Thoracic Epidural Morphine for Postoperative Analgesia after Hemiclamshell Incision in Castleman Disease

The hemiclamshell incision is a valid but infrequent surgical alternative for the resection of tumors from mediastinum. This point makes this approach impossible to be studied under a randomized controlled trial. The triple association of thoracotomy, sternotomy and cervicothomy makes the hemiclamshell approach a high intensity postoperative pain surgery. However, there is no published data on this topic, and the reviewed articles only mention the analgesic regimens as a secondary point. Indeed, no author defines the best epidural drugs mixture for the patients. Multimodal analgesic regimen based on regional anesthesia should be used. Based on the recent advances on spinal opioids, morphine could be a good choice as epidural coadjutant to local anesthetics for hemiclamshell incision.

The effect of postoperative epidural analgesia in women possessing severe gestational hypertension undergoing cesarean delivery

Introduction: The purpose of this study was to examine the clinical usefulness of postoperative epidural analgesia in patients possessing severe gestational hypertension after Cesarean delivery. Methods: We reviewed the obstetric records of 99 patients possessing severe gestational hypertension undergoing singleton Cesarean delivery at ≥ 22 weeks’ gestation. Thirty patients were received continuous epidural analgesia with 0.2% ropivacaine for pain relief after Cesarean delivery with spinal anesthesia, 69 patients were not received epidural analgesia after Cesarean delivery with spinal anesthesia. Results: During the preoperative period, there were no measurable differences in the diastolic blood pressure between the 2 groups (108 vs± 7 vs. 106 mmHg ± 10 mmHg, p = 0.29). The diastolic blood pressure at 2 and 4 hours after Cesarean section in the epidural analgesia group were significantly lower than those in the non-epidural group (2 hours after Cesarean section: 88 vs ± 13 vs. 95 mmHg ± 8 mmHg, p < 0.01;4 hours after Cesarean section: 92 vs ± 15 vs. 102 mmHg ± 9 mmHg, p < 0.01). Conclusions: The current results indicated that the postoperative epidural analgesia can inhibit the rise in diastolic blood pressure in patients possessing severe gestational hypertension after Cesarean delivery. This electronic document is a “live” template. The various components of your paper [title, text, heads, etc.] are already defined on the style sheet, as illustrated by the portions given in this document.

Comparison of Postoperative Analgesic Efficacy between Continuous Transversus Abdominis Plane Block, Lumbar Paravertebral and Epidural Blocks after Abdominal Surgeries

Background: The study was done to assess the postoperative analgesic efficacy of ultrasound-guided continuous transverses abdominis plane block, continuous lumbar paravertebral block and a continuous lumbar epidural block in patients undergoing lower abdominal surgeries (unilateral inguinal hernia repair). We compared their analgesic efficacy over the first 48 hour postoperative, in a randomized, single-blind study in 120 patients divided into four equal groups, 30 patients in each group. Methods: 120 patients randomly assigned into four equal groups, with 30 patients in each group. Group T received ultrasound-guided transverses abdominis plane block with 20 ml of bupivacaine 0.25% followed by continuous infusion of bupivacaine 0.125% (0.1 ml/kg/hr) and group P received ultrasound-guided continuous lumbar paravertebral block with bupivacaine 0.25% bolus dose 20 ml, followed by continuous infusion of bupivacaine 0.125% (0.1 ml/kg/hr). Group E received continuous lumbar epidural infusion of bupivacaine 0.25% bolus dose 20 ml, followed by continuous infusion of bupivacaine 0.125% (0.1 ml/kg/hr) and group C received normal saline bolus dose 20 ml, followed by continuous infusion of normal saline (0.1 ml/kg/hr). General anesthesia induced with fentanyl 1 - 2 μg/kg and propofol 1 - 3 mg/kg followed by atracurium 0.5 mg/kg. At the end of the surgical procedure, we activated the regional block with recording of parameters in the postoperative period each patient was assessed for visual analog scale (VAS) at rest and on movement, analgesic consumption, vital signs and presence of complications (nausea, vomiting, sedation), and postoperative patient satisfaction all data collected postoperatively by a blinded investigator at one, two, 6, 12, 24 and 48 hours postoperatively. Results: Postoperative analgesic efficacy is more in group E than group P and group T, the latter is least effective in pain control. Also in group E the postoperative analgesic consumption is lower than in group P and group T, re-garding complications as nausea and vomiting more recorded in epidural than the other two groups. Conclusion: Regarding postoperative analgesic efficacy, the continuous lumbar epidural block is more effective than continuous paravertebral and continuous transverses abdominis plane block, but regarding complications, there was a higher incidence in epidural group than other two groups.

Effectiveness and safety of continuous wound infiltrationfor postoperative pain management after open gastrectomy

AIM: To prospectively evaluate the effectiveness and safety of continuous wound infiltration(CWI) for pain management after open gastrectomy. METHODS: Seventy-five adult patients with American Society of Anesthesiologists(ASA) Physical Status Classification System(ASA) grade 1-3 undergoing open gastrectomy were randomized to three groups. Group 1 patients received CWI with 0.3% ropivacaine(group CWI). Group 2 patients received 0.5 mg/m L morphine intravenously by a patient-controlled analgesia pump(PCIA)(group PCIA). Group 3 patients received epidural analgesia(EA) with 0.12% ropivacaine and 20 μg/m L morphine with an infusion at 6-8 m L/h for 48 h(group EA). A standard general anesthetic technique was used for all three groups. Rescue analgesia(2 mg bolus of morphine, intravenous) was given when the visual analogue scale(VAS) score was ≥ 4. The outcomes measured over 48 h after the operation were VAS scores both at rest and during mobilization, total morphine consumption, relative side effects, and basic vital signs. Further results including time to extubation, recovery of bowel function, surgical wound healing,mean length of hospitalization after surgery, and the patient's satisfaction were also recorded.RESULTS: All three groups had similar VAS scores during the first 48 h after surgery. Group CWI and group EA, compared with group PCIA, had lower morphine consumption(P < 0.001), less postoperative nausea and vomiting(1.20 ± 0.41 vs 1.96 ± 0.67, 1.32 ± 0.56 vs 1.96 ± 0.67, respectively, P < 0.001), earlier extubation(16.56 ± 5.24 min vs 19.76 ± 5.75 min, P < 0.05, 15.48 ± 4.59 min vs 19.76 ± 5.75 min, P < 0.01), and earlier recovery of bowel function(2.96 ± 1.17 d vs 3.60 ± 1.04 d, 2.80 ± 1.38 d vs 3.60 ± 1.04 d, respectively, P < 0.05). The mean length of hospitalization after surgery was reduced in groups CWI(8.20 ± 2.58 d vs 10.08 ± 3.15 d, P < 0.05) and EA(7.96 ± 2.30 d vs 10.08 ± 3.15 d, P < 0.01) compared with group PCIA. All three groups had similar patient satisfaction and wound healing, but group PCIA was prone to higher sedation scores when compared with groups CWI and EA, especially during the first 12 h after surgery. Group EA had a lower mean arterial pressure within the first postoperative 12 h compared with the other two groups.CONCLUSION : CWI with ropivacaine yields a satisfactory analgesic effect within the first 48 h after open gastrectomy, with lower morphine consumption and accelerated recovery.

Role of epidural anesthesia in a fast track liver resection protocol for cirrhotic patients-results after three years of practice

AIM To evaluate the potential benefits and risks of the use of epidural anaesthesia within an enhanced recovery protocol in this specific subpopulation.METHODS A retrospective review was conducted, including all cirrhotic patients who underwent open liver resection between January 2013 and December 2015 at Bologna University Hospital. Patients with an abnormal coagulation profile contraindicating the placement of an epidural catheter were excluded from the analysis. The control group was composed by patients refusing epidural anaesthesia. RESULTS Of the 183 cirrhotic patients undergoing open liver resections, 57 had contraindications to the placement of an epidural catheter; of the remaining 126, 86 patients received general anaesthesia and 40 combined anaesthesia. The two groups presented homogeneous characteristics. Intraoperatively the metabolic data did not differ between the two groups, whilst the epidural group had a lower mean arterial pressure(P = 0.041) and received more colloid infusions(P = 0.007). Postoperative liver and kidney function did not differ significantly.Length of mechanical ventilation(P = 0.003) and hospital stay(P = 0.032) were significantly lower in the epidural group. No complications related to the epidural catheter placement or removal was recorded.CONCLUSION The use of Epidural Anaesthesia within a fast track protocol for cirrhotic patients undergoing liver resections had a positive impact on the patient's outcomes and comfort as demonstrated by a significantly lower length of mechanical ventilation and hospital stay in the epidural group. The technique appears to be safely manageable in this fragile population even though these results need confirmation in larger studies.

Value of Epidural Injection of Hydromorphone for Postoperative Analgesia after Cesarean Section

Objective To explore the value of epidural injection of hydromorphone for postoperative analgesia after cesarean section.Methods 98 patients with cesarean section in our hospital from April 2019 to April 2020 were selected and divided into observation group and control group according to the order of admission.The control group was given a large dose of0.6 mg hydromorphone,and the observation group was given a small dose of 0.4 mg hydromorphone.The postoperative pain score,postoperative complications,and patients’recognition of analgesia were compared between the two groups.Results The pain scores of the observation group were(2.30±0.45),(2.50±0.33),(2.98±0.73)at 4 h,8 h,and 12 h after operation,which were better than those in the control group.The analgesic satisfaction of the observation group was 93.88%,and that of the control group was 71.43%.The analgesic effect of the observation group was better,and the incidence of postoperative complications was 10.20%in the observation group and 26.52%in the control group.The situation of SAS and SDS in the observation group was better than that in the control group(P<0.05).Conclusion The use of a small dose of 0.4 mg hydromorphone epidural injection,can effectively improve postpartum pain of puerpera,and improve satisfaction of maternal analgesia,while reducing the incidence of postoperative complications of maternal,with clinical research value,worthy of promotion in clinical medicine.

鞘内吗啡镇痛与硬膜外镇痛对机器人辅助根治性膀胱切除术患者术后疼痛和并发症的影响

目的:比较鞘内吗啡与硬膜外镇痛对接受机器人辅助根治性膀胱切除术患者的术后疼痛和并发症的影响。方法:选取2020年1月—2023年6月接受机器人辅助根治性膀胱切除术患者96例,以随机数表法进行分组,分为对照组(硬膜外镇痛,48例)和研究组(鞘内吗啡镇痛,48例),比较两组手术相关指标、术后疼痛和并发症。结果:与对照组比较,研究组排气时间、排便时间、饮食恢复时间、住院时间更短,复发率更低,并发症发生率更低,两组死亡率无统计学意义。两组患者术后12 h、24 h、48 h静息状态VAS评分无统计学意义,与对照组比较,研究组术后12 h、24 h咳嗽状态VAS评分更低。结论:与硬膜外镇痛相比较,鞘内吗啡镇痛应用于接受机器人辅助根治性膀胱切除术患者,可减轻咳嗽状态的疼痛,降低复发率和并发症发生率,促进患者更快康复。

腰麻-硬膜外联合麻醉对老年下肢骨折患者术后镇痛的影响效果分析

目的 分析对老年下肢骨折患者开展腰麻-硬膜外联合麻醉的术后镇痛效果。方法 目的选取江苏省盐城市东台梅氏中西医结合医院于2020年1月—2023年1月收治的80例老年下肢骨折手术患者为研究对象,依麻醉方案差异将其分为对照组(n=40,气管插管全身麻醉)和观察组(n=40,腰麻-硬膜外联合麻醉)。对比不同麻醉方式的麻醉效果。结果 观察组术后12、24、48 h疼痛程度评分低于对照组,观察组麻醉相关时间短于对照组,差异有统计学意义(P均<0.05)。观察组不良反应发生率(2.50%)低于对照组(20.00%),差异有统计学意义(χ^(2)=4.507,P<0.05)。结论 与全身麻醉相比,老年下肢骨折患者术中采用腰麻-硬膜外联合麻醉,术后镇痛效果更好,且术后不良反应少。

腰-硬联合麻醉剖宫产术后超声引导双侧腹横肌平面阻滞的镇痛效果探讨

目的探讨静脉自控镇痛联合超声引导双侧腹横肌平面阻滞在腰-硬联合麻醉剖宫产术后的有效性和安全性。方法选取68例剖宫产产妇为研究对象,根据随机数字表法分为两组,各34例。对照组予以静脉自控镇痛,研究组在对照组基础上联合超声引导双侧腹横肌平面阻滞,比较两组的疼痛程度、镇痛效果及应激反应。结果研究组术后12h、24h、48h的视觉模拟评分量表得分均低于对照组,自控镇痛需求次数少于对照组,差异有统计学意义(P<0.05);术后48h,研究组去甲肾上腺素、皮质醇、血管紧张素Ⅱ水平低于对照组,差异有统计学意义(P<0.05);术后48h,研究组CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)高于对照组,差异有统计学意义(P<0.05)。结论腰-硬联合麻醉剖宫产术后实施静脉自控镇痛联合超声引导双侧腹横肌平面阻滞,可明显降低产妇疼痛感,减少镇痛药物使用次数,应激反应低,免疫功能影响小,值得应用。

剖宫产术后单次硬膜外阻滞与腰方肌阻滞镇痛效果对比

目的:探讨单次硬膜外阻滞与腰方肌阻滞在剖宫产术后镇痛效果对比。方法:选取2019年6月—2022年6月本院行剖宫产产妇94例,随机分为两组各47例,硬膜组予以单次硬膜外阻滞;腰方肌组产妇予以腰方肌阻滞。比较两组数字疼痛评分法(NRS)、Bromage运动评分、首次下床时间、首次运动时间、首次按压时间、有效按压次数、镇痛满意度、尿潴留、行动过缓、呼吸抑制及术后恶心呕吐发生情况。结果:静息时及运动时术后12h、24h NRS评分两组无差异(P>0.05),术后4h、8h NRS评分腰方肌组均低于硬膜组(均P<0.05);两组术后各时间点Bromage评分无差异(P>0.05);腰方肌组有效按压次数(51.3±18.1次)低于硬膜组(64.1±22.7次),镇痛满意度(8.72±0.90分)高于硬膜组(8.01±0.88分),尿潴留(8.5%)、不良反应总发生率(21.3%)低于硬膜组(23.4%、42.6%)(均P<0.05)。结论:与单次硬膜外阻滞相比,腰方肌阻滞在剖宫产术后镇痛效果更好,产妇镇痛满意度高,可降低不良反应发生率。

羟考酮和舒芬太尼用于二次剖宫产术后的镇痛效果

目的 研究羟考酮和舒芬太尼在二次剖宫产术后镇痛的效果观察。方法 选择2018至2020年接受椎管内麻醉的二次剖宫产手术患者100例,随机分为对照组和试验组,每组50例,对照组采用硬膜外给予舒芬太尼80μg+1.192%甲磺酸罗哌卡因16 ml加NaCl溶液稀释到200 ml配泵(脉冲式输注泵),试验组采用硬膜外给予0.1 mg/ml羟考酮+1.192%甲磺酸罗哌卡因16 ml加NaCl溶液稀释到200 ml配泵(脉冲式输注泵)。2组通过硬膜外脉冲泵按照手术结束时给予5 ml负荷剂量,然后开启镇痛泵,给患者单次脉冲,脉冲剂量4 ml/次(1 s内将4 ml药量推注),锁定时间30 min,自控量3 ml。观察2组术后4、8、12、24、36 h各时间点患者切口痛,宫缩痛,下肢运动阻滞Bromage评分,患者自控镇痛(PCIA)次数、肛门排气时间、恶心呕吐、瘙痒各种并发症,患者的初乳时间和首次下床活动时间以及皮质醇的浓度(出手术室0 h、术后12、24 h)。结果 试验组产妇宫缩痛评分,术后并发症,产妇初乳时间和首次下床活动时间以及皮质醇浓度均低于对照组,差异有统计学意义(P<0.05),而2组下肢运动阻滞Bromage评分,差异无统计学意义(P>0.05)。结论 在二次剖宫产术后应用羟考酮和罗哌卡因硬膜外间歇脉冲输注镇痛,可有效阻止切口痛和宫缩痛,降低皮质醇浓度和应激反应,从而获得满意的镇痛效力,且术后相关不良反应少。

艾司氯胺酮联合硬膜外阻滞麻醉对剖宫产产妇术后镇痛与血浆皮质醇的影响

目的探究艾司氯胺酮联合硬膜外阻滞麻醉对剖宫产产妇术后镇痛与血浆皮质醇的影响。方法前瞻性选取2019年1月至2021年12月在青岛市中医医院就诊的行剖宫产产妇84例,按照随机数字表法分为对照组与研究组,每组42例。两组均行硬膜外阻滞麻醉,对照组术中给予利多卡因进行麻醉,研究组术中给予艾司氯胺酮+利多卡因进行麻醉。比较两组感觉麻醉情况、围手术期指标、疼痛情况[(视觉模拟评分法(VAS)评分)]、血浆指标[皮质醇、纤维蛋白原(FIB)、D-二聚体(D-D)、凝血酶原时间(PT)]及不良反应。结果研究组感觉麻醉Ⅰ、Ⅱ、Ⅲ、Ⅳ级占比分别为78.57%、19.05%、2.38%、0,优于对照组(57.14%、30.95%、11.90%、0),差异有统计学意义(P<0.05)。研究组感觉阻滞用时为(4.13±1.05)min,短于对照组[(7.38±2.12)min],术后使用镇痛药物患者比率为23.81%,低于对照组(47.62%),差异均有统计学意义(P<0.05)。术后6、12、24、48 h,研究组VAS评分分别为(2.48±0.61)、(2.52±0.66)、(1.71±0.38)、(0.95±0.15)分,均低于对照组[(3.35±0.74)、(3.64±0.53)、(1.88±0.32)、(1.04±0.21)分],差异均有统计学意义(P<0.05)。术后24 h,研究组皮质醇、FIB、D-二聚体、PT分别为(615.39±20.12)ng/mL、(3.41±0.52)g/L、(0.45±0.11)mg/L、(11.80±1.12)s,均低于对照组[(742.38±26.53)ng/mL、(3.74±0.61)g/L、(0.63±0.19)mg/L、(12.74±1.39)s],差异均有统计学意义(P<0.05)。研究组不良反应总发生率为16.67%,低于对照组(38.10%)低,差异有统计学意义(P<0.05)。结论艾司氯胺酮联合硬膜外阻滞麻醉对剖宫产产妇术后镇痛效果较好,可有效抑制术中血浆皮质醇分泌,且安全性较高。

腰硬联合麻醉对骨科手术患者血流动力学、疼痛程度和认知功能的影响

目的:探讨腰硬联合麻醉对骨科手术患者血流动力学、疼痛程度和认知功能的影响。方法:回顾性分析2021年6月—2022年6月宁夏回族自治区人民医院收治的72例骨科手术患者的临床资料。根据不同麻醉方式将其分为观察组和对照组,各36例。对照组给予全身麻醉,观察组给予腰硬联合麻醉。比较两组麻醉前(T_(0))、手术开始前(T_(1))、手术30 min时(T_(2))、手术结束时(T_(3))的血流动力学,术后6 h、12 h、1 d、2 d的疼痛程度,术后1 h、6 h、12 h、1 d的认知功能及不良反应。结果:T_(1)、T_(2)、T_(3),两组心率(HR)和平均动脉压(MAP)均较T_(0)时下降,但观察组HR和MAP均明显高于对照组,差异有统计学意义(P<0.05)。术后6 h、12 h、1 d、2 d,观察组视觉模拟评分法(VAS)评分低于对照组,差异有统计学意义(P<0.05)。术后1 h、6 h、12 h、1 d,观察组简易精神状态量表(MMSE)评分均明显高于对照组,差异有统计学意义(P<0.05)。观察组术后不良反应发生率明显低于对照组,差异有统计学意义(P<0.05)。结论:腰硬联合麻醉应用于骨科手术中具有显著的效果,可稳定患者术中的血流动力学,发挥良好镇痛效果,减轻患者术后疼痛,对患者认知功能的影响更小,且安全性高,可减少患者术后不良反应风险。

连续硬膜外镇痛联合射频毁损治疗带状疱疹后遗神经痛的临床疗效

目的探讨连续硬膜外镇痛联合射频毁损治疗带状疱疹后遗神经痛的临床疗效。方法选取2019年2月至2020年8月于本院治疗的92例带状疱疹后遗神经痛患者作为研究对象,随机分为对照组与观察组,每组46例。对照组行连续硬膜外镇痛,观察组行连续硬膜外镇痛联合射频毁损治疗,比较两组疼痛程度、不良反应发生情况及临床疗效。结果治疗前,两组疼痛评分比较差异无统计学意义;治疗后,观察组疼痛评分低于对照组,差异有统计学意义(P<0.05)。治疗后,观察组不良反应发生率低于对照组,差异有统计学意义(P<0.05)。治疗后,观察组治疗总有效率为95.65%,高于对照组的82.61%,差异有统计学意义(P<0.05)。结论连续硬膜外镇痛联合射频毁损治疗带状疱疹后遗神经痛疗效显著,可缓解患者疼痛,减少不良反应,值得临床推广应用。

Feasibility study of bilateral thoracic paravertebral block for postoperative analgesia in patients after off-pump coronary artery bypass grafting

Objective To investigate the feasibility of bilateral thoracic paravertebral block for postoperative analgesia in patients after off-pump coronary artery bypass grafting(OPCABG).Methods Upon the approval of institutional Ethics Committee and informed consent,forty patients ASAⅡorⅢaged 52-77 yr with BMI(body mass index)【

氢吗啡酮替代吗啡改善术后镇痛的效能

【目的】调研氢吗啡酮应用于术后镇痛的效能。【方法】择期ASAⅠ-Ⅱ级肝胆或胃肠开腹手术120例,手术后随机双盲等分为4组,每组30例,根据术后镇痛方法分为静脉氢吗啡酮组（VH）、静脉吗啡组（VM）、硬膜外氢吗啡酮组（EH）、硬膜外吗啡组（EM）。VH组首剂量生理盐水5 mL＋氢吗啡酮0.4 mg,维持为生理盐水100 mL＋氢吗啡酮3.6 mg;VM组首剂量生理盐水5 mL＋吗啡2 mg,维持为生理盐水100 mL＋吗啡18 mg;EH组首剂量0.25%罗派卡因5 mL＋氢吗啡酮0.4mg,维持为0.125%罗派卡因100 mL＋氢吗啡酮1.6 mg;EM组首剂量0.25%罗派卡因5 mL＋吗啡2 mg,维持为0.125%罗派卡因100 mL＋吗啡8 mg,所有镇痛泵速度2 mL/h,镇痛48 h。围术期监测呼吸、循环、镇静、镇痛效果及不良反应。【结果】所有患者均顺利完成手术安返病房,术后镇痛满意度达98%,Ramsey镇静评分均为2～3分,属于满意镇静。VH组镇痛后12 h、24 h、48 h时与镇痛前SPO2比较下降,P〈0.05;VM组镇痛后2 h Sp O2较镇痛前下降,P〈0.05;VH组镇痛后48 h R-VAS评分较镇痛后6 h下降,P〈0.05;VH组镇痛后24 h、48 h M-VAS评分较镇痛后2 h、6 h下降,P〈0.05;VM组镇痛后6 h MVAS评分较镇痛后2 h下降,P〈0.05。EH组镇痛后2、6、12、24、48 h较镇痛前SBP下降,P〈0.05;EH组镇痛后12、24、48 h较镇痛前HR增快,P〈0.05;EH组镇痛后6、12、24、48 h较镇痛前SPO2下降,P〈0.05;EH组镇痛后48 h M-VAS评分较镇痛后2 h下降,P〈0.05。EH组镇痛后24 h、48 h时DBP较VH组下降,P〈0.05;VH组镇痛后12～48 h Sp O2较镇痛前下降,P〈0.05。四组术后恶心、呕吐的发生率无明显差异（P〈0.05）,硬膜外用药组瘙痒发生率均高于静脉用药组,P〈0.05;EM组和VH组嗜睡发生率均多于EH组,P〈0.05;EM组和VM组头晕发生率分别多于EH组和VH组,P〈0.05。【结论 】氢吗啡酮可以代替吗啡,无论静脉与硬膜外应用都能取得良好的术后镇痛效果,氢吗啡酮的副作用相对少于吗啡,值得临床推广应用。

高乌甲素复合液硬膜外腔注射对术后镇痛的临床研究

本研究观察高乌甲素复合液硬膜外腔注射对术后镇痛的效能和副作用。１２０例患者随机分为４组，Ⅰ组为观察组，用高乌甲素１２ｍｇ和布比卡因２２．５ｍｇ的复合液（ＬＢ液）；Ⅱ、Ⅲ、Ⅳ３组为对照组，分别单用高乌甲素１２ｍｇ、布比卡因２２．５ｍｇ、吗啡２ｍｇ，于术后切口复痛时，以单盲法将药液注入硬膜外腔。结果：镇痛起效时间是Ⅰ组、Ⅲ组快于Ⅱ组、Ⅳ组，镇痛效力强度是Ⅳ组＞Ⅰ组＞Ⅲ组＞Ⅱ组，以上两项的Ⅰ、Ⅱ组比较均有显著性差异（Ｐ＜０．０１，Ｐ＜０．０５）。而单次镇痛作用持续时间的长短顺序是Ⅳ组＞Ⅰ组＞Ⅱ组＞Ⅲ组，其中Ⅰ、Ⅳ组比较有显著性差异（Ｐ＜０．０１）。表明ＬＢ液的硬膜外术后镇痛效能较单用高乌甲素可更快、更好地达到临床术后镇痛要求，且不良反应少，比吗啡安全。

硬膜外持续注入吗啡用于开胸手术后镇痛的研究

目的：探讨硬膜外持续恒速注入吗啡镇痛技术（ｃｏｎｔｉｎｕｏｕｓ ｃｏｎｓｔａｎｔ ｅｐｉｄｕｒａｌ ａｎａｌｇｅｓｉａ ＣＣＥＡ）用于开胸手术后镇痛的效果及安全性。方法：１００例ＡＳＡ１－３级开胸肿瘤手术病人随机分为ＣＣＥＡ组和肌注吗啡镇痛组（ＩＭ组）。记录术后４、１２、２４、３６、４８小时两组病人镇痛、镇静评分及副作用发生情况，持续监测血压、心率、呼吸频率、脉搏氧饱和度、血气等体征，并于术后７２小时对两组病人进行镇痛满意度调查。结果：ＣＣＥＡ组病人镇静评分、病人满意度评分显著高于ＩＭ组，镇痛评分显著低于 ＩＭ组（Ｐ＜ ０.０１）。 ＩＭ组病人 ＨＲ、 ＲＲ显著增高， ＳｐＯ_２降低（ Ｐ＜０.０５）。结论：开胸手术后应用 ＣＣＥＡ技术，镇痛完全，安全，并能改善呼吸功能。

硬膜外镇痛和肋间神经冷冻镇痛对开胸术后急性和慢性疼痛的影响

目的:比较开胸术后硬膜外镇痛和肋间神经冷冻的短期镇痛效果以及慢性疼痛发生率。方法:87位择期后外侧开胸手术的患者,随机分为硬膜外组(E组,n=46)和肋间神经冷冻组(C组,n=41)。术毕E组接硬膜外病人自控镇痛泵。C组于关胸前行切口、上下各一肋间以及胸引管处肋间神经冷冻(-70℃,90s)。记录术后3天内NRS评分、镇痛满意度、副作用。电话随访术后12个月内慢性疼痛的发生率。结果:两组术后3天内疼痛评分和镇痛满意度无统计学差异。E组皮肤瘙痒发生率显著高于C组(P<0.01)。C组在术后3、6、12个月时总体慢性疼痛发生率和触诱发痛发生率均高于E组,其中触诱发痛发生率在术后6个月时差异有统计学意义(P<0.05)。结论:开胸术后硬膜外镇痛能提供有效的术后镇痛,但硬膜外吗啡皮肤瘙痒发生率高。肋间神经冷冻有可能增加开胸术后慢性疼痛的发生率,其推广还有待研究。