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

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

Foot and ankle surgery:Tourniquet placement site to cause as little postoperative pain as possible

There is controversy in the literature on where to place the tourniquet(thigh,calf,ankle)for foot and ankle surgery.While some authors prefer the ankle tourniquet to the calf tourniquet,others state that the surgeon can decide between using the thigh tourniquet or the ankle tourniquet,since there was no difference in postoperative pain between them.Where to place the tourniquet during foot and ankle surgery to cause the least possible postoperative pain to the patient as a result of the tourniquet is a common question in clinical practice.The reality is that,unfortunately,there is no consensus on this issue.Perhaps the only possible way to answer this question would be to conduct a comparative study with sufficient statistical power to reach scientifically sound conclusions.It does not seem easy to carry out such a study,but it would be important to be able to answer the question posed in the title of this Editorial once and for all.

Analysis of factors impacting postoperative pain and quality of life in patients with mixed hemorrhoids:A retrospective study

BACKGROUND Hemorrhoids are among the most common and frequently encountered chronic anorectal diseases in anorectal surgery.They are venous clusters formed by con-gestion,expansion,and flexion of the venous plexus in the lower part of the rec-tum.Mixed hemorrhoids bleed easily and recurrently,and this can result in severe anemia.Hence,they may have a negative effect on the health of the patient and surgical treatment is required.Milligan-Morgan hemorrhoidectomy has been widely used since 1937 for the treatment of grade III and IV hemorrhoids.How-ever,most patients experience different degrees of postoperative pain that may cause anxiety.with mixed hemorrhoids post-surgery.METHODS The clinical data of patients with mixed hemorrhoids who underwent Milligan-Morgan hemorrhoidectomy were collected retrospectively.The basic character-istics of the enrolled patients with mixed hemorrhoids were recorded,and based on the Goligher clinical grading system,the hemorrhoids were classified as grades III or IV.The endpoint of this study was the disappearance of pain in all patients.Quantitative data were presented as mean±SD,such as age,pain score,and QoL score.Student’s t-test was used to compare the groups.RESULTS A total of 164 patients were enrolled.The distribution of the visual analog scale pain scores of all patients at 3,7,14 and 28 d after surgery showed that post-surgery pain was significantly reduced with the passage of time.Fourteen days after the operation,the pain had completely disappeared in some patients.Twenty-eight days after the surgery,none of the patients experienced any pain.Comparing the World Health Or-ganization Quality of Life-BREF self-reporting questionnaire scores of patients between 14 and 28 d after surgery,we observed that the quality-of-life scores of the patients post-surgery had significantly improved.There were six items that were compared at 14-and 28-d post-surgery.The mean QoL score 28 d after surgery(4.79±0.46)was higher than that at 14 d post-surgery(3.79±0.57).The mean health condition score 28 d after surgery(4.80±0.41)was also higher than that at 14 d post-surgery(4.01±0.62).The mean physical health score 28 d after surgery(32.10±2.96)was significantly higher than that at 14 d post-surgery(23.41±2.85).The mean psychological health score 28 d after surgery(27.22±1.62)was significantly higher than that at 14 d post-surgery(21.37±1.70).The mean social relations score 28 d after surgery(12.21±1.59)was significantly higher than that at 14 d post-surgery(6.32±1.66).The mean surrounding environment score 28 d after surgery(37.13±2.88)was significantly higher than that at 14 d post-surgery(28.42±2.86).The differences in quality-of-life scores at day 14 and day 28 post-surgery were ob-served to be statistically significant(P<0.001).CONCLUSION Milligan-Morgan hemorrhoidectomy can significantly improve the postoperative QoL of patients.Age,sex,and the number of surgical resections were important factors influencing Milligan-Morgan hemorrhoidectomy.

Neuroanatomical Basis of Postoperative Pain and Assessment of Its Management in a Series of Patients Undergoing Caesarean Sections

Introduction: In recent decades, the cost of postoperative pain has been the subject of many studies based on protocols developed by scientific societies for its assessment and optimization. At the Regional Hospital of Saint-Louis (Senegal), several protocols have been developed for pain management, but no study has focused on the assessment of postoperative pain management specifically. We therefore initiated this work, the objectives of which were to remind the neuroanatomical and neurophysiological bases of postoperative pain, and to analyze the assessment and management of this pain in patients who have undergone a caesarean section. Materials and methods: This was a prospective and descriptive study, which took place in the gynecology-obstetrics department, over a period from January 2019 to July 2020. All patients who gave birth by cesarean section were included. The data was collected from a survey sheet written for this purpose. For each of the patients, the information was taken every day throughout the duration of postoperative hospitalization. Results: It appears from our work that after a cesarean section, the pain felt evolves on the first postoperative days with a peak during the second day. As in the data reported in the literature, there does not seem to be a difference in terms of pain intensity and analgesia dosage between scheduled and emergency caesarean sections. However, young age and female gender—for other types of surgeries—are risk factors associated with high postoperative pain scores. This trend is probably related to the low pain experience of tested patients. Our initial hypothesis was that acute post-operative pain after caesarean sections could be linked to defects in the perception and processing of pain by caregivers. Indeed, we have shown that awareness-raising, information, and training actions have made it possible to significantly improve the management of pain after a cesarean section. Conclusion: After a cesarean section the pain is intense, especially when the effects of the morphine wear off. However, in our context where morphine and its derivatives are only slightly used, the post-operative pain is maximal rapidly. This pain therefore needs to be researched and treated appropriately. After a campaign to raise awareness among healthcare personnel, it is possible to significantly improve the systematic administration of analgesics.

Analysis of the Effects of Local Injection of Epinephrine and Lidocaine on Postoperative Pain and Bleeding in Children Undergoing Tonsillectomy

Objective:To explore the effects of local injection of epinephrine and lidocaine on postoperative pain and bleeding in children undergoing tonsillectomy.Methods:Sixty-eight children who underwent a tonsillectomy in our hospital from March 2019 to October 2020 were selected.The children were randomly divided into two groups of 34 cases each.The observation group received local anesthetic injections of lidocaine and the control group received local anesthetic injections of epinephrine.The postoperative pain,operation time,blood pressure changes,and intraoperative blood loss of the two groups of children were observed and analyzed.Results:The postoperative pain,operation time,and intraoperative blood loss scores of the children in the observation group were 4.36±0.69,0.36±0.09,and 39.36±1.78 respectively,which were significantly better than those of the children in the control group(P<0.05)at 5.36±0.77,0.79±0.05,and 45.36±1.56,respectively.The systolic blood pressure and diastolic blood pressure of the observation group 3 minutes before surgery and 180 minutes after surgery were no different from those of the control group(P>0.05).Conclusion:Local injection of epinephrine and lidocaine effectively relieved postoperative pain and reduced bleeding in children undergoing tonsillectomy as compared to epinephrine alone.

Clinical Observation of Chinese Medicinal Prescriptions for Swelling and Pain in The Postoperative Treatment of Mixed Hemorrhoids

Objective:To observe the clinical effect of traditional Chinese medicine(TCM)on reducing swelling and pain in patients with mixed hemorrhoids.Methods:Sixty patients with mixed hemorrhoids who were admitted to the Hospital of Traditional Chinese Medicine of Qiqihar from January 2023 to January 2024 were selected and divided into two groups.The treatment group(n=30)was treated with mixed hemorrhoid ligation combined with traditional Chinese swelling and pain medicine,and the control group(n=30)was only treated with mixed hemorrhoid ligation.The pain level,edema score,and prognosis of the two groups after the intervention were analyzed.The clinical efficacy was used as the evaluation criterion to compare the clinical effects of different treatment options.Results:After the treatment,the pain score,edema score,and prognostic wound score of the treatment group were all lower than those of the control group(P 0.05).The total clinical effectiveness of the treatment group(100%)was higher than that of the control group(76.67%),(χ^(2)=4.2857,P<0.05).Conclusion:The application of traditional Chinese swelling and pain medicine in treating patients with mixed hemorrhoids effectively reduced the patient’s pain,reduced the degree of wound edema,promoted wound healing,and improved the patient’s prognosis.The curative effect was significant and had a positive impact.

Postoperative pain assessment and management among nurses in selected hospitals in Benin City,Edo State,Nigeria

Objective:This study was designed to determine the nurse assessment of postoperative pain and its management in selected hospitals,Benin City,Edo State,Nigeria.Materials and Methods:A descriptive cross-sectional survey was adopted.The target population consist of 222 purposely nurses who are in the cadre of nursing officer II to chief nursing officer who works in the various surgical wards/units of the selected health facilities.The data were collected from the participants using the pretested structured questionnaire developed by the researcher.Results:Results showed that 66.2%of nurses had a poor level of knowledge on postoperative pain assessment.The McGill Pain Questionnaire was the most used pain assessment tool with a mean score of 2.84 whereas the Dallas Pain Questionnaire was the least used with a mean score of 1.90.“Providing clean,calm,and well-ventilated ward environment”(3.69±0.61)was the most used nonpharmacological method for postoperative pain management,followed by“distraction,relaxation,and guided imagery”(3.52±0.50),“dressing,bandage,splint,and reinforce wound sites postoperatively”(3.39±0.54),and“early ambulation/exercise”(3.20±0.62).The most used pharmacological interventions were“acetaminophen”(3.63±0.55),“topical anesthetic”(2.92±0.62),“nonselective nonsteroidal anti-inflammatory drugs”(2.87±0.43),and“mixed opioid agonist-antagonist”(2.56±0.56).Conclusion:There is a poor level of knowledge on postoperative pain assessment among nurses in this study setting.It is,therefore,pertinent for hospitals to organize continuous in-service training for postoperative pain assessment and management,especially on nonpharmacological approaches among nurses.

Comparison of external treatment of Acupuncture and moxibustion and intervention of Chinese and Western Medicine on postoperative pain of hemorrhoids:A systematic review and meta-analysis

Background To evaluate the clinical efficacy and safety of acupuncture and moxibustion in the treatment of postoperative pain of hemorrhoids compared with traditional Chinese medicine and western medicine.Methods CNKI,PubMed,Cochrane Library,Science Direct,Wan Fang,VIP,CBM,WOS,Bailian Yun Library and other databases were systematically retrieved from January 1,2017 to October 31,2022 for clinical randomized controlled trials of acupuncture versus traditional Chinese medicine and Western medicine for postoperative pain in hemorrhoids.The two evaluators independently retrieved,sifted through literature and extracted data for inclusion in a randomized controlled trial of acupuncture for the treatment of hemorrhoid pain that matched the study.Literature quality assessment was performed using RevMan5.4 for meta-analysis.Results A total of 540 related literature articles were retrieved,of which 139 were from CNKI,104 from Wan Fang,26 from VIP,7 from PubMed,9 from Cochrane Library,35 from WOS,173 from CMB,1 from Science Direct and 46 from the Bailian Yun Library,Screening resulted in inclusion of 10 RCTs including 870 patients.Meta analysis showed no statistically significant difference between the degree of pain in 2 hours[MD=-0.01,95%CI(-0.23,0.24),P=0.95].And it showed that the total effective rate of the two groups was[RR=1.14,95%CI(1.06,1.24),P=0.001],intervention for 2 days pain degree was[MD=0.41,95%CI(0.13,0.69),P=0.004],the length of hospital stay was[SMD=1.10,95%CI(0.73,1.48),P<0.00001],the incidence of adverse reaction was[RR=0.15,95%CI(0.03,0.79),P=0.03],the difference was statistically significant(P<0.05).Conclusion Drug treatment is effective quickly,analgesia effect is better than acupuncture in early treatment,but the effect is not lasting.Acupuncture treatment is slow to start but the effects of acupuncture will gradually become apparent at a later stage.However,due to the poor quality of collection,multicenter,large sample size and double-blind randomized controlled trials are still needed.

Effect of moxibustion combined with five‑element music therapy on postoperative pain relief after mixed hemorrhoid operation

Objective:To investigate the effect of moxibustion combined with five‑element music therapy on the postoperative pain relief of patients undergoing surgical operation for mixed hemorrhoid with damp‑heat syndrome.Methods:Totally,159 patients meeting the inclusion criteria were assigned to the control group,study group 1,and study group 2,with 53 cases in each group.All patients received routine care after surgical treatment,including acupoint application and Chinese herbal fumigation.In addition,patients in the study group 1 received moxibustion,and those in the study group 2 were given moxibustion combined with five‑element music therapy.The degree of postoperative pain was evaluated using visual analog scale(VAS).Results:There was no significant difference in VAS score on pain during dressing changes among three groups(P>0.05).After 3,5,and 7 days of intervention,there was a significant difference in VAS score on pain at rest among three groups(P<0.001),and VAS score in the study group 2 was lower than that in the study group 1 and the control group after 3 and 5 days of intervention,respectively(P<0.05).Conclusion:Moxibustion combined with five‑element music therapy is effective to relieve the postoperative pain of patients undergoing a surgical operation for mixed hemorrhoids with damp‑heat syndrome.

Efficacy and safety of thermobalancing therapy with Dr Allen’s Device for chronic low back pain:A randomised controlled trial

BACKGROUND Lumbar disc herniation and non-specific low back pain are common conditions that seriously affect patients’health-related quality of life(HRQoL).Although empirical evidence has demonstrated that novel Thermobalancing therapy and Dr Allen’s Device can relieve chronic low back pain,there have been no randomised controlled trials for these indications.AIM To evaluate the efficacy of Dr Allen’s Device in lumbar disc herniation(LDH)and non-specific low back pain(NSLBP).METHODS A randomised clinical trial was conducted investigating 55 patients with chronic low back pain due to LDH(n=28)or NSLBP(n=27),out of which 15 were randomly assigned to the control group and 40 were assigned to the treatment group.The intervention was treatment with Dr Allen’s Device for 3 mo.Changes in HRQoL were assessed using the Numerical Pain Rating Scale and the Japanese Orthopedic Association Back Pain Questionnaire.RESULTS Thermobalancing therapy with Dr Allen’s Device showed a significant reduction in pain in the treatment group(P<0.001),with no recorded adverse effects.Both pain assessment scales showed a significant improvement in patients’perception of pain indicating improvement in HRQoL.CONCLUSION The out-of-hospital use of Thermobalancing therapy with Dr Allen’s Device for Low Back Treatment relieves chronic low back pain significantly and without adverse effects,improves the level of activity and HRQoL among patients with LDH and NSLBP.This study demonstrates the importance of this safe first-line therapy that can be used for effective at-home management of chronic low back pain.

Pain threshold, anxiety and other factors affect intensity of postoperative pain in gastric cancer patients: A prospective cohort study

Objective: This prospective cohort study explored factors related to postoperative pain in gastric cancer patients.Methods: A total of 236 patients who underwent gastrectomy were enrolled. All patients enrolled in the study completed the Hospital Anxiety and Depression Scale(HADS) questionnaire and Life Orientation Test-Revised(LOT-R) questionnaire on the day before surgery. Heat pain threshold(HPT), cold pain threshold(CPT) and pressure pain threshold(PPT) were measured for all patients one day prior to surgery and demographic details were collected. All patients were connected to a patient-controlled intravenous analgesia(PCIA) pump at the end of the surgery. The occurrence of postoperative pain was used as a dependent variable, and multivariate logistic regression analyses were conducted to screen for factors affecting postoperative pain.Results: In total, 83 patients(35.2%) had postoperative pain. Body mass index(BMI) ≥28 kg/m^(2) [odds ratio(OR): 2.67;95% confidence interval(95% CI): 1.07-6.67], total gastrectomy(OR: 2.64;95% CI: 1.42-4.91),preoperative anxiety score ≥8(OR: 2.37;95% CI: 1.12-5.02), heat pain threshold ≤4.9 s(OR: 2.14;95% CI:1.06-4.32), pressure pain threshold ≤4 g(OR: 2.05;95% CI: 1.05-4.03), and female gender(OR: 1.99;95% CI:1.04-3.83) were risk factors for postoperative pain.Conclusions: Obesity, wide range of gastrectomy, high preoperative anxiety, low HPT and PPT, and female gender are associated with increased risk for postoperative pain.

Spa therapy relieves knee and shoulder pain:a randomized controlled trial

Objective:To study the effect of spa therapy on relieving knee and shoulder pain.Methods:Participants were randomized to an intervention group(n=26)or a control group(n=23).The intervention group received the hot spring intervention program(1-2 times a day for two weeks),while the control group didn’t receive any intervention.Primary outcomes were assessed by the Western Ontario and McMaster University Osteoarthritis Index(WOMAC)and Shoulder Pain and Disability Index(SPADI).Secondary outcomes were assessed by general physical symptoms and Short Form-36(SF-36)health survey.Results:All parameters before intervention were homogenous between the groups.At baseline,there was no significant difference in WOMAC and SPADI index between the two groups,but there was a statistically significant difference in blurred vision,which was worse in the intervention group than in the control group(P<0.05).After intervention,general physical symptoms were relieved significantly in the intervention group compared with the control group(P<0.05).WOMAC index,SPADI index,social functioning,and general physical symptoms were relieved significantly after intervention in the intervention group(P<0.05).There is a significant difference in the blurred vision before and after the comparison of the control group(P<0.05).Conclusion:Spa therapy may relieve knee and shoulder pain and improve general physical symptoms and quality of life.

Optimizing pain management in elderly patients post-knee surgery:A novel collaborative strategy

Total knee replacement,a common surgery among the elderly primarily necessitated by osteoarthritis,replaces the damaged knee joint with an artificial one.Given the aging population and the increasing prevalence of such surgeries,the article highlights the critical need for effective postoperative care strategies.This editorial provides an overview of rehabilitation care for pain in elderly knee replacement patients,emphasizing the importance of a multimodal approach to postoperative recovery.Furthermore,the article advocates for a patient-centered,comprehensive rehabilitation regimen that enhances recovery and quality of life in elderly patients undergoing knee replacement surgery.

Early Application Study of Intravenous Pain Pump Combined with Parecoxib Injection in Relieving Pain in Patients after Thoracoscopy

Objective: To explore the clinical effectiveness of combined use of intravenous pain pump with Parecoxib injection in alleviating pain in patients during the early postoperative period after thoracoscopic surgery. Methods: Eighty patients who underwent thoracoscopic surgery in a tertiary hospital were selected as the study subjects and randomly divided into two groups, with 40 patients in each group. The control group received routine postoperative treatment with intravenous pain pump, while the experimental group received Parecoxib in addition to the standard postoperative pain pump treatment. Visual Analog Scale (VAS) pain scores were used to evaluate postoperative pain relief in both groups, along with adverse reactions, postoperative complications, and patient satisfaction with pain relief. Results: Patients who received Parecoxib injection in addition to the routine use of intravenous pain pump had VAS pain scores lower than 3 points at 6 h, 12 h, 24 h, and 36 h postoperatively compared to those in the control group. The incidence of postoperative lung collapse, pleural effusion, and pulmonary infections was also significantly lower in the experimental group. The differences between the two groups were statistically significant (P Conclusion: Early combined use of Parecoxib injection in the early postoperative period after thoracoscopic surgery has shown good clinical efficacy. It can reduce the level of pain in patients, promote effective coughing and expectoration, facilitate early mobilization of patients, improve patient compliance, reduce complications, shorten hospital stay, and expedite patient recovery. Therefore, it is worth promoting the widespread clinical application of Parecoxib injection in this setting.

Quality Control of Postoperative Acute Pain Service

To establish an effective method of continuous quality control of acute pain service, a retrospective study on incident reporting during postoperative anal-gesia period was conducted. Incidents were reported and analyzed in 1507 patients who received epidural postoperative analgesia, and the results of satisfaction of pain relief was compared with those of incident analysis. In this study, an incident was defined as any factor that might or had affected patient's safety during analgesia period. Our results showed that 1203 incidents were reported in 641 of 1507 patients, of which 122 incidents were critical. 78. 3 % of all incidents were detect-ed by acute pain service stuff. The most common incidents included complica-tions, insufficient analgesia and problems with delivery circuits. Human factors were involved in 28. 9 % of the incidents, most being associated with technical failure due to unskillfu1ness, poor communications between APS stuff and pa-tients and lack of cooperation with surgeons and nurses. The general satisfactionrate of the patients was 90. 8 %. There was a very significant difference between the satisfaction of the patients who suffered from incidents and who did not (P<t0.001). It is concluded that incidents affect the satisfaction of the patients who received postoperative pain relief. Incident reporting is a more effective method for quality control of acute pain service.

Diabetic Patients Develop Greater Intensity of Postoperative Pain than Non-Diabetics after Open Cholecystectomy: A Pilot Study

Background: Pre-clinical and clinical studies have shown that inflammatory pain intensity is increased under diabetes condition. Open cholecystectomy (OC) is a surgical procedure with predictable postoperative pain. However, the comparison of postoperative pain due to open cholecystectomy in diabetic and non-diabetic patients remains unknown. The research question to answer was whether diabetic patients undergoing OC development greater intensity of postoperative pain than non-diabetic patients. Methods: The study was conducted between June 2016 and February 2018 at the Regional Hospital of High Specialty “Dr. Juan Graham Casasús” of Villahermosa, Tabasco, Mexico. Seventy patients in two groups of 35 patients each scheduled for OC under general anesthesia were studied. Pain was assessed using the 11-point numerical rating scale (NRS). The primary endpoint was to know NRS pain scores after awaking of general anesthesia. Secondary outcomes included the time of onset of pain and comparing NRS scores between diabetic and non-diabetic patients undergoing OC. Results: Diabetic patients reported significantly greater intensity pain than non-diabetic patients. The mean overall pain score in the diabetic and non-diabetic patients was 7.2 ± 0.3 and 5.3 ± 0.3 (P = 0.0002), respectively. Furthermore, 60% of diabetic patients had severe pain (NRS ≥ 8) compared to 20% of non-diabetics (P = 0.006). The time to onset postoperative pain was about 35 minutes in both groups (P = 0.876). Conclusions: Diabetic patients undergoing OC have greater intensity postoperative pain and also more frequency of patients with severe pain scores compared with non-diabetic patients. Therefore, analgesic treatment in those patients should consider this point in order to provide a satisfactory postoperative analgesia.

Minimally invasive interventional therapy for pain

Pain interventional therapy,known as the most promising medical technology in the 21st century,refers to clinical treatment technology based on neuroanatomy,neuroimaging,and nerve block technology to treat pain diseases.Compared with traditional destructive surgery,interventional pain therapy is considered a better and more economical choice of treatment.In recent years,a variety of minimally invasive pain interventional therapy techniques,such as neuroregulation,spinal cord electrical stimulation,intervertebral disc ablation,and intrasheath drug infusion systems,have provided effective solutions for the treatment of patients with post-herpetic neuralgia,complex regional pain syndrome,cervical/lumbar disc herniation,and refractory cancer pain.

Effects of Electroacupuncture on Pain Threshold and Prostaglandin E2 in Spinal Cord in Postoperative Pain Rat

Objective:Electroacupuncture(EA)is good at post-surgical pain.But point selection method in treating incision-induced pain remains a major clinical challenge.We reasoned that different acupoints may work though adjusting prostaglandin E2 in spinal cord.We wish to explore the analgesic mechanism of electroacupuncture on plantar incision pain rats and provide more therapeutic ideas for acupuncture analgesia.Methods:A total of 50 male rats were randomly divided into a sham operation group,a model group,an EA 1,EA 2 and a drug group(n=10,each).A rat model of left plantar incision pain was established.The rats in EA1 group was needled at ipsilateral Yanglingquan(GB34)and Taixi(KI3).The rats in EA2 group was needled at ipsilateral Quchi(LI11)and Hegu(LI4).EA stimulation(2/100 Hz,1-2-3 mA)was administered 30 minutes immediately after operation.The rats in drug group were fed with Fenbid by gavage 20 minutes before incision(30 mg/kg,p.o.).The hot plate pain detector was used to measure the thermal pain threshold(TPT)before and 24 hours after operation Prostaglandin E2 content of spinal cord was detected by enzyme-linked immunosorbent assay(ELISA)at 1 and 24 hours after operation.Results:Compared with sham operation group,the TPT in model group decreased 41%.Compared with the model group,the TPT increased 56%in EA1,29%in EA2,190%in drug group(P>0.05).At 1 h after operation,compared with the sham operation group,PGE_2 in model group increased 15%.Compared with the model group,PGE_2 in drug group decreased 5%.At 24 hours after operation,compared with sham operation group,PGE_2 in model group increased 9%.Compared with model group,it decreased 4%in EA 1 group,8%in drug group and increased 3%in EA2 group.Conclusion:Both the drug and the electroacupuncture can adjust the 24-hour pain threshold and PGE_2 in spinal cord.The curative effects of the drug are better than that of electroacupuncture.The proximal point is better than that of the distal point.Electroacupuncture can treat postoperative pain by regulating PGE_2 in spinal cord.

Effects of individual shock wave therapy vs celecoxib on hip pain caused by femoral head necrosis

BACKGROUND Celecoxib has been used to treat hip discomfort and functional difficulties associated with osteonecrosis of the femoral head(ONFH),although significant adverse reactions often follow long-term use.Extracorporeal shock wave therapy(ESWT)can delay the progression of ONFH,alleviate the pain and functional limitations it causes,and avoid the adverse effects of celecoxib.AIM To investigate the effects of individual ESWT,a treatment alternative to the use of celecoxib,in alleviating pain and dysfunction caused by ONFH.METHODS This was a randomized,controlled,double-blinded,non-inferiority trial.We examined 80 patients for eligibility in this study;8 patients were excluded based on inclusion and exclusion criteria.A total of 72 subjects with ONFH were randomly assigned to group A(n=36;celecoxib+alendronate+sham-placebo shock wave)or group B(n=36;individual focused shock wave[ESWT based on magnetic resonance imaging three-dimensional(MRI-3D)reconstruction]+alendronate).The outcomes were assessed at baseline,at the end of treatment,and at an 8-wk follow-up.The primary outcome measure was treatment efficiency after 2 wk of intervention using the Harris hip score(HHS)(improvement of 10 points or more from the baseline was deemed sufficient).Secondary outcome measures were post-treatment HHS,visual analog scale(VAS),and Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC)scores.RESULTS After treatment,the pain treatment efficiency of group B was greater than that of group A(69%vs 51%;95%CI:4.56%to 40.56%),with non-inferiority thresholds of-4.56%and-10%,respectively.Furthermore,the HHS,WOMAC,and VAS scores in group B dramatically improved during the follow-up period as compared to those in group A(P<0.001).After therapy,the VAS and WOMAC in group A were significantly improved from the 2nd to 8th wk(P<0.001),although HHS was only significantly altered at the 2 wk point(P<0.001).On the 1st d and 2nd wk after treatment,HHS and VAS scores were different between groups,with the difference in HHS lasting until week 4.Neither group had severe complications such as skin ulcer infection or lower limb motorsensory disturbance.CONCLUSION Individual shock wave therapy(ESWT)based on MRI-3D reconstruction was not inferior to celecoxib in managing hip pain and restrictions associated with ONFH.

Preoperative administration of intramuscular dezocine reduces postoperative pain for laparoscopic cholecystectomy

Postoperative pain is the most common complaint after laparoscopic cholecystectomy. This study was carried out to evaluate whether preoperative administration of intramuscular dezocine can provide postoperative analgesia and reduce postoperative opioid consumption in patients undergoing laparoscopic cholecystectomy. Patients （ASA Ⅰ or Ⅱ ） scheduled for laparoscopic cholecystectomy were randomly assigned into intramuscular dezocine group （group 1） or intramuscular normal saline group （group 2）. Dezocine and equal volume normal saline were administered intramuscularly 10 rain before the induction of anesthesia. After operation, the severity of postoperative pain, postoperative fentanyl requirement, incidence and severity of side-effects were assessed. Postoperative pain and postoperative patient-controlled fentanyl consumption were reduced significantly in group l compared with group 2. The incidence and severity of side effects were similar between the two groups. Preoperative single-dose administration of intramuscular dezocine 0.1 mg/kg was effective in reducing postoperative pain and postoperative patient-controlled fentanyl requirement in patients undergoing laparoscopic cholecystectomy.