Effect of intraperitoneal local anesthetic on pain characteristics after laparoscopic cholecystectomy

AIM : To systematically evaluate the effect of intraperitoneal local anesthetic on pain characteristics after laparoscopic cholecystectomy(LC).METHODS: We searched MEDLINE, EMBASE, and the Cochrane Library. Randomized controlled trials in English that compared the effect of intraperitoneal administration of local anesthetics on pain with that of placebo or nothing after elective LC under general anesthesia were included. The primary outcome variables analyzed were the combined scores of abdominal, visceral, parietal, and shoulder pain after LC at multiple time points. We also extracted pain scores at resting and dynamic states.RESULTS: We included 39 studies of 3045 patients in total. The administration of intraperitoneal local anesthetic reduced pain intensity in a resting state after laparoscopic cholecystectomy: abdominal [standardized mean difference(SMD) =-0.741; 95%CI:-1.001 to-0.48, P < 0.001]; visceral(SMD =-0.249; 95%CI:-0.493 to-0.006, P = 0.774); and shoulder(SMD =-0.273; 95%CI:-0.464 to-0.082, P = 0.097). Application of intraperitoneal local anesthetic significantly reduced the incidence of shoulder pain(RR = 0.437; 95%CI: 0.299 to 0.639, P < 0.001). There was no favorable effect on resting parietal or dynamic abdominal pain.CONCLUSION: Intraperitoneal local anesthetic as an analgesic adjuvant in patients undergoing laparoscopic cholecystectomy exhibited beneficial effects on postoperative abdominal, visceral, and shoulder pain in a resting state.

Effect of local wound infiltration with ropivacaine on postoperative pain relief and stress response reduction after open hepatectomy

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.

Comparison of perceived pain and patients’ satisfaction with traditional local anesthesia and single tooth anesthesia: A randomized clinical trial

BACKGROUND Contemporary innovations in the area of local anesthesia have attempted to provide an absolutely pain free experience for patients.Since the introduction of Computer-Controlled Local Anesthetic Delivery Systems to dentistry,many studies have compared its efficacy and safety to conventional anesthesia.However,very few studies have compared single tooth anesthesia(STA)and traditional local anesthesia.AIM To compare pain rating,changes in blood pressure,and heart rate during the local anesthetic injection.The secondary objectives were to measure the patients’level of satisfaction and the differences in anesthetic efficiency between the STA system and traditional local infiltration.METHODS A randomized controlled trial was conducted and a total of 80 patients with dental restorative needs were enrolled for the study.The patients were evaluated for their general physical status and oral clinical findings before enrollment.Information regarding perceived pain,changes in heart rate and blood pressure,and patients’satisfaction was collected using an electronic data form and was analyzed using paired and unpaired t-tests.RESULTS No significant difference was noted in perceived pain(P=0.59)and systolic blood pressure(P=0.09)during anesthetic injection using both traditional and STA techniques.STA patients had a significantly higher heart rate during anesthesia,although a statistically significant difference was noted among the traditional anesthesia and the STA groups even before anesthesia.During the restorative procedure,less pain was perceived by STA patients on the Wong-Baker FACES pain scale,which was statistically significant(P<0.001).Analyses of post-procedure patient responses showed that STA patients had a significantly better treatment experience and preferred to have the same method of injection in the future(P=0.04).CONCLUSION STA system can provide less painful and more comfortable restorative treatment procedures in comparison to the traditional infiltration technique.

新型局部浸润麻醉应用于人工全膝关节置换的早期效果评估

背景:全膝关节置换后患者会经历明显的疼痛,这对功能恢复存在负面影响,探索并寻求有效的镇痛手段具有重要的临床价值。目的:为探求全膝关节置换患者有效的围术期镇痛策略,首次提出了一种由吗啡、氟比洛芬酯和复方倍他米松配置而成的新型局部浸润麻醉制剂,同时探讨该方案的有效性及安全性。方法:对2023年11月至2024年4月在安徽医科大学第一附属医院关节外科接受初次单侧全膝关节置换60例患者的临床资料进行回顾性分析,根据置换过程中是否使用局部浸润麻醉将患者分为对照组与研究组,每组30例。研究组在全膝关节置换过程中关节腔周围注射吗啡、氟比洛芬酯及复方倍他米松配置而成的局部浸润麻醉制剂,而对照组术中未使用任何镇痛药物作为空白对照。记录并比较两组患者在术后不同时间节点的疼痛目测类比评分、膝关节活动度、膝关节学会评分、术后膝关节肿胀程度及术后并发症的发生情况。结果与结论:①与对照组相比,研究组患者置换后6,12及24 h的疼痛目测类比评分更低,差异有显著性意义(Z=-2.367,-2.906,-4.199,P<0.05);但在术后48,72 h,两组患者的疼痛目测类比评分并无显著性差异(Z=-1.287,-1.478,P>0.05);②置换后第3天,研究组患者的膝关节活动度和膝关节学会评分均优于对照组,差异有显著性意义(t=-2.519,-8.027,P<0.05);③研究组患者术后的膝关节肿胀程度轻于对照组,差异有显著性意义(Z=-2.818,P<0.05);④在术后早期,两组患者的发热发生率相比无显著性差异(P>0.05),两组均未发生切口愈合不良及假体周围感染;⑤结果表明:在全膝关节置换过程中应用由吗啡、氟比洛芬酯及复方倍他米松组成的局部浸润麻醉制剂,可以明显减轻患者术后早期疼痛,并显示出较高的安全性,但仍需大样本的前瞻性研究提供数据支持。

Implantation of Radioactive ^(125)I Seeds Improves the Prognosis of Locally Advanced Pancreatic Cancer Patients:A Retrospective Study

Locally advanced pancreatic cancer is associated with a very poor prognosis. This study was performed to evaluate whether patients with locally advanced pancreatic cancer benefit from 125 ^I seed implantation. This retrospective study included 224 patients with locally advanced pancreatic cancer, with 137 patients（61.2%） in the implantation（IP） group and 87（38.9%） in the non-implantation（NIP） group. The survival status, complications and objective curative effects were compared between the groups. The average operative time in the IP group was significantly longer than that in the NIP group（243±51 vs. 214±77 min）. The tumor response rates were 9.5% and 0 at the 2nd month after surgery in the IP and NIP groups, respectively（P〈0.05）. The IP group exhibited a trend toward pain relief at the 6th month after surgery. The global health status scores of the IP group were higher than those of the NIP group at the 3rd and 6th month after surgery. The median survival time in the IP group was significantly longer than that in the NIP group. In conclusion, patients with locally advanced pancreatic cancer can benefit from 125 I seed implantation in terms of local tumor control, survival time, pain relief and quality of life.

Chronic Pain Review Following Lichtenstein Hernia Repair: A Personal Series

Introduction: Chronic groin pain is both a topical subject and important outcome measurement following inguinal hernia repair. It has been suggested its incidence is related to the management of the nerves of the inguinal canal as well as the type of mesh used and methods of fixation for both open and laparoscopic surgery. The level of pre-operative and post operative pain, its duration as well as complications may all be factors in predicting whether chronic pain could develop. The method of measurement of chronic pain is itself a contentious issue. It is now apparent that the qualitative measurement of activity and functional status as well as quantitative is important. As a result several uniform methods of assessing chronic post-operative pain have been designed, validated and implemented. One of these is used here. Methods: A study reviewing a consecutive series of Lichtenstein repairs performed by a single experienced hernia surgeon was carried out. 248 inguinal hernia patients operated on in 2005 were reviewed. Patients were contacted via telephone at a median of 50 months. Franneby’s recently validated inguinal pain questionnaire was used to assess the incidence of chronic pain. Results: 185 (75%) patients were able to be contacted for follow-up, making a total of 213 inguinal hernia repairs (including bilateral and recurrent hernias). At the time of review 3% of patients reported having pain. No patients reported that pain or discomfort was limiting their work, exercise or activities of daily living. No patients had disabling pain. Conclusion: Chronic pain did not appear to be a major problem within this cohort of patients. The Lichtenstein technique can produce favourable results in terms of chronic pain for unilateral, bilateral and recurrent inguinal hernias in an unselected group of patients with the usual mix of risk factors and complications.

Analgesic Appraisal of Bidens pilosa (Asteraceae) Leaf Extracts Used in Management of Oral Lesion Pain in HIV/AIDS Patients in Rodents

Oral lesions, diarrhoea, Pneumocystis carinii pneumonia, tuberculosis and urinary tract infections are some of the opportunistic infections (OIs) which arise when the CD4 cells of the HIV/AIDS patient fall below 200 cells/mm3. HIV/AIDS infection complications include tissue damage from oral lesions accompanied with pains. Pain is a disagreeable sensory and sensitive experience associated with actual or potential tissue damage. This condition requires immediate treatment with analgesics and antibiotics. However, the inability of rural dwellers to afford readily available drugs is a consequence for using herbs like Bidens pilosa whose local usefulness in the management of oral lesions of HIV/AIDS has not been proven scientifically. Therefore, the objective of this study was to provide the scientific basis in rats for the traditional healers’ use of Bidens pilosa leaves’ extracts in managing pain associated with oral lesions of HIV/AIDS patients in South Western Uganda. Assessment of the analgesic effects of Bidens pilosa was conducted using acetic acid in mice, formalin-induced pain and tail flick methods in rats. Both aqueous and ethanolic extracts of the leaves of Bidens pilosa produced statistically significant dose dependent inhibition of acetic acid induced pain, non dose dependent pain reduction in formalin induced pain, (p < 0.05;student t-test) and non dose dependent tail withdrawal pattern (p < 0.05, Multivariate ANOVA test). Hence, we conclude that extracts of Bidens pilosa have an analgesic basis for their local use in treatment of oral lesions associated pain in HIV/AIDS patients in South-Western Uganda.

Myofascial Foot Pain Following Uneventful Epidural Analgesia for Labor and Delivery

Following an uneventful delivery under epidural analgesia, a 17 year old female patient was referred to the Pain Clinic because of numbness and pain of the left big toe for 2 and a half Months. An Orthopedic consultation had ruled out foot injury and concluded that the pain was radicular and secondary to nerve damage from the epidural analgesia. A Pain Clinic evaluation made the diagnosis of myofascial pain which was successfully treated with trigger pint block using normal saline.

Preoperative Pain Management of Patients with Hip Fractures: Blind Fascia Iliaca Compartment Block Compared to Ultrasound Guided Femoral Nerve Block—A Randomized Controlled Trial

Introduction: Blind fascia iliaca compartment block (FICB) and ultrasound guided femoral nerve block (FNB) are two types of peripheral nerve blocks, commonly used in preoperative pain management in patients with hip fractures in Danish emergency departments. The aim of this study was to compare the efficacy in pain management of these two types of peripheral nerve blocks in the preoperative period in patients with hip fractures. Method: We performed a randomized controlled study. The primary outcome was the proportion of patients with a numeric rating scale (NRS) pain score equal to three or less at rest and after passive leg raise test three hours after block administration. Results: A total of 88 patients were included in the study and 67 patients in the statistical analysis with 33 in the FICB group and 34 in the FNB group. The results showed a significant reduction in the proportion of patients with an NRS score higher than three, three hours after administration of either FICB or FNB compared to at inclusion. There was no significant difference in pain scores between patients receiving FICB versus patients receiving FNB at rest or after passive leg raise (p = 0.25 and p = 0.86, respectively). Conclusion: Blind FICB and ultrasound guided FNB were effective in preoperative pain management in patients with hip fractures. The results showed that the two types of peripheral nerve blocks were equally efficient in providing pain management in the preoperative period.

神经根筋膜鞘显影下注射富血小板血浆治疗神经病理性疼痛的疗效

目的:探讨神经根筋膜鞘显影下注射富血小板血浆(PRP)与局部封闭治疗神经病理性疼痛(NP)的疗效。方法:选取2022年1月~2022年12月收治的符合纳入标准的60例NP患者为研究对象,随机分为治疗组与对照组各30例,对照组采用5%利多卡因注射液2.5 ml+醋酸泼尼松龙2.5 ml(0.125 g/5 ml)规格混合液5 ml单侧注射治疗;治疗组则采用神经根筋膜鞘显影下注射PRP 5 ml,两组患者共治疗12 w。分别记录患者治疗前、治疗后2 h、治疗后1 w、治疗后12 w的视觉模拟疼痛评分(VAS)、Oswestry功能障碍指数(ODI)、下肢直腿抬高试验的离床面角度及行走距离测定。结果:治疗组治疗后2 h、治疗后1 w及12 w的VAS评分、ODI指数功能评分明显低于对照组(P<0.05);治疗组治疗后2 h、治疗后1 w及12 w的下肢直腿抬高试验、行走距离明显优于对照组(P<0.05);治疗组治疗有效率后期疗效显著优于对照组,且治疗期间均无不良反应发生。结论:经神经根筋膜鞘显影下注射PRP治疗神经病理性疼痛能获得更佳的临床疗效,较好地缓解患者神经病理性疼痛程度,促进其损伤神经修复及下肢功能的恢复,具有良好的安全性和可行性,为临床治疗病理性神经痛提供了新的治疗方案。

Regional anesthesia for acute pain management in elderly patients

Normal aging is a process that involves loss of functional reserve of most organ systems of the human body, most significantly: cardiovascular, pulmonary, renal and nervous systems. Advancements in both surgery and anesthesia have made it possible to operate more safely on the elderly population and those older patients with multiple severe co-morbidities that were not routinely possible in the recent past. Regional anesthesiologist have proven to be instrumental in this regard as regional anesthetic/analgesic techniques may now permit surgeons to operate on the elderly who were not ideal surgical candidates or unable to tolerate general anesthesia. In addition, regional techniques provide alternatives that may optimize acute pain control and reduce the incidence of devastating side effects during the perioperative period such as: myocardial infarction, pulmonary embolism, pneumonia, and also increases the opportunity to allow for early ambulation and shorter hospital stays. These anesthetic options now provide the elderly patient with better medical care alternatives, but also can show a significant financial impact on health care system resources. Further understanding on aging molecular biology, physiology and pathophysiology, together with technical improvements of regional anesthetic techniques will continue to make it safer and more efficacious to operate on the elderly population with evidence of reduced morbidity and mortality. Although there is only anecdotal evidence that regional anesthesia(RA) improves survival, there is little doubt that RA plays an important role in perioperative optimization of pain control and decreases pain management complications as well as a reduction in healthcare costs. Beyond traditional operating rooms, elderly patients may increasingly benefit from RA and acute pain management in Emergency Rooms, medical clinics and even within a patient's home. Therefore, the focus of this review is directed toward geriatric patients and beneficial effects of RA on outcomes in the elderly.

基于灶点理论的弧刃针疗法治疗顽固性网球肘的临床疗效

目的探讨基于灶点理论的弧刃针疗法治疗顽固性网球肘的临床疗效。方法收集64例顽固性网球肘患者,采用随机数字表法分为对照组和观察组。其中对照组32例,采用局部痛点注射治疗。观察组32例,采用弧刃针疗法治疗,每周治疗1次,均治疗2次,分别记录并比较两组患者治疗前、治疗后1、2、4及24周随访的疼痛数字评分(numberal rating scale,NRS)、肘关节功能评分(Mayo elbow perfor⁃mance score,MEPS)、肩臂手残障(disabilities of the arm,shoulder and hand,DASH)评分以及24周随访时的疾病的疗效评分(Wangxuechang diease efficacy score,WDES)。结果治疗过程中两组患者均未见不良事件发生。两组患者治疗前的NRS、MEPS及DASH差异均无统计学意义(P>0.05);治疗后各时期,两组NRS、MEPS、DASH及24周随访时的WDES较治疗前均改善,治疗1周后,两组NRS差异无统计学意义(P>0.05),治疗2、4及24周随访时的NRS观察组低于对照组;治疗后1、2、4及24周随访时,观察组DASH评分低于对照组,MEPS评分高于对照组,差异有统计学意义(P<0.05),治疗24周后随访时的WDES,观察组优于对照组,差异有统计学意义(P<0.05)。结论局部痛点注射及弧刃针灶点松解治疗顽固性网球肘早期均能缓解疼痛,改善肘关节功能,而局部痛点注射治疗后远期效果欠佳,观察组治疗效果逐渐提升。

罗哌卡因对自然分娩后产妇会阴部疼痛的镇痛效果

目的 探讨罗哌卡因对自然分娩后产妇会阴部疼痛的镇痛效果。方法 选取2021年1月至2022年1月我院收治的121例单胎足月产妇作为研究对象,按照随机数字表法将其分为对照组(61例)和观察组(60例)。侧切会阴前5 min和产后修补会阴前5 min,对照组采取利多卡因局部浸润麻醉,观察组采取罗哌卡因局部浸润麻醉。比较两组的产后不同时间镇痛效果、日常活动疼痛情况、新生儿出生情况、满意度及恢复情况。结果 产后2、6、8、12 h,观察组的视觉模拟评分法(VAS)评分低于对照组,差异具有统计学意义(P<0.05);产后24 h,两组的VAS评分比较,差异无统计学意义(P>0.05)。产后10 h,观察组的坐立、排尿、睡眠VAS评分低于对照组,差异具有统计学意义(P<0.05)。娩出后1、5、10 min,两组的新生儿Apgar评分比较,差异无统计学意义(P>0.05)。观察组的满意度为95.00%,高于对照组的81.97%,差异具有统计学意义(P<0.05)。观察组的再次应用镇痛药、产后3 d影响活动占比低于对照组,差异具有统计学意义(P<0.05);两组的尿潴留、伤后愈合不良占比比较,差异无统计学意义(P>0.05)。结论 罗哌卡因局部浸润麻醉不仅可以为自然分娩产妇提供更有效、更持久的镇痛效果,改善产妇的日常活动疼痛情况,提高满意度,而且具有一定的安全性。

加热的奥布卡因凝胶在经直肠超声引导前列腺活检术中的镇痛作用

目的探讨应用加热的奥布卡因凝胶直肠内局部表面麻醉(intrarectal local anesthesia,IRLA)对经直肠超声引导前列腺活检(transrectal ultrasound guided prostate biopsy,TRUSPB)术中疼痛的影响。方法前瞻性纳入2023年1月至6月于湖州市中心医院行TRUSPB的150例患者。采用随机数字表法将患者分为A组(常规组)、B组(应用室温下奥布卡因凝胶行IRLA)和C组(应用40℃奥布卡因凝胶行IRLA),每组50例。由对麻醉类型不知情的护士使用视觉模拟评分(visual analogue scale,VAS)对患者各时期的疼痛程度进行评分(VASⅠ:超声探头插入直肠时;VASⅡ:活检过程中;VASⅢ:活检后30min),并比较活检后并发症发生率。结果C组患者VASⅡ评分低于A组和B组,差异有统计学意义(P<0.05)。三组患者的VASⅠ、VASⅢ评分和活检后并发症发生率比较差异无统计学意义(P>0.05);未见奥布卡因凝胶过敏反应。结论在TRUSPB中应用加热的奥布卡因凝胶的IRLA比常规IRLA可更有效地控制疼痛,且不增加并发症发生率。

切口周围局部浸润麻醉对拇外翻术后镇痛效果的影响

目的:探讨切口周围局部浸润麻醉对拇外翻术后镇痛效果的影响。方法:选取2022年3月至2022年7月于首都医科大学附属北京同仁医院足踝外科中心行拇外翻截骨矫形手术的患者70例,根据术后不同镇痛方式随机分为试验组和对照组,每组35例。对照组术后给予静脉镇痛泵镇痛,试验组在术后静脉镇痛泵镇痛基础上给予手术切口周围0.375%盐酸罗哌卡因局部浸润麻醉,比较两组术后6、18、24及48h的疼痛视觉模拟量表(visual analogue scale,VAS)评分、术后止疼药物使用剂量、静脉镇痛泵的按压次数、术后伤口近期并发症发生率及患者术后疼痛控制满意度。结果:试验组术后6、18及24h的VAS疼痛评分分别为1.17±0.954、1.80±0.868、1.74±1.172,低于对照组的2.57±2.160、4.27±1.886、3.66±1.984,差异有统计学意义(P<0.05)。试验组术后48h的VAS评分为1.26±0.980,对照组为1.69±1.078,两组比较无统计学差异(P>0.05)。对照组术后氨酚氢考酮片、塞来昔布胶囊、氟比洛芬酯注射液等止疼药物使用剂量、静脉镇痛泵的按压次数分别为603.43±282.811mg、285.71±176.806mg、40.87(0,150)mg、9(6,10.25),高于试验组的278.14±214.655mg、205.71±141.302mg、30.13(0,400)mg、4.5(3,6.75),差异有显著性(P<0.05)。试验组术后伤口近期并发症切口渗液、脂肪液化、切口红肿的发生率为5.71%、2.85%、8.57%,与对照组的8.57%、0%、2.85%比较差异无统计学意义(P>0.05)。试验组术后疼痛满意度高于对照组,差异有统计学意义(P<0.05)。结论:切口周围局部浸润麻醉可以降低拇外翻患者术后的疼痛程度、减少术后止疼药物的使用剂量及静脉镇痛泵的按压次数,提高患者疼痛控制满意度,同时不增加术后伤口近期并发症的发生率,值得临床推广应用。

儿科护士局部麻醉剂临床应用采纳意愿模型的构建

目的:探索儿科护士局部麻醉剂临床应用采纳意愿的影响因素。方法:采用自行设计的调查问卷于2022年11月1日—15日对四川省10所医院的251名儿科护士进行调查,基于创新扩散理论和计划行为理论构建儿科护士局部麻醉剂临床应用采纳意愿模型。采用AMOS 24.0软件进行结构方程模型分析。结果:局部麻醉剂临床应用的相对优势和易用性对儿科护士态度有正向影响,局部麻醉剂临床应用的态度、主观规范及感知行为控制对儿科护士的采纳意愿有正向影响。模型卡方自由度比值为1.515,适配度指数为0.910,调整拟合优度指数为0.880,近似误差均方根为0.045,均方根残差为0.020。该模型可解释儿科护士采纳意愿71.4%的变异度。结论:局部麻醉剂临床应用的主观规范、感知行为控制和态度对儿科护士采纳意愿有正向影响,其中,态度对采纳意愿的影响作用最强;局部麻醉剂临床应用的相对优势和易用性通过态度对儿科护士采纳意愿产生正向影响。该模型对儿科护士应用局部麻醉剂减轻儿童静脉穿刺疼痛的采纳意愿有较强的解释力。

冷敷联合氨甲环酸对全膝关节置换术后患者局部肿胀、疼痛程度及炎性因子水平的影响

目的探讨冷敷联合氨甲环酸对全膝关节置换术后患者局部肿胀、疼痛程度及炎性因子水平的影响。方法选取2021年12月至2022年12月收治的100例全膝关节置换术后患者为研究对象,以随机数字表法将其分为对照组和观察组,各50例。对照组术前静脉滴注氨甲环酸治疗,观察组在对照组基础上增加切口关闭时关节腔内输注氨甲环酸、冷敷治疗。比较两组的治疗效果。结果术后1、3、7 d,观察组的两股部周径差小于对照组(P<0.05)。术后1、3 d,观察组的被动运动状态视觉模拟评分法(PVAS)、静息状态视觉模拟评分法(RVAS)评分均低于对照组(P<0.05)。术后1、3 d,观察组的白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)及C反应蛋白(CPR)水平均低于对照组(P<0.05)。结论冷敷联合氨甲环酸不仅能够快速减轻全膝关节置换术后患者局部肿胀与疼痛程度,而且能抑制炎性因子水平,促进术后恢复,值得推广。

局部正骨推拿配合针灸治疗颈肩腰腿痛疗效及对患者中医症候和功能恢复的影响

目的:探究局部正骨推拿配合针灸治疗颈肩腰腿痛疗效及对中医症候和功能恢复的影响。方法:选取颈肩腰腿痛患者110例,以随机数字分组法均分为对照组及观察组,对照组采用局部正骨推拿治疗,观察组采用局部正骨推拿配合针灸治疗。比较两组患者的中医症候积分、视觉模拟评分法(VAS)评分、颈椎/腰椎评估治疗分数(JOA)、肩关节评分(CMS)、肢体运动功能评估量表(FMA)、颈椎病临床评价量表(CASCS)、功能障碍指数(ODI)评分、氧化应激指标[丙二醛(MDA)、超氧化物歧化酶(SOD)]等。结果:治疗1个月后,观察组治疗总有效率、JOA、CMS、FMA、CASCS评分及SOD水平较对照组高(均P<0.05);观察组中医症候积分、VAS评分、ODI评分及MDA水平均较对照组低(均P<0.05)。结论:局部正骨推拿结合针灸治疗颈肩腰腿痛能够提高疗效,改善局部血液循环及氧化应激反应,缓解肌肉紧张和疼痛。

超声引导下骶管麻醉对肛肠患者术后疼痛疗效和负性情绪的影响

目的分析超声引导下骶管麻醉对肛肠患者术后疼痛疗效和负性情绪的影响。方法选择淮安市中医院2021年9月—2022年12月收治的120例肛肠患者为研究对象,并将患者随机分为两组,对照组(n=60例)接受硬膜外麻醉,观察组(n=60例)接受超声引导下骶管阻滞麻醉,比较两组的麻醉效果、术后患者疼痛视觉模拟评分法(VAS)、焦虑自评量表(SAS)及生活质量评分量表(QOL)。结果观察组麻醉起效时间明显短于对照组,组间差异与统计学意义(P<0.05)。观察组痛觉消失时间显著短于对照组,组间差异与统计学意义(P<0.05)。术前,两组患者VAS、SAS及QOL评分比较,差异无统计学意义(P>0.05);术后,观察组在VAS和SAS上的评分显著优于对照组,QOL评分高于对照组,组间差异有统计学意义(P<0.05)。结论超声引导下骶管麻醉对肛肠患者术后疼痛疗效较好,阻滞速度快,患者焦虑情绪得到明显改善。

超声定位监测输尿管结石经体外冲击波碎石的效果分析

目的 分析输尿管结石患者接受经体外冲击波碎石治疗中,采取超声定位监测的价值。方法 选择2021年6月至2023年6月收治的172例输尿管结石患者为研究对象,随机分2组。对照组(86例)实施气压弹道碎石治疗,观察组(86例)在超声定位下实施碎石治疗。比较2组临床疗效、并发症发生率、临床指标、排尿功能。结果 观察组临床疗效高于对照组,并发症发生率、定位时间、疼痛程度低于对照组(P<0.05);2组排尿功能比较,观察组国际前列腺症状评分(IPSS)低于对照组,最大尿流率(Qmas)高于对照组(P<0.05)。结论 输尿管结石患者接受经体外冲击波碎石治疗中,采取超声定位监测可提高定位成功率,减轻机体疼痛程度,避免碎石中出现血尿等并发症,值得借鉴与学习。