Effect of Transverse Abdominis Plane Block on Chronic Post-Operative Pain—A Review

Chronic post-operative pain is a recognized adverse consequence of surgery;managing and preventing it are always a better choice. Proper choice of Anesthetic technique, use of combined anesthesia and pre-emptive analgesia may prevent and decrease the incidence of chronic post-operative pain. Transverse abdominis plane block (TAP Block) is a regional anesthesia technique following abdominal surgeries which involve injection of a large amount of local anesthetics in TAP, an anatomical space between the internal oblique and transverse abdominis muscle. The aim of this review is to show the effect and uses of TAP block as a combined anesthesia and multimodal analgesia in preventing chronic post-operative pain.

Effects of Ropivacaine-sufentanil Epidural Analgesia on Labor and Maternal and Neonatal Outcomes

[Objectives]This study aimed to investigate the effects of ropivacaine-sufentanil epidural analgesia on labor and maternal and neonatal outcomes.[Methods]A total of 180 primiparas in full-term pregnancy were selected.They were randomly divided into treatment group(n=90)and control group(n=90).The primiparas in the treatment group were injected epidurally with ropivacaine and sufentanil for analgesia,and the primiparas in the control group were subjected to vaginal delivery.The VAS scores at 5,10,30 and 60 min of analgesia were observed.The vaginal bleeding amount,total labor duration,neonatal Apgar score and vaginal delivery rate of the two groups were compared.[Results]Compared with the control group,the VAS score in the treatment group differed insignificantly after 5 min of analgesia(P>0.05),and decreased significantly after 10,30 and 60 min of analgesia(P<0.05).The vaginal bleeding amount of the treatment group was significantly smaller than that of the control group(P<0.05).There was no significant difference in the neonatal Apgar score between the two groups(P>0.05).In the treatment group,the vaginal delivery rate increased(P<0.05),the second stage of labor was prolonged(P<0.05),and the first and third stages of labor did not change significantly(P>0.05).[Conclusions]Epidural analgesia with ropivacaine and sufentanil has a good analgesic effect and good safety,and is worthy of clinical promotion.

The effect of adjunct caudal block on postoperative analgesia in robot-assisted laparoscopic radical prostatectomy: A prospective randomized controlled, single blinded pilot study in a tertiary centre

Objective:Caudal block provides satisfactory postoperative pain relief in lower abdominal operations.This pilot study explores its safety and effect on postoperative pain control in patients who underwent robot-assisted laparoscopic radical prostatectomy(RARP).Methods:From 2013 to 2014,40 consecutive patients were randomized into two groups d one received caudal block using ropivacaine immediately after operation,the other received standard analgesia.Primary outcome measure was pain score based on 11-point Likert scale(0e10)recorded at recovery room,and at 6,12,24,48,and 72 h after operation.All analgesic requirements,opioid-related adverse events and time to passage of flatus were examined.Results:Mean age of the two groups was similar(60.4 vs.62.3 years,p Z 0.33),as was American Society of Anaesthesiologists(ASA)class,body mass index(BMI)and operation times.No significant difference in median pain scores was reported in recovery room(2 vs.3,p Z 0.34),and at 6 h(2 vs.2,p Z 0.94),12 h(0 vs.0,p Z 0.62),24 h(1 vs.0,p Z 0.58),48 h(1 vs.0,p Z 0.36)and 72 h(0 vs.0,p Z 0.78)postoperatively between control and caudal block groups,respectively.There was a higher mean opioid usage in the caudal block group which was not statistically significant.Although this was statistically insignificant while no significant difference in mean paracetamol usage was observed postoperatively.Median time to passage of flatus was similar(2.0 vs.2.0 days,p Z 0.97).There was one case of superficial wound infection and no opioid-related adverse events observed.Hospital stay was similar in both groups(2.5 vs.2.5 days,p Z 0.96).

Application of dezocine patient-controlled epidural analgesia in postoperative analgesia in patients with total myomectomy

BACKGROUND Uterine fibroids are common benign gynecological conditions.Patients who experience excessive menstruation,anemia,and pressure symptoms should be administered medication,and severe cases require a total hysterectomy.This procedure is invasive and causes severe postoperative pain,which can affect the patient’s postoperative sleep quality and,thus,the recovery process.AIM To evaluate use of dezocine in patient-controlled epidural analgesia(PCEA)for postoperative pain management in patients undergoing total myomectomy.METHODS We selected 100 patients undergoing total abdominal hysterectomy for uterine fibroids and randomized them into two groups:A control group receiving 0.2%ropivacaine plus 0.06 mg/mL of morphine and an observation group receiving 0.2%ropivacaine plus 0.3 mg/mL of diazoxide in their PCEA.Outcomes assessed included pain levels,sedation,recovery indices,PCEA usage,stress factors,and sleep quality.RESULTS The observation group showed lower visual analog scale scores,shorter postoperative recovery indices,fewer mean PCEA compressions,lower cortisol and blood glucose levels,and better polysomnographic parameters compared to the control group(P<0.05).The cumulative incidence of adverse reactions was lower in the observation group than in the control group(P<0.05).CONCLUSION Dezocine PCEA can effectively control the pain associated with total myomectomy,reduce the negative impact of stress factors,and have less impact on patients’sleep,consequently resulting in fewer adverse effects.

Acupuncture effects on the hippocampal cholinergic system in a rat model of neuropathic pain

The present study observed the effects of repeated electroacupuncture of Zusanli （ST36） and Yanglingquan （GB34） on expression of hippocampal acetylcholinesterase, vesicular acetylcholine transporter, and muscarinic M1 receptor mRNA in chronic constrictive injury （neuropathic pain） and/or ovariotomy rats. Results demonstrated increased expression of hippocampal acetylcholinesterase, vesicular acetylcholine transporter, and muscarinic M1 receptor mRNA, as well as decreased pain threshold, in a rat model of chronic neuropathic pain after electroacupuncture. The effects of electroacupuncture increased with prolonged time, but the above-mentioned effects decreased in memory-deficient animals. Results indicated that repeated electroacupuncture has a cumulative analgesic effect, which is closely associated with upregulation of acetylcholinesterase and vesicular acetylcholine transporter activity, as well as M1 receptor mRNA expression and memory.

Correlation between the cumulative analgesic effect of electroacupuncture intervention and synaptic plasticity of hypothalamic paraventricular nucleus neurons in rats with sciatica

In the present study, a rat model of chronic neuropathic pain was established by ligation of the sciatic nerve and a model of learning and memory impairment was established by ovariectomy to investigate the analgesic effect of repeated electroacupuncture stimulation at bilateral Zusanfi （ST36） and Yanglingquan （GB34）. In addition, associated synaptic changes in neurons in the paraventricular nucleus of the hypothalamus were examined. Results indicate that the thermal pain threshold （paw withdrawal latency） was significantly increased in rats subjected to 2-week electroacupuncture intervention compared with 2-day electroacupuncture, but the analgesic effect was weakened remarkably in ovariectomized rats with chronic constrictive injury. 2-week electroacupuncture intervention substantially reversed the chronic constrictive injury-induced increase in the synaptic cleft width and thinning of the postsynaptic density. These findings indicate that repeated electroacupuncture at bilateral Zusanfi and Yanglingquan has a cumulative analgesic effect and can effectively relieve chronic neuropathic pain by remodeling the synaptic structure of the hypothalamic paraventricular nucleus.

The cumulative analgesic effect of repeated electroacupuncture involves synaptic remodeling in the hippocampal CA3 region

In the present study, we examined the analgesic effect of repeated electroacupuncture at bilateral Zusanfi （ST36） and Yanglingquan （GB34） once a day for 14 consecutive days in a rat model of chronic sciatic nerve constriction injury-induced neuropathic pain. In addition, concomitant changes in calcium/calmodulin-dependent protein kinase II expression and synaptic ultrastructure of neurons in the hippocampal CA3 region were examined. The thermal pain threshold （paw withdrawal latency） was increased significantly in both groups at 2 weeks after electroacupuncture intervention compared with 2 days of electroacupuncture. In ovariectomized rats with chronic constriction injury, the analgesic effect was significantly reduced. Electroacupuncture for 2 weeks significantly diminished the injury-induced increase in synaptJc cleft width and thinning of the postsynaptJc density, and it significantly suppressed the down-regulation of intracellular calcium/ calmodulin-dependent protein kinase II expression in the hippocampal CA3 region. Repeated electroacupuncture intervention had a cumulative analgesic effect on injury-induced neuropathic pain reactions, and it led to synaptic remodeling of hippocampal neurons and upregulated calcium/calmodulin-dependent protein kJnase II expression in the hippocampal CA3 region.

Combined lumbar muscle block and perioperative comprehensive patient-controlled intravenous analgesia with butorphanol in gynecological endoscopic surgery

BACKGROUND Laparoscopic surgery has become a common surgical approach for the clinical treatment of intra-abdominal lesions in recent years.We hypothesized that lumbar block with postoperative patient-controlled intravenous analgesia(PCIA)by butorphanol after gynecological surgery under general anesthesia would be more effective than PCIA by butorphanol alone.AIM To investigate the effect of lumbar block with PCIA by butorphanol after gynecological surgery under general anesthesia.METHODS This study assessed 120 women scheduled for laparoscopic surgery at our hospital between May 2017 and May 2020.They were divided using a random number table into a research group(those who received quadratus lumborum block combined with PCIA analgesia by butorphanol)and a control group(those who received only PCIA analgesia by butorphanol),with 60 patients in each group.Demographic factors,visual analog scale scores for pain,serum inflammatory markers,PCIA compressions,Ramsay scores,and adverse events were compared between groups using a t-test,analysis of variance,orχ2 test,as appropriate.RESULTS There were no significant differences in demographic factors between groups(all P>0.05).The visual analog scale scores of the research group in the resting state 12 h and 24 h postoperatively were significantly lower than those of the control group(P<0.05).Two hours after surgery,there were no significant differences in the levels of serum tumor necrosis factor-α,interleukin(IL)-6,or IL-8 between groups(P>0.05).The serum tumor necrosis factor-αlevels of the research group 24 h postoperatively were significantly lower than those of the control group(P<0.05).The levels of serum IL-6 and IL-8 in the study group 24 h and 48 h postoperatively were significantly lower than those in the control group(P<0.05).CONCLUSION Lumbar block with PCIA with butorphanol after gynecological surgery under general anesthesia significantly improves the analgesic effect and reduces the degree of inflammation,instances of PCIA compression,and adverse reactions.

Analgesic effects of JCM-16021 on neonatal maternal separation-induced visceral pain in rats

AIM:To investigate the pharmacological effect of JCM-16021,a Chinese herbal formula,and its underlying mechanisms.METHODS:JCM-16021 is composed of seven herbal plant materials.All raw materials of the formula were examined according to the quality control criteria listed in the Chinese Pharmacopeia(2005).In a neonatal maternal separation(NMS)model,male SpragueDawley rats were submitted to daily maternal separation from postnatal day 2 to day 14,or no specific handling(NH).Starting from postnatal day 60,rats were administered JCM-16021(2,4,8 g/kg per day)orally twice a day for 28 d.Pain threshold pressure and electromyographic activities of external oblique muscles in response to colorectal distention recorded with a Power Lab System(AD Instruments International),were tested as pain indices.Changes in serotonin(5-HT)and 5-hydroxyindoleacetic acid(5-HIAA)concentrations in the colon of rats were analyzed;the enterochromaffin cell numbers and serotonin transporter in the colon of rats were also evaluated with an immunohistochemistry method.RESULTS:NMS treatment significantly reduced pain threshold pressure(37.4±1.4 mmHg),as compared to that of NH rats(57.7±1.9 mmHg,P<0.05).After JCM-16021 treatment,the pain threshold pressure significantly increased when compared to that before treatment(34.2±0.9 mmHg vs 52.8±2.3 mmHg in the high dose group,40.2±1.6 mmHg vs 46.5±1.3 mmHg in the middle dose group,and 39.3±0.7 mmHg vs 46.5±1.6 mmHg in the low dose group,P<0.05).Also JCM-16021 significantly and dose-dependently decreased electromyographic activity to the graded colorectal distension(CRD),(the meanΔAUC values were:0.17±0.03,0.53±0.15,1.06±0.18,1.22±0.24 in the high dose group;0.23±0.04,0.68±0.17,1.27 ±0.26,1.8±0.3 in the middle dose group;and 0.29 ±0.06,0.8±0.16,1.53±0.24,2.1±0.21 in the low dose group for the pressures 20,40,60,80 mmHg),as compared to the NMS vehicle group.The meanΔAUC values were:0.57±0.12,1.33±0.18,2.57±0.37,3.08±0.37 for the pressures 20,40,60,80 mmHg(P <0.05).JCM-16021 treatment significantly reduced the 5-HT concentrations(from high,middle and low dosage groups:60.25±5.98 ng/100 mg,60.32±4.22 ng/100 mg,73.31±7.65 ng/100 mg),as compared to the NMS vehicle groups(93.11±9.85 ng/100 mg,P<0.05);and increased the 5-HIAA concentrations(after treatment,from high,middle and low dosage groups:54.24±3.27 ng/100 mg,50.34±1.26 ng/100 mg,51.37±2.13 ng/100 mg)when compared to that in the NMS vehicle group(51.75±1.98 ng/100 mg,P <0.05);but did not change the enterochromaffin cell numbers in the colon of rats.In addition,NMS rats had higher SERT expression(n=10)than NH rats(n=8,P<0.05).JCM-16021 treatment significantly decreased SERT expression when compared to the NMS group(P <0.01-0.001).CONCLUSION:JCM-16021 can attenuate visceral hypersensitivity,and this analgesic effect may be mediated through the serotonin signaling pathway in the colon of rats.

THE ROLE OF CONNEXIN 43 GENE IN ACUPUNCTURE ANALGESIA

Objective To and connexin 43. Methods investigate the possible relationship between the analgesic effect of acupuncture Connexin 43 gene knock-out mice were randomly divided into 4 groups： a wide type （WT） control group, a WT acupuncture group, a heterozygous （HT） control group and HT acupuncture group. Hot-plate test and writhing response induced by acetic acid were used for investigating the different analgesic effect of acupuncture on HT and WT mice. Results There was no significant difference in the basic pain threshold value between HT and WT mice （P 〉0.05）. Acupuncture could significantly increase the pain threshold value, prolong the latency period of writhing body and decrease the number of writhing body as compared with pre-acupuncture in WT and HT mice （P 〈 0.01 or P 〈 0.05）. The pain threshold, latency period of writhing and number of writhing body in HT mice were less than WT mice post-acupuncture （P〈0.05）. Conclusion Connexin 43 gene knock-out might partially inhibit the analgesic effect of acupuncture, suggesting that connexin 43 is possibly related with meridians and the effect of acupuncture.

Intrathecal morphine for postoperative analgesia: Current trends

The practice of anesthesiology has always been governed by evidence-based medicine. The quick turnover rate of patients in the operating room and patient safety and satisfaction, have also further changed the way we practice anesthesia. The use of intrathecal(IT) opiates as an effective form of postoperative pain relief has been established for many years. Morphine was the first opioid used by IT route. In clinical practice, morphine is regarded as the gold standard, or benchmark, of analgesics used to relieve intense pain. Perhaps for this reason, IT morphine has been used for over 100 years for pain relief. IT morphine is one of the easiest, costeffective and reliable techniques for postoperative analgesia and technical failures are rare. And yet there is no consensus amongst anesthesiologists regarding the dose of IT morphine. Like all other methods of pain relief, IT morphine also has some side effects and some of them are serious though not very common. This review article looks into some of the key aspects of the use of IT morphine for post-operative analgesia and various doses for different procedures are discussed. This article also describes the side effects of IT morphine and how to treat and prevent them.

Artificial intelligence technology and ultrasound-guided nerve block for analgesia in total knee arthroplasty

BACKGROUND Knee diseases are more common in middle-aged and elderly people,so artificial knee replacement is also more used in middle-aged and elderly people.Although the patient’s pain can be reduced through surgery,often accompanied by moderate pain after surgery and neutralization,which not only increases the psychological burden of the patient,but also greatly reduces the postoperative recovery effect,and may also lead to the occurrence of postoperative adverse events in severe cases.AIM To investigate the analgesic effect of artificial intelligence(AI)and ultrasoundguided nerve block in total knee arthroplasty(TKA).METHODS A total of 92 patients with TKA admitted to our hospital from January 2021 to January 2022 were opted and divided into two groups according to the treatment regimen.The control group received combined spinal-epidural anesthesia.The research group received AI technique combined with ultrasound-guided nerve block anesthesia.The sensory block time,motor block time,visual analogue scale(VAS)at different time points and complications were contrasted between the two groups.RESULTS The time of sensory block onset and sensory block perfection in the research group was shorter than those in the control group,but the results had no significant difference(P>0.05).Duration of sensory block in the research group was significantly longer than those in the control group(P<0.05).The time of motor block onset and motor block perfection in the research group was shorter than those in the control group,but the results had no significant difference(P>0.05).Duration of motor block in the research group was significantly longer than those in the control group.The VAS scales of the research group were significantly lower than that of the control group at different time points(P<0.05).The postoperative hip flexion and abduction range of motion in the research group were significantly better than those in the control group at different time points(P<0.05).The incidence of complications was significantly lower in the research group than in the control group(P=0.049).CONCLUSION In TKA,the combination of AI technology and ultrasound-guided nerve block has a significantly effect,with fewer postoperative complications and significantly analgesic effect,which is worthy of application.

Salient concerns in using analgesia for cancer pain among outpatients: A cluster analysis study

AIM To identify unique clusters of patients based on their concerns in using analgesia for cancer pain and predictors of the cluster membership.METHODS This was a 3-mo prospective observational study(n = 207).Patients were included if they were adults(≥ 18 years), diagnosed with solid tumors or multiple myelomas, and had at least one prescription of around the clock pain medication for cancer or cancer-treatment-related pain.Patients were recruited from two outpatient medical oncology clinics within a large health system in Philadelphia.A choice-based conjoint(CBC) analysis experiment was used to elicit analgesic treatment preferences(utilities).Patients employed trade-offs based on five analgesic attributes(percent relief from analgesics, type of analgesic, type of sideeffects, severity of side-effects, out of pocket cost).Patients were clustered based on CBC utilities using novel adaptive statistical methods.Multiple logistic regression was used to identify predictors of cluster membership.RESULTS The analyses found 4 unique clusters: Most patients made trade-offs based on the expectation of pain relief(cluster 1, 41%).For a subset, the main underlying concern was type of analgesic prescribed, i.e., opioid vs non-opioid(cluster 2, 11%) and type of analgesic side effects(cluster 4, 21%), respectively.About one in four made trade-offs based on multiple concerns simultaneously including pain relief, type of side effects, and severity of side effects(cluster 3, 27.5%).In multivariable analysis, to identify predictors of cluster membership, clinical and socioeconomic factors(education, health literacy, income, social support) rather than analgesic attitudes and beliefs were found important; only the belief, i.e., pain medications can mask changes in health or keep you from knowing what is going on in your body was found significant in predicting two of the four clusters [cluster 1(-); cluster 4(+)].CONCLUSION Most patients appear to be driven by a single salient concern in using analgesia for cancer pain.Addressing these concerns, perhaps through real time clinical assessments, may improve patients' analgesic adherence patterns and cancer pain outcomes.

Postoperative Analgesia for Abdominal Laparoscopic Surgery: Tap Block vs Peri-Orificial Infiltrations

Introduction/Purpose: The “transverse abdominal plane block” or TAP block was described by Rafi in 2001. It describes an approach to the neurofascial plane of the transverse abdominal muscle via the Jean-Louis Petit triangle and provides analgesia of the entire homolateral hemi abdomen. The aim of our study was to compare post-operative analgesia and post-operative morphine requirements between transverse abdominal plane block (TAP) and peri-orificial infiltration during laparoscopic abdominal surgery. Material and method: Prospective, randomized study conducted over a 2-year period. The study was conducted in the operating theatre of the Saint Louis Regional Hospital in Senegal. All adult patients undergoing laparoscopic abdominal surgery were included. Clinical aspects, pain scales and morphine consumption were analyzed. Results: A total of 60 patients were enrolled: 30 patients in the TAP group and 30 patients in the infiltration group. The average age was 32.9 years. The indications for laparoscopy were acute appendicitis in 50% of cases, gallbladder stones in 16% and inguinal hernia in 8%. For the TAP group, the mean numerical pain scale was 3.9 at 6 hours post-operatively and 2.1 at 24 hours post-operatively. For the infiltration group, the mean numerical pain scale was 4.3 at 6 hours post-op and 3 at 24 hours post-op. Morphine consumption at 6 hours post-op was on average 0.4 mg/patient for the TAP group and 0.9 mg/patient for the infiltration group. Discussion/conclusion: Analgesia provided by ultrasound-guided TAP block for laparoscopic abdominal surgery appears to be identical to periorificial infiltration. However, the simplicity and reproducibility of ultrasound-guided TAP block gives it a definite advantage.

Intraoperative Hemodynamic and Analgesic Effects of Pre-Incisional Transversus Abdominis Plane Block during Total Abdominal Hysterectomy

Background: The efficacy of transversus abdominis plane (TAP) block has been demonstrated in postoperative analgesia, but few studies have evaluated its intraoperative effects. We aimed to describe the intraoperative hemodynamic and analgesic effects of pre-incisional TAP block in patients undergoing total abdominal hysterectomy. Methods: Seventy women proposed for total abdominal hysterectomy indicated for uterine fibroids, classified ASA I and II were randomized in a double-blinded model to Group A (n = 35) receiving bilateral ultrasound-guided TAP block with ropivacaine and Group B (n = 35) receiving bilateral ultrasound-guided TAP block with normal saline, followed by general anesthesia. The variations of the heart rate (HR) and mean arterial blood pressure (MABP) and intraoperative fentanyl consumption were studied. Results: At the arrival in the operating room, there was no significant difference in heart rate and mean arterial pressure noted in both groups. (HR: 85.38 ± 8.44 pulsations/min versus 86.30 ± 10.05 pulsations/min, p = 0.621;MABP: 94.97 ± 13.46 mmHg versus 96.36 ± 12.41 mmHg, p = 0.533). Before surgical incision, no statistically significant difference was detected between the two groups regarding the heart rate and the mean arterial blood pressure. After surgical incision, both the heart rate and mean arterial blood pressure were significantly higher in the Group B. There was a significant decrease in intraoperative fentanyl requirements in the Group A compared to the Group B (293.58 ± 60.59 mcg versus 449.44 ± 71.31 mcg, p Conclusion: Pre-incisional TAP block attenuates hemodynamic responses to surgical stress and decreases intraoperative fentanyl requirements in patients undergoing total abdominal hysterectomy.

盐酸氢吗啡酮超前镇痛对全身麻醉腔镜手术患者的作用

目的探讨盐酸氢吗啡酮超前镇痛对全身麻醉腔镜手术患者的镇痛效果。方法选取行腹腔镜胆囊切除术的患者98例,用随机数字表法分为对照组和观察组,各49例。对照组实施常规麻醉,观察组在对照组常规麻醉的基础上予以盐酸氢吗啡酮超前镇痛。记录2组患者的拔管时间、清醒时间和自主呼吸恢复时间,分别于患者手术结束时(t_(1))、手术后1 h(t_(2))、手术后4 h(t_(3))、手术后12 h(t_(4))和手术后24 h(t_(5)),用视觉模拟评分(visual analogue scale,VAS)对患者阵痛效果进行评分;于t_(0)、t_(1)和t_(2)检测血清肿瘤坏死因子-α(tumor necrosis factor-α)、白细胞介素-10(interleukin-10,IL-10)和白细胞介素-6(interleukin-6,IL-6)水平,于t_(0)和t_(1)检测患者肾素、血管紧张素Ⅱ、醛固酮和皮质醇水平,并记录患者不良反应的发生情况。结果与t_(0)相比,t_(1)、t_(2)、t_(3)和t_(4)时间点2组患者的VAS评分均升高,且观察组低于对照组(P<0.05);t_(1)和t_(2)时间点2组患者TNF-α、IL-10和IL-6水平均较t_(0)时升高,且观察组TNF-α和IL-6水平更低,IL-10水平更高(P<0.05);t_(1)时2组患者肾素、血管紧张素Ⅱ、醛固酮和皮质醇水平较t_(0)均升高,且观察组低于对照组(P<0.05)。2组患者围手术期指标和不良反应发生情况比较,差异无统计学意义。结论盐酸氢吗啡酮超前镇痛可减少全身麻醉腔镜手术患者术后躁动,缓解应激反应,减轻炎性反应,具有较好的镇痛效果。

纳布啡用于硬脊膜穿破硬膜外阻滞分娩镇痛的有效性及安全性

目的探讨纳布啡用于硬脊膜穿破硬膜外阻滞分娩镇痛的有效性及安全性。方法选择经阴试产的足月单胎初产妇319例,按使用药物不同分为舒芬太尼硬脊膜穿破硬膜外阻滞组(A组)160例,纳布啡硬脊膜穿破硬膜外阻滞组(B组)159例。两组均采用硬脊膜穿破硬膜外阻滞分娩镇痛法,置入硬膜外导管后,注入1.5%利多卡因3 mL试验量,然后A组注入0.5 mg/L舒芬太尼复合1 mg/L罗哌卡因混合液,B组注入0.3 g/L纳布啡复合1 mg/L罗哌卡因混合液,均6~15 mL为首次量,30 min后两组均连接电子镇痛泵,分别使用舒芬太尼和纳布啡进行自控硬膜外镇痛。收集两组患者的如下指标:镇痛起效时间、首次自控按压镇痛(PCA)时间、PCA有效按压次数、罗哌卡因用量;镇痛前(T0)、镇痛后30 min(T1)、宫口开全(T2)与用力分娩(T3)时疼痛视觉模拟(VAS)评分及Ramsay镇静评分;产妇发热、恶心呕吐、皮肤瘙痒、术后头痛发生等不良反应情况以及胎儿胎心减速发生率、新生儿1 min Apgar评分≤7分发生率、脐动脉血气分析,新生儿神经与适应能力评分。结果与A组比较,B组恶心呕吐、皮肤瘙痒、胎心减速及新生儿1 min Apgar评分≤7分的发生率显著降低(χ^(2)=4.159~5.628,P<0.05),PCA有效按压次数、罗哌卡因用量显著增加(χ^(2)=8.594、6.363,P<0.05),T2及T3产妇VAS评分明显升高(F=45.314、26.717,P<0.05),其他观察指标两组间比较差异无统计学意义(P>0.05)。结论纳布啡用于硬脊膜穿破硬膜外阻滞分娩镇痛与舒芬太尼相比第一产程镇痛效果类似,第二产程效果较差,但可降低产妇镇痛相关不良反应发生率,对新生儿具有较高的安全性。

0.2%氯普鲁卡因联合罗哌卡因对硬膜外分娩镇痛效果及对罗哌卡因EC_(50)的影响

目的探讨0.2%氯普鲁卡因联合罗哌卡因对硬膜外分娩镇痛效果及对罗哌卡因半数有效浓度(EC_(50))的影响。方法选择2023年7月至10月在我院行阴道分娩且有镇痛需求的产妇67例,按随机数字表法分为RL组(33例)和R组(34例)。采用Dixon改良序贯法确定罗哌卡因的浓度。RL组产妇给予0.2%盐酸氯普鲁卡因注射液+盐酸罗哌卡因注射液+0.4μg/mL枸橼酸舒芬太尼注射液;R组产妇给予盐酸罗哌卡因注射液+0.4μg/mL枸橼酸舒芬太尼注射液。观察两组产妇的罗哌卡因EC_(50)、分娩镇痛效果、镇痛药总用量、镇痛满意度评分、不良反应发生情况、分娩情况及新生儿Apgar评分。结果RL组产妇的罗哌卡因EC_(50)、镇痛起效时间、补救镇痛率、会阴胀痛和爆发痛发生率、镇痛药总用量均显著低于R组,镇痛满意度评分显著高于R组(P<0.05);两组产妇的下肢麻木、下肢无力、寒战等不良反应发生率,产程时间、出血量、分娩方式及新生儿Apgar评分比较,差异均无统计学意义(P>0.05)。结论0.2%氯普鲁卡因联合罗哌卡因用于硬膜外分娩镇痛,可降低罗哌卡因的EC_(50),改善分娩镇痛效果,且安全性较好。

肺癌患者术后使用艾司氯胺酮自控静脉镇痛的效果研究

探讨艾司氯胺酮在肺癌患者术后自控静脉镇痛中的应用效果。选取2021年6月—2024年6月南通市第六人民医院收治的102例肺癌手术患者进行对比试验。采取盲抽法将患者分为两组,分别为对照组和观察组,每组各51例,对照组采用舒芬太尼+阿扎司琼进行镇痛,观察组在此基础上联合应用艾司氯胺酮,比较两组患者的镇痛效果。结果显示,观察组术后不同时间段舒芬太尼用量明显少于对照组(P<0.05);观察组术后不同时间段的疼痛评分均低于对照组(P<0.05)。观察组患者的不良反应总发生率低于对照组(P<0.05)。研究发现,在肺癌患者术后自控静脉镇痛中应用艾司氯胺酮可有效减少舒芬太尼用量,减轻患者的疼痛感,切实改善患者的负性情绪及睡眠质量,降低不良反应发生风险。

分析多模式镇痛下持续髂筋膜间隙阻滞与收肌管阻滞对老年患者全膝关节置换术后快速康复的影响

目的探讨对老年人全膝关节置换术患者在多模式镇痛下分别给予超声引导下持续髂筋膜间隙阻滞以及收肌管阻滞对术后快速康复的影响。方法随机选取2020年2月—2022年11月常州市中医医院收治的60例老年人全膝关节置换术患者为研究对象,以随机数表法分为研究组和参照组,每组30例。参照组在多模式镇痛基础下施以超声引导下持续髂筋膜间隙阻滞,研究组在多模式镇痛基础下施以超声引导下持续收肌管阻滞。对比两组患者动态视觉模拟评分法(Visual Analogue Scale,VAS)评分、术后各时间点静息状态VAS评分、美国特种外科医院膝关节评分量表(Hospital for Special Surgery Knee Score,HSS)评分以及膝关节关节活动度(Range of Motion,ROM)。结果术后6、12、24、48 h,两组VAS评分比较,差异无统计学意义(P均>0.05)。研究组HSS评分为(71.25±7.25)分,高于参照组的(63.55±6.79)分,差异有统计学意义(t=4.246,P<0.05)。术后3、7、10、12 d,研究组ROM均高于参照组,差异有统计学意义(P均<0.05)。结论临床对老年人全膝关节置换术患者在给予镇痛干预期间,同超声引导下持续髂筋膜间隙阻滞比较,超声引导下持续收肌管阻滞方法的有效应用,可对患者的术后早期康复给予明显促进。