, total morphine consumption without serious side effect. Conclusion: Local wound infiltration with ketamine or dexmedetomidine added to bupivacaine has a good postoperative analgesic profile and attenuated cytokines inflammatory response more than bupivacaine alone after total abdominal hysterectomy, with highest attenuation in ketamine group.展开更多
Objective:To study the effect of ropivacaine combined with dexamethasone local infiltration on the pain level and inflammatory stress response after pediatric tonsillectomy.Methods:A total of 84 children who received ...Objective:To study the effect of ropivacaine combined with dexamethasone local infiltration on the pain level and inflammatory stress response after pediatric tonsillectomy.Methods:A total of 84 children who received selective tonsillectomy in Mianyang Central Hospital between June 2014 and April 2017 were selected as the research subjects and divided into two groups by random number table method, combined group received ropivacaine combined with dexamethasone local infiltration, and control group accepted ropivacaine local infiltration anesthesia. Serum levels of pain mediators, inflammatory mediators and stress mediators were detected 6 h, 12 h and 24 h after surgery.Results: 6 h after surgery, serumβ-EP, SP, BK, TNF-α, MCP-1, IL-4, IL-10, F-Cor, NE, AT-II and GH levels were not significantly different between the two groups;12 h and 24 h after surgery, serumβ-EP, SP, BK levels of control group were significantly higher than those 6 h after surgery, serumβ-EP, SP, BK levels of combined group were not significantly different from those 6 h after surgery. Serum TNF-α, MCP-1, IL-4, IL-10, F-Cor, NE, AT-II and GH levels of two groups were significantly higher than those 6 h after surgery, and Serum TNF-α, MCP-1, IL-4, IL-10, F-Cor, NE, AT-II and GH levels of combined group were significantly lower than control group.Conclusion:Ropivacaine combined with dexamethasone local infiltration is with more durable and exact effect than ropivacaine local infiltration alone on relieving the pain and inflammatory stress response after pediatric tonsillectomy.展开更多
Objective： To study the effect of tumor infiltrating lymphocytes at cancer nest on local control of rectal cancer after preoperative radiotherapy. Methods： From Jan. 1999 to Oct. 2007, a total of 107 patients with r...Objective： To study the effect of tumor infiltrating lymphocytes at cancer nest on local control of rectal cancer after preoperative radiotherapy. Methods： From Jan. 1999 to Oct. 2007, a total of 107 patients with rectal cancer were reviewed. They were treated by preoperative radiotherapy, 30 Gy/10 fractions/12 days. Two weeks later, the patient underwent a surgical operation. Their pathological samples were kept in our hospital before and after radiotherapy. Lymphocyte infiltration （LI） degree, pathologic degradation and fibrosis degree after radiotherapy in paraffin section were evaluated under microscope. Results： After followed-up of 21 months （2-86 months）, a total of 107 patients were reviewed. Univariate analysis showed that lymphocyte infiltration （LI）, fibrosis and pathologic changes after radiotherapy were significant factors on local control. Logistic regression analysis showed that LI after radiotherapy was a significant effect factor on local control. Conclusion： LI, fibrosis and pathologic degradation after radiotherapy are significant for local control of rectal cancer after preoperative radiotherapy. LI after radiotherapy was a significantly prognostic index for local control of rectal cancer after preoperative radiotherapy.展开更多
目的观察电针术前预处理对全麻下行全膝关节置换术(TKA)患者术后镇痛的效果。方法选取2022年10月—2022年12月于徐州市中心医院首次全麻下行单侧TKA患者96例,用随机数字法将患者分为观察组、对照组,各48例。观察组给予电针预处理+局部...目的观察电针术前预处理对全麻下行全膝关节置换术(TKA)患者术后镇痛的效果。方法选取2022年10月—2022年12月于徐州市中心医院首次全麻下行单侧TKA患者96例,用随机数字法将患者分为观察组、对照组,各48例。观察组给予电针预处理+局部浸润麻醉+静脉自控镇痛(PCIA),对照组给予局部浸润麻醉+PCIA。比较2组手术前后血浆缓激肽(BK)、前列腺素E2(PGE2)、P物质(SP)、β内啡肽(β-ep)、强啡肽(Dyn),术后12、24、48 h VAS评分,麻醉药物使用情况及不良反应。结果术后2组血浆BK、PGE2、SP、β-ep、Dyn水平与同组术前比较,差异有统计学意义(P<0.01)。观察组血浆BK、PGE2、SP水平低于对照组(P<0.05),β-ep、Dyn水平高于对照组(P<0.05)。静息VAS评分:术后12、24、48 h,2组间VAS评分比较,差异无统计学意义(F=0.694,P=0.406);组内各时间点VAS评分比较,差异有统计学意义(F=256.6,P<0.01)。活动VAS评分:术后12、24、48 h,2组间VAS评分比较,差异有统计学意义(F=7.072,P=0.008);组内各时间点VAS评分比较,差异有统计学意义(F=300.885,P<0.01)。观察组首次按压时间晚于对照组(P<0.01),PCIA总按压次数少于对照组(P<0.01),补救镇痛例数少于对照组,但差异无统计学意义(P>0.05)。观察组术后恶心、呕吐发生率低于对照组(P<0.05);2组头晕、嗜睡、呼吸抑制、瘙痒发生率比较,差异无统计学意义(P>0.05)。结论电针预处理可增强TKA患者术后局部浸润麻醉+PCIA的镇痛效果。展开更多
基金Supported by National Natural Science foundation of China,No.81571367 and No.81502050Scientific and Technological Project of Shandong Province,No.2016GSf201082
文摘AIM To prospectively evaluate the effect of local wound infiltration with ropivacaine on postoperative pain relief and stress response reduction after open hepatectomy.METHODS A total of 56 patients undergoing open hepatectomy were randomly divided into two groups:a ropivacaine group(wound infiltration with ropivacaine solution)and a control group(infiltration with isotonic saline solution).A visual analog scale(VAS)at rest and on movement was used to measure postoperative pain for the first 48 h after surgery.Mean arterial pressure(MAP),heart rate(HR),time to bowel recovery,length of hospitalization after surgery,cumulative sufentanil consumption,and incidence of nausea and vomiting were compared between the two groups.Surgical stress hormones(epinephrine,norepinephrine,and cortisol)were detected using enzyme-linked immunosorbent assay,and the results were compared. RESULTS VAS scores both at rest and on movement at 24 h and48 h were similar between the two groups.Significantly lower VAS scores were detected at 0,6,and 12 h in the ropivacaine group compared with the control group(P<0.05 for all).MAP was significantly lower at 6,12,and 24 h(P<0.05 for all);HR was significantly lower at 0,6,12,and 24 h(P<0.05 for all);time to bowel recovery and length of hospitalization after surgery(P<0.05 for both)were significantly shortened;and cumulative sufentanil consumption was significantly lower at 6,12,24,and 36 h(P<0.05 for all)in the ropivacaine group than in the control group,although the incidence of nausea and vomiting showed no significant difference between the two groups.The levels of epinephrine,norepinephrine,and cortisol were significantly lower in the ropivacaine group than in the control group at 24 and 48 h(P<0.01 for all). CONCLUSION Local wound infiltration with ropivacaine after open hepatectomy can improve postoperative pain relief,reduce surgical stress response,and accelerate postoperative recovery.
文摘Patients who suffer a Fractured Neck of Femur (NOF) have a high mortality and morbidity rate with up to 20% needing long term care post fracture and a further 30% not returning to their pre fracture functioning. Hip fracture accounts for 87% of total fragility fractures. We describe an anaesthetic technique of fixation of fracture of the femoral neck under direct infiltration local anaesthesia;that can be performed on the sick elderly patient. Twenty-eight NOF fractures were included in this series (24 DHS, 4 Hemiarthroplasty);twenty-three procedures were completed (82.14%);no patient required conversion to another form of anaesthesia either general or spinal;five patients required some degree of light sedation due to agitation (17.8%). This method presents itself as an option in managing patient with high comorbidities which can also be implemented in impoverished areas with limited access to operating surgical facilities.
文摘Background: Ketamine or dexmedetomidine as an adjuvant to bupivacaine in local wound infiltration attenuated postoperative stress response, especially with ketamine in patients undergoing total abdominal hysterectomy. Objectives: Compare effect of local wound infiltration with ketamine or dexmedetomidine added to bupivacaine to bupivacaine alone on inflammatory cytokine response after total abdominal hysterectomy. Methods: Sixty female patients with endometrial carcinoma underwent total abdominal hysterectomy and scheduled to receive local wound infiltration before wound closure either with one of three;40 ml of 0.25% bupivacaine alone (C Group) or with the addition of 2 mg/kg ketamine (K Group) or 2 μg/kg dexmedetomidine (D Group). After extubation, they were followed up for postoperative interleukin 6 (IL6), IL1β, IL10, and TNF-α levels were assessed at baseline, pre-infiltration, 6, and 24 h by blood samples obtained from each patient, hemodynamic variables, analgesic profile and side effects. Results: Inflammatory cytokines response was attenuated in K and D groups, evidenced by decreased mean pro-inflammatory cytokines IL6, TNF-α, and increased anti-inflammatory IL10 at 6 and 24 h postoperatively compared to pre-infiltration levels (p ≤ 0.01) with preservation of IL1β at its preoperative level (p > 0.05). Attenuation was more in K and D groups than in the C group and was highest in the K group with decreased 1<sup>st</sup> request, total morphine consumption without serious side effect. Conclusion: Local wound infiltration with ketamine or dexmedetomidine added to bupivacaine has a good postoperative analgesic profile and attenuated cytokines inflammatory response more than bupivacaine alone after total abdominal hysterectomy, with highest attenuation in ketamine group.
文摘Objective:To study the effect of ropivacaine combined with dexamethasone local infiltration on the pain level and inflammatory stress response after pediatric tonsillectomy.Methods:A total of 84 children who received selective tonsillectomy in Mianyang Central Hospital between June 2014 and April 2017 were selected as the research subjects and divided into two groups by random number table method, combined group received ropivacaine combined with dexamethasone local infiltration, and control group accepted ropivacaine local infiltration anesthesia. Serum levels of pain mediators, inflammatory mediators and stress mediators were detected 6 h, 12 h and 24 h after surgery.Results: 6 h after surgery, serumβ-EP, SP, BK, TNF-α, MCP-1, IL-4, IL-10, F-Cor, NE, AT-II and GH levels were not significantly different between the two groups;12 h and 24 h after surgery, serumβ-EP, SP, BK levels of control group were significantly higher than those 6 h after surgery, serumβ-EP, SP, BK levels of combined group were not significantly different from those 6 h after surgery. Serum TNF-α, MCP-1, IL-4, IL-10, F-Cor, NE, AT-II and GH levels of two groups were significantly higher than those 6 h after surgery, and Serum TNF-α, MCP-1, IL-4, IL-10, F-Cor, NE, AT-II and GH levels of combined group were significantly lower than control group.Conclusion:Ropivacaine combined with dexamethasone local infiltration is with more durable and exact effect than ropivacaine local infiltration alone on relieving the pain and inflammatory stress response after pediatric tonsillectomy.
文摘Objective： To study the effect of tumor infiltrating lymphocytes at cancer nest on local control of rectal cancer after preoperative radiotherapy. Methods： From Jan. 1999 to Oct. 2007, a total of 107 patients with rectal cancer were reviewed. They were treated by preoperative radiotherapy, 30 Gy/10 fractions/12 days. Two weeks later, the patient underwent a surgical operation. Their pathological samples were kept in our hospital before and after radiotherapy. Lymphocyte infiltration （LI） degree, pathologic degradation and fibrosis degree after radiotherapy in paraffin section were evaluated under microscope. Results： After followed-up of 21 months （2-86 months）, a total of 107 patients were reviewed. Univariate analysis showed that lymphocyte infiltration （LI）, fibrosis and pathologic changes after radiotherapy were significant factors on local control. Logistic regression analysis showed that LI after radiotherapy was a significant effect factor on local control. Conclusion： LI, fibrosis and pathologic degradation after radiotherapy are significant for local control of rectal cancer after preoperative radiotherapy. LI after radiotherapy was a significantly prognostic index for local control of rectal cancer after preoperative radiotherapy.
文摘目的观察电针术前预处理对全麻下行全膝关节置换术(TKA)患者术后镇痛的效果。方法选取2022年10月—2022年12月于徐州市中心医院首次全麻下行单侧TKA患者96例,用随机数字法将患者分为观察组、对照组,各48例。观察组给予电针预处理+局部浸润麻醉+静脉自控镇痛(PCIA),对照组给予局部浸润麻醉+PCIA。比较2组手术前后血浆缓激肽(BK)、前列腺素E2(PGE2)、P物质(SP)、β内啡肽(β-ep)、强啡肽(Dyn),术后12、24、48 h VAS评分,麻醉药物使用情况及不良反应。结果术后2组血浆BK、PGE2、SP、β-ep、Dyn水平与同组术前比较,差异有统计学意义(P<0.01)。观察组血浆BK、PGE2、SP水平低于对照组(P<0.05),β-ep、Dyn水平高于对照组(P<0.05)。静息VAS评分:术后12、24、48 h,2组间VAS评分比较,差异无统计学意义(F=0.694,P=0.406);组内各时间点VAS评分比较,差异有统计学意义(F=256.6,P<0.01)。活动VAS评分:术后12、24、48 h,2组间VAS评分比较,差异有统计学意义(F=7.072,P=0.008);组内各时间点VAS评分比较,差异有统计学意义(F=300.885,P<0.01)。观察组首次按压时间晚于对照组(P<0.01),PCIA总按压次数少于对照组(P<0.01),补救镇痛例数少于对照组,但差异无统计学意义(P>0.05)。观察组术后恶心、呕吐发生率低于对照组(P<0.05);2组头晕、嗜睡、呼吸抑制、瘙痒发生率比较,差异无统计学意义(P>0.05)。结论电针预处理可增强TKA患者术后局部浸润麻醉+PCIA的镇痛效果。
