Thienorphine induces analgesia by binding κ -and δ-, or by partially binding μ-opioid receptor,thus further regulating cAMP-PKA activity

OBJECTIVE Thienorphine,a new oripavine derivative,has shown to possess stronger antinociceptive effects and better oral bioavailability compared to buprenorphine.The present study examines the effect of thienorphine on c AMP-dependent protein kinase A(PKA) activity in CHO cells expressing μ-,κ-,δ-and ORL1 receptors.In addition,we further examined its analgesic effect in vivo.METHODS The effect of thienorphine on cA MP-dependent PKA redistribution and cA MP inhibition were analyzed in CHO-PKAcatEGFP cells.PKA redistribution assays in CHO-PKAcatEGFP cells stably expressing μ-,κ-,δ-and ORL1 receptors were analyzed by high-throughput screening system to elucidate the efficacy of agonists or antagonists on opioid receptors.Moroever,the antinociceptive effects of thienorphine in vivo were examined using hot plate test.RESULTS Briefly,the maximum inhibition of thienorphine on PKA activity was about 36%,100%,100%and 12% in CHO-μ/κ/δ/ORL1-PKAcatE GFP cel s,respectively.In addition,thienorphine concentrationdependently inhibited the PKA activity with EC50 value of(22.7±18.1) nmol·L^(-1) in CHO-κ-PKAcatE GFP cels and(12.4±7.7) nmol·L^(-1) in CHO-δ-PKAcatE GFP cells.Thienorphine induced approximately 50%antinociceptive effect in mice lacking μ receptors compared to their wild-type controls(P<0.05).Also,the κ and δ selective antagonist nor-binaltorphimine,naltrindole decreased approximately 50%-60% in % MPE of theinorphine in μ-KO mice,respectively.The ORL1 receptor selective antagonist J113397 had no effect in %MPE of theinorphine in μ-KO mice.CONCLUSION Thienorphine induces analgesia through bindingκ-and δ-,or by partially binding μ-opioid receptor,thus further regulating the cAMP-PKA activity.Therefore,thienorphine may be used in acute or chronic pain with minimal addictive potential.

DN-9: a multifunctional agonist of opioid and neuropeptide FF receptors that produces nontoleranceforming analgesia via peripheral opioid receptors in inflammatory and neuropathic pain models

OBJECTIVE Considerable effort has recently been directed at developing multifunctional opioid drugs as an alternative strategy to minimize the unwanted side effects of opioid analgesics.We recently developed a novel multifunctional agonist for opioid and neuropeptide FF(NPFF) receptors named DN-9.The present study was conducted to evaluate the pharmacological activities of DN-9 after peripheral administration.METHODS Antinociceptive activities of subcutaneous DN-9 were investigated in mouse models of acute inflammatory and neuropathic pain.Furthermore,the side-effects of DN-9 were evaluated after peripheral injection in rotarod,antinociceptive tolerance,abuse and gastrointestinal transit tests.RESULTS Subcutaneous DN-9 dose-dependently produced antinociception via peripheral mu-and kappa-opioid receptors,independent of delta-opioid and NPFF receptors,in the tail-flick assay.Similarly,a dose-dependent antinociceptive effect of DN-9 was mediated via peripheral opioid receptors in other inflammatory and neuropathic pain models.Repeated treatment with DN-9 produced antinociceptive effects without a loss of potency in various models of acute,inflammatory and neuropathic pain.DN-9 maintained potent analgesia in morphine-tolerant mice.The gastrointestinal motility inhibition and abuse properties of DN-9 were significantly reduced after subcutaneous injection compared to morphine.DN-9 did not significantly influence the motor coordination of mice.CONCLUSION Subcutaneous administration of DN-9 produces potent analgesic activities with minimal side effects.These data strengthen the therapeutic potential of peripherally acting opioids with multifunctional agonistic properties that are active in a broad range of experimental pain models after peripheral delivery.

前交叉韧带重建术后三种不同药物镇痛早期疗效的对比

目的:比较去痛片(复方氨基比林、非那西丁片,商品名去痛片)、盐酸曲马多缓释片(商品名:奇曼丁)及盐酸哌替啶(商品名:杜冷丁)在膝关节前交叉韧带自体肌腱单束重建术后早期的止疼效果及安全性。方法:回顾性分析2018年11月至2019年2月,北京大学第三医院连续收治的45例由同一组医师施行膝关节镜下前交叉韧带自体肌腱单束重建术患者,术后疼痛情况和使用药物镇痛情况的临床资料。采用随机区组设计,根据前交叉韧带断裂是否合并半月板损伤将患者分为两组,A组为单纯膝关节前交叉韧带重建的患者24例,B组为前交叉韧带断裂合并半月板损伤的患者21例。两组又根据患者实际使用的术后镇痛药物各分为3组,其中,A组口服去痛片4例、口服奇曼丁11例、肌肉注射(简称肌注)杜冷丁联合盐酸异丙嗪(商品名:非那根)9例;B组口服去痛片3例、口服奇曼丁10例、肌注杜冷丁联合非那根8例。术后早期,患者诉疼痛并主动要求镇痛时随机给予去痛片、奇曼丁或杜冷丁联合非那根这三种不同的止痛药物缓解疼痛,采用疼痛视觉模拟评分(visual analogue scale, VAS)评估疼痛缓解情况,并观察不良反应发生情况。结果:患者在性别、年龄、体重指数、住院时间等基本情况上差异无统计学意义(P>0.05)。应用三种止痛药物缓解疼痛的两组患者,在用药前及用药1 h后通过VAS评分判断结果表明,患者疼痛情况明显缓解,用药前后疼痛差异有统计学意义(P<0.05)。对两组患者应用的三种药物进行两两比较显示,杜冷丁联合非那根组对于疼痛缓解的程度显著高于其余两种药物(P<0.05),用药1 h后,两组差异无统计学意义(P>0.05)。应用杜冷丁患者易出现恶心、呕吐等副反应,但应用杜冷丁的同时使用非那根可减少副反应。在不良反应方面,仅单纯前交叉韧带重建组中应用奇曼丁组的患者出现恶心1例,其余各组患者均未出现严重的并发症及过敏反应。结论:无论是单纯交叉韧带重建,还是合并半月板成型或缝合的交叉韧带重建,患者应用去痛片、奇曼丁、杜冷丁联合非那根这三种药物均能有效缓解疼痛,其中杜冷丁对疼痛的缓解幅度最大。应用杜冷丁的同时,合用非那根可有效减轻患者的呕吐、恶心等不良反应,增加用药安全性。

无阿片类药物麻醉在老年腹部外科手术的应用

目的:评价无阿片类药物麻醉在老年腹部外科手术中的可行性和应用效果。方法:选取2021年6月至2022年12月本院104例65~85岁接受过腹部外科手术的患者,随机分为无阿片类药物麻醉(opioid-free anesthesia,OFA)组(右美托咪定、利多卡因联合硬膜外镇痛方案)和阿片类药物麻醉(opioid anesthesia,OA)组(舒芬太尼、瑞芬太尼联合硬膜外镇痛方案),每组各52例。观察主要指标:术后24 h内视觉模拟评分(visual analogue scale,VAS),术中、术后硬膜外镇痛药物消耗量;次要指标:术中不同时刻平均动脉压(mean arterial pressure,MAP)、心率(heart rate,HR),术中麻醉效果,术后24 h内不良反应发生情况。结果:与OA组相比,OFA组在术后8 h后VAS评分降低(P<0.001);两组术中硬膜外混合药物消耗量比较差异无统计学意义(P>0.05);OFA组术后24 h硬膜外罗哌卡因累积消耗量低于OA组(P<0.001);两组间不同时刻MAP、HR比较差异无统计学意义(P>0.05);两组术中麻醉效果比较差异无统计学意义(P>0.05);两组术后苏醒时间、拔管时间,OFA组短于OA组(P<0.05);OFA组术后24 h内恶心、呕吐发生率及严重程度低于OA组(P<0.05)。结论:对于老年腹部外科手术,无阿片类药物麻醉方案是可行的。与阿片类药物麻醉方案相比,术中麻醉效果相同,但该方案可以缩短术后苏醒时间,降低术后24 h内疼痛程度、恶心和呕吐发生率及严重程度。

罗哌卡因联合右美托咪定对剖宫产产妇镇痛效果、术后恢复和血清炎症因子的影响

目的:探讨罗哌卡因联合右美托咪定对剖宫产产妇镇痛效果和术后恢复的影响。方法:按镇痛方案不同,将行116例剖宫产术的产妇分为对照组与试验组,每组各58例。对照组使用罗哌卡因+舒芬太尼镇痛;试验组使用罗哌卡因+右美托咪定镇痛。分别于术后3、6、12、24、及48 h,对产妇的疼痛程度进行评估;记录产妇术后镇痛泵使用情况;记录两组产妇阻滞时效和术后恢复相关指标;检测产妇术前及术后24 h血清白细胞介素6(IL-6)和肿瘤坏死因子α(TNF-α)水平;记录产妇术后48 h内不良反应发生情况。结果:两组术后3~48 h各时间点VAS评分、首次镇痛按压时间及术后48 h内镇痛泵按压次数差异均无统计学意义(P>0.05)。与对照组比较,试验组腰麻感觉阻滞达到最高平面经历的时间、感觉恢复时间较长(P<0.05),两组腰麻感觉阻滞起效时间无统计学差异(P>0.05)。与对照组相比,试验组首次肛门排气时间、泌乳始动时间均明显提前(P<0.05),48 h哺乳次数增多(P<0.05)。与对照组比较,试验组术后24 h血清IL-6、TNF-α水平更低(P<0.05),术后48 h内恶心呕吐发生率、皮肤瘙痒发生率更低(P<0.05)。结论:与罗哌卡因联合舒芬太尼比较,在腰硬联合麻醉中使用罗哌卡因联合右美托咪定也能够提供确切镇痛效果,且可减少不良反应,更能促进产妇术后恢复。

镇痛药物研发的潜在方向

生理状态下,疼痛是一种保护性反应,可使机体免受更严重的伤害,有利于物种生存。病理状态下,疼痛作为一种常见的疾病/症状,严重影响患者的生活质量。近年来,疼痛机制研究与镇痛药物研发取得了重要进展,但仍存在许多问题和挑战。本研究旨在系统性梳理该领域的历史经验,展望未来发展方向,以期将疼痛机制研究和镇痛药物研发工作推向更高层次。

加速康复外科背景下腹腔镜胆囊切除术后复苏期多模式镇痛研究进展

胆囊结石是一种常见的胆石病。腹腔镜胆囊切除术常用于治疗胆囊结石。加速康复外科对腹腔镜胆囊切除术后镇痛安全和舒适性提出了更高的要求。强阿片类(opioid)镇痛效果不容置疑,但同时也增加了术后呼吸抑制或延迟性呼吸抑制和术后恶心呕吐风险。多模式镇痛不仅能确保患者术后所必需的镇痛效果,同时也能最大程度减少opioid副作用,促进患者术后快速康复。

超声引导腹直肌肌内电刺激在上腹开腹手术患者术后镇痛的临床应用

目的探讨超声引导腹直肌肌内电刺激在上腹开腹手术患者术后镇痛的应用效果。方法本研究为前瞻性单中心单盲随机对照试验,选择中山市人民医院2022年5月至2023年8月择期行上腹部开腹手术治疗患者80例,采用随机数表法分为两组,每组各40例,两组术后均行自控静脉静脉镇痛泵,观察组患者手术结束后在超声引导下进行腹直肌肌内电刺激,记录两组围术期阿片类药物使用量、术后前3 d疼痛视觉模拟评分、总住院时长以及不良反应发生情况。结果观察组围术期使用阿片类药物总量少于对照组,差异有统计学意义(P<0.05)。观察组术后前3 d的视觉模拟量表评分均低于对照组,差异有统计学意义(P<0.05)。观察组总住院时长短于对照组,差异有统计学意义(P<0.05)。观察组患者术后不良反应总发生率低于对照组,差异有统计学意义(P<0.05)。结论在超声引导下行腹直肌肌内电刺激可以减少上腹开腹手术患者围术期阿片类药物使用总量,降低术后视觉模拟量表评分,并且可以缩短总住院时长,减少不良反应发生率。

无阿片麻醉在小儿手术应用的研究进展

阿片类药物可导致呼吸抑制,因此可通过限制阿片类药物的使用降低其相关风险,儿童是该药使用的重点关注人群。随着多模式镇痛和加速康复外科的发展,无阿片麻醉(OFA)的临床应用越来越多,其常用药物有α_(2)受体激动剂、N-甲基-D-天冬氨酸受体拮抗剂、非甾体抗炎药、局部麻醉药,主要应用方式为椎管内阻滞、外周神经阻滞和局部浸润。目前已知成人OFA的效果较好,但有关OFA在小儿手术中应用的研究较少,未来还需对OFA在小儿手术中的应用及其获益进行深入研究。

Efficacy of Perioperative Intravenous Lidocaine for Multimodal Analgesia

Given the rising incidence of opioid misuse and opioid-related deaths worldwide, it is imperative to find nonopioid analgesic adjuncts for perioperative pain management. Perioperative opioid exposure in opioid-naïve patients for even minor surgical procedures may result in significant opioid dependence. Although the use of intravenous lidocaine in the perioperative period is not novel, recently it has been proposed as an important adjunct to multimodal analgesia. In addition to improving acute pain, lidocaine may reduce the incidence of chronic post-operative pain syndrome (CPPS), improve bowel function, and decrease post-operative nausea and vomiting (PONV) thereby speeding up the post-operative recovery process. Furthermore, lidocaine has efficacy in a variety of procedures including abdominal, gynecological, and urological surgeries. The aim of this narrative review is to evaluate the effects of intravenous lidocaine compared to traditional analgesic methods on post-operative pain control and recovery for various surgical procedures.

艾司氯胺酮在去阿片麻醉中的研究进展

随着加速康复外科(ERAS)理念的普及,去阿片麻醉(OFA)成为围手术期医师共同关注的热点,阿片类药物及其代谢物是N-甲基-D-天冬氨酸受体的激动剂,使用多模式镇痛,少或无阿片类药物,尤其是N-甲基-D-天冬氨酸受体拮抗剂,可能是一种有效的预防策略。艾司氯胺酮对N-甲基-D-天冬氨酸受体的亲和力更高,镇静和镇痛效应可达氯胺酮的两倍,作为氯胺酮的新型升级产物,艾司氯胺酮可兴奋交感神经系统,降低全身麻醉药物对心血管系统的抑制作用,因此在临床应用中其剂量相关不良反应相应减少,更具临床应用前景。本文就艾司氯胺酮在OFA方案中的临床应用及相关机制进行阐述。

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.

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.

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.

Analgesic and anti-inflammatory potential of aerial parts of the Daphne mucronata Royle extract in mice: Opioid-independent action

Objective: To investigate the analgesic and anti-inflammatory property and possible involvement of opioid receptors of ethyl acetate extract from aerial parts of Daphne mucronata(D. mucronata) in mice by formalin test.Methods: Single doses of 2.5, 5.0 and 10.0 mg/kg of body weight of ethyl acetate extract of D. mucronata were intraperitoneally administered to the mice 30 min before analgesic test. The anti-nociceptive effect of preparations was evaluated based on the formalin in mice.Results: The results indicated that the extract(2.5, 5.0 and 10.0 mg/kg) increased the pain threshold of mice and induced analgesia in both phases of formalin test. Like morphine sulfate(5.0 mg/kg, i.p.), the extract also showed more effective analgesic effect on the late phase of formalin test. Pre-treatment of animals with naloxone(5.0 mg/kg i.p.)did not inhibit the effects of the extract.Conclusions: Our findings suggest that D. mucronata contains potential analgesic and anti-inflammatory compounds which support its traditional use. Moreover, it seems that the analgesic and anti-inflammatory effects of the extract is mediated by non-opioid mechanisms. Further pharmacological studies are required to determine whether the analgesic mechanisms are actually responsible for such properties.

Endorphinergic Attenuation of Distress by Concomitantly Enhancing Endogenous Opioid Release and Switching Opioid Receptor Signaling from an Excessively Excitatory to a Normal Inhibitory Mode

The endogenous opioid system plays a significant role in the modulation of distress in many psychiatric, neurologic, and neurodevelopmental disorders. Many clinical distress symptoms show similarities to the excitatory autonomic withdrawal effects in chronic opioid-dependent animals and humans, as well as to the “quasi-morphine withdrawal syndrome” evoked in naive rodents shortly after acute systemic injection of cyclic AMP-phosphodiesterase (cAMP-PDE) inhibitors. These symptoms result from excessive excitatory opioid receptor signaling and increased endorphin release. Pharmacologic analyses of the remarkably plastic bimodal (excitatory/inhibitory) signaling functions of opioid receptors have utilized microelectrode recordings from opioid-sensitive neurons in tissue cultures of mouse sensory ganglia and hot-water tail-flick assays in mice. These studies led to development of specific chemical formulations that switch opioid receptor signaling from an excessively excitatory to a normal inhibitory mode. Critical combinations of cAMP-PDE inhibitors that release endorphins plus specific agents that switch opioid receptors from excitatory Gs-coupled to inhibitory Gi/Go-coupled signaling were shown to attenuate hyperalgesia and distress evoked by diverse chemical stressors in mouse tail-flick assays. Both the “quasi-morphine withdrawal syndrome” in naive rodents as well as the excitatory withdrawal effects in chronic, opioid-dependent animals and humans may be manifestations of a common Endorphinergic Distress Syndrome (EDS). We suggest that many distress symptoms are caused by EDS, a dysfunctional imbalance in the endogenous opioid system, consisting of abnormal endorphin levels, together with opioid receptors predominately in their excitatory mode. Therefore, concomitantly enhancing endogenous opioid release and switching excessive excitatory opioid receptor signaling to inhibitory signaling can attenuate these distress symptoms. Trials of a critically formulated oral preparation, containing both endorphin enhancers and opioid receptor switchers, have resulted in long-term anxiolytic efficacy and enhanced calm and mental clarity in large numbers of individuals with distress symptoms. These endorphinergic formulations may provide treatment for the emotional and physical distress associated with many psychiatric, neurologic, and neurodevelopmental disorders.

Analgesia after liver transplantation

This article addresses postoperative analgesia in patients with end-stage liver disease who have undergone liver transplantation(LT). Postoperative analgesia determines how patients perceive LT. Although important, this topic is underrepresented in the current literature. With an increased frequency of fast tracking in LT, efficient intraand postoperative analgesia are undergoing changes. We herein review the current literature, compare the benefits and disadvantages of the therapeutic options, and make recommendations based on the current literature and clinical experience.

A systematic Review of the Safety and Effectiveness of Epidural Analgesia for Labor Analgesia

Objective To re-evaluate the systematic review of the safety and effectiveness of epidural analgesia(EA)for labor analgesia.Methods The Cochrane database,PubMed,EMBASE,EBSCO,Web of Science,ScienceDirect,China Biomedical Literature database,CNKI,Wanfang and VIP databases were searched,and the search time was limited to August 2020.Two researchers screened the literature and extracted data according to the inclusion criteria.AMSTAR was used to evaluate the methodological quality of the included studies.Pain intensity and pain relief satisfaction were used as the main indicators for re-evaluation of the effectiveness.Midwifery rate,cesarean section rate,back pain,fever,nausea and vomiting,umbilical artery pH value,and newborn Apgar score were used as the main indicators to re-evaluate the safety.Results and Conclusion A total of 9 meta-analyses were included.The safety and effectiveness of EA and opioid intravenous analgesia,acupuncture stimulation,inhalation analgesia,no analgesia,and continuous delivery were evaluated separately.The included systematic reviews showed that EA could increase the rate of device-assisted delivery,causing maternal fever,and prolonging the first and second stages of labor.But the incidence of back pain,nausea,and vomiting was lower.Therefore,analgesia had a good effect with better satisfactory degree.Current evidence shows that EA is safe and effective for labor analgesia,but the quality of the reports of current studies is not high.

A Comparison of Local Infiltration Analgesia and PECS II Block for Analgesia in Mastectomy with Axillary Dissection—A Randomised Equivalence Study

Objective: Various analgesic techniques can be used for a mastectomy with axillary dissection with varying degrees of efficacy. In our institution, local anaesthesia infiltration (LIA) is commonly performed by surgeons. In this study, we hypothesise that the relatively novel PECS II block is equivalent to the analgesic profile of LIA. Methodology: In this single center, prospective, randomised control trial, 40 patients undergoing unilateral mastectomy with axillary dissection were randomly assigned to receive either 30 ml 0.5% ropivacaine before skin via LIA by a specialist breast surgeon during surgery or 30 ml 0.5% ropivacaine via PECS II block, before skin incision. Fentanyl was used as rescue analgesia intraoperatively, and all patients received morphine via patient-controlled analgesia (PCA) device postoperatively. The primary outcome was the difference in total morphine consumption in 24 hours between the 2 groups after surgery with equivalency set at ±1 mg. Secondary outcomes included time to rescue analgesia after block administration, post-operative pain score over 24 hours, adverse effects encountered, total intraoperative opioid usage, effect on operative time, block performance time as well as block and surgery related complications. Results: Unadjusted mean PCA morphine consumption over 24 hours post-operatively comparing local infiltration analgesia (LIA) to that of PECS II at 95% confidence interval was -1.22 mg (95% CI: -3.77, 1.33). Total IV Fentanyl use comparing LIA to PECS II was 2.53 ± 0.98 mcg/kg and 1.96 ± 0.57 mcg, P = 0.035. There were no other significant differences in the secondary outcome. Conclusion: We conclude there is a lack of equivalence between that of LIA and PECS II block, with the PECS II block providing superior analgesia.

以髂筋膜间隙阻滞为基础的无阿片镇痛在糖尿病足膝上截肢围术期中的应用

目的观察超声引导下以腹股沟韧带上髂筋膜间隙阻滞(SFICB)为基础的无阿片镇痛(OFA)用于糖尿病足患者膝上截肢围术期的镇痛和康复效果。方法选择2016年1月至2022年12月在廊坊市人民医院行糖尿病足膝上截肢术患者40例作为研究对象。按镇痛方法的不同将患者分为阿片镇痛(OA)组和OFA组,每组20例。OA组行腰硬联合麻醉,术毕行阿片患者自控静脉镇痛(OPCIA);OFA组行SFICB和腰硬联合麻醉,术毕行无阿片患者自控静脉镇痛(OFPCIA)。观察并记录麻醉前(T1)、平卧转侧卧(T2)、侧卧弓腰(T3)、麻醉后24 h(T4)时疼痛数字等级评价量表(NRS)评分和术后正常饮食时间、无痛期持续时间、有效按压容量、补救镇痛药用量,以及术后48 h内恶心/呕吐、皮肤瘙痒、谵妄、幻觉、重度疼痛等不良事件的发生情况。结果OA组T2、T3、T4时NRS评分均明显高于OFA组(分:5.35±1.76比3.15±0.75,4.10±1.07比2.50±0.69,2.90±0.97比1.65±0.59,均P<0.05)。OA组正常饮食时间、患者自控静脉镇痛(PCIA)有效按压容量、补救镇痛药用量均明显高于OFA组〔正常饮食时间(h):6.60±2.41比3.45±1.32,PCIA有效按压容量(mL):22.75±2.45比11.70±4.78,补救镇痛药用量(mg):108.00±35.63比30.00±27.53,均P<0.05〕,无痛期持续时间较OFA组明显缩短(h:4.25±1.68比23.60±5.14,P<0.05)。OA组术后48 h内恶心/呕吐、皮肤瘙痒、谵妄、重度疼痛发生率明显高于OFA组〔分别为60.0%(12/20)比15.0%(3/20),65.0%(13/20)比10.0%(2/20),30.0%(6/20)比5.0%(1/20),60.0%(12/20)比10.0%(2/20),均P<0.05〕,幻觉发生率明显低于OFA组〔0%(0/20)比20.0%(4/20),P<0.05〕。结论行超声引导下以SFICB为基础的OFA较OA安全有效地降低了糖尿病足膝上截肢术患者围术期阿片类药物的不良反应,并加速了患者康复。