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.

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.

Intrathecal morphine vs femoral nerve block for postoperative-analgesia after total knee arthroplasty:A two-year retrospective analysis

AIM To compare the efficacy of intrathecal morphine and single shot femoral nerve block for patients undergoing primary total knee arthroplasty.METHODS Data was extracted from electronic medical records and case-paper record files of patients who underwent unilateral primary total knee arthroplasty under spinal anesthesia using bupivacaine 12.5 mg with intrathecal morphine(ITM) 0.2 mg and under general anesthesia(GA) with single shot femoral nerve block(FNB) using 20 m L 0.5% bupivacaine at our hospital in 2013 and 2014.All patients had received peri-articular infiltration as per the hospital protocol.Data for gender,age,weight,American Society of Anesthesiologists status,total surgical time,postoperative pain score using visual analogue scale(VAS) from 1 to 10 at 6 h,12 h and 24 h postoperatively,24 h opioid consumption,use of oral multimodal analgesia,postoperative high dependency unit(HDU) admission and the time to discharge from the hospital was collected.The data was analyzed using Mann-Whitney U test for continuous variables and Fischer's exact-t-test for categorical variables.RESULTS Twenty-two patients in ITM group and 32 patients in FNB group were analyzed.Median pain scores using VAS in ITM group were significantly lower at 6 h(0.0 vs 2.0,P<0.001),12 h(0.0 vs 2.0,P<0.001) and 24 h(0.0 vs 2.0,P<0.001) postoperatively.Also,postoperative morphine consumption in ITM group was significantly lower(P<0.001).However,median of nonsteroid anti-inflammatory drug unit requirement in 24 h postoperatively was statistically significant higher in ITM compared to FNB group(2.0 vs 1.0,P=0.025).The difference in postoperative paracetamol consumption in 24 h was not statistically significant(P=0.147).There was no significant difference in the postoperative HDU admission or time to discharge from the hospital.No respiratory depression in either group was noticed.CONCLUSION The ITM group patients had much lower pain scores and morphine requirement in the first 24 hour postoperatively compared to FNB group.

Effect of intraoperative injection of esketamine on postoperative analgesia and postoperative rehabilitation after cesarean section

BACKGROUND Following cesarean section,a significant number of women encounter moderate to severe pain.Inadequate management of acute pain post-cesarean section can have far-reaching implications,adversely impacting maternal emotional wellbeing,daily activities,breastfeeding,and neonatal care.It may also impede maternal organ function recovery,leading to escalated opioid usage,heightened risk of postpartum depression,and the development of chronic postoperative pain.Both the Chinese Enhanced Recovery After Surgery(ERAS)guidelines and the American ERAS Society guidelines consistently advocate for the adoption of multimodal analgesia protocols in post-cesarean section pain management.Esketamine,functioning as an antagonist of the N-Methyl-D-Aspartate receptor,has been validated for pain management in surgical patients and has exhibited effectiveness in depression treatment.Research has suggested that incorporating esketamine into postoperative pain management via pain pumps can lead to improvements in short-term depression and pain outcomes.This study aims to assess the efficacy and safety of administering a single dose of esketamine during cesarean section.AIM To investigate the effect of intraoperative injection of esketamine on postoperative analgesia and postoperative rehabilitation after cesarean section.METHODS A total of 315 women undergoing elective cesarean section under combined spinal-epidural anesthesia were randomized into three groups:low-dose esketamine(0.15 mg/kg),high-dose esketamine(0.25 mg/kg),and control(saline).Postoperative Visual Analog Scale(VAS)scores were recorded at 6 hours,12 hours,24 hours,and 48 hours.Edinburgh Postnatal Depression Scale(EPDS)scores were noted on 2 days,7 days and 42 days.Ramsay sedation scores were assessed at specified intervals post-injection.Postoperative adverse reactions were also recorded.RESULTS Low-dose group and high-dose group compared to control group,had significantly lower postoperative VAS pain scores at 6 hours 12 hours,and 24 hours(P<0.05),with reduced analgesic usage(P<0.05).EPDS scores and postpartum depression rates were significantly lower on 2 days and 7 days(P<0.05).No significant differences in first exhaust and defecation times were observed(P>0.05),but ambulation times were shorter(P<0.05).Ramsay scores were higher at 5 minutes,15 minutes,and upon room exit(P<0.05).Low-dose group and high-dose group had higher incidences of hallucination,lethargy,and diplopia within 2 hours(P<0.05),and with low-dose group had lower incidences of hallucination,lethargy,and diplopia than high-dose group(P<0.05).CONCLUSION Esketamine enhances analgesia and postpartum recovery;a 0.15 mg/kg dose is optimal for cesarean sections,balancing efficacy with minimized adverse effects.

Comparative study of single or combined epidural administration of neostigmine and morphine for postoperative analgesia

To compare the analgesic and side effects of post-operative analgesia between epidural administration ofneostigmine (NEO) and morphine (MOR) or their combination in patients undergoing abdominal surgery. Methods: One hundredand two selective patients undergoing surgery were randomly divided into five groups at the end of the surgical procedure. GroupN1 (n=11) and Group N2(n =15) were administered epidurally with NEO 1 mg and 2 mg respectively, Group M1 (n=18)and Group M2 (n=55) were administered epidurally with MOR 1 mg and 2 mg respectively, Group M1 + N1 (n=17) was administered epidurally with the combination of MOR 1 mg and NEO 1 mg. Results: Single dose epidural administration of NEO (1mg and 2 mg) or MOR (1 mg and 2 mg) showed dose-dependent analgesic effects. The analgesic duration in Group N1 (4.7 ± 2.7 h) was significantly shorter than other four groups (P<0. 01). Group M1, M2 and M1 + N1 showed better analgesic effectsthan group N1 and N2 (16.1±8.7h) , with similar analgesic durations in Group M1, M2 and M1 + N1. me percentages of excellent, good and poor effects were 0%, 54.5 % and 45.5 % respectively in Group N1. The percentages of excellent and good effects were 100% in Group M2 and M1 + N1, but 83.3% in Group N2. The time to first use analgesic medication was similar inGroup M1, M2 and M1 + N1, but longer compared with Croup N1 and N2. The incidences of nausea and vomiting closelyresem-bled one another in Croup N1, N2 and M1 + N1, which were less than those in Group M1 and M2. The incidence of urinary retention was 51.2%, 25.0% and 31.3% in Group M2, M1 and M1 + N1, respectively, but 0% in Group N1 and N2. In GroupN2 two patients opened the bowel movement and one patient developed bradycardia (58 beats/min) at 45 min after receiving NEO.Conclusion: Epidural administration of NEO produces dose-dependent prolonged analgesic effects (similar to MOR) and the combination of MOR and NEO could produce analgesia with fewer side effects than administration of equivalent analgesic doses of eachdrug separately. me epidural administration of NEO 2 mg could provide satisfactory postoperative analgesia.

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.

Ultrasound-guided serratus anterior plane block enhances postoperative analgesia and recovery in thoracoscopic surgery

BACKGROUND The serratus anterior muscle,located in the lateral aspect of the thorax,plays a crucial role in shoulder movement and stability.Thoracoscopic surgery,while minimally invasive,often results in significant postoperative pain,complicating patient recovery and potentially extending hospital stays.Traditional anesthesia methods may not adequately address this pain,leading to increased complications such as agitation due to inadequate pain management.AIM To evaluate the application value of ultrasound-guided serratus anterior plane block(SAPB)in patients undergoing thoracoscopic surgery,focusing on its effects on postoperative analgesia and rehabilitation.METHODS Eighty patients undergoing thoracoscopic surgery between August 2021 and December 2022 were randomly divided into two groups:An observation group receiving ultrasound-guided SAPB and a control group receiving standard care without SAPB.Both groups underwent general anesthesia and were monitored for blood pressure,heart rate(HR),oxygen saturation,and pulse.The primary outcomes measured included mean arterial pressure(MAP),HR,postoperative visual analogue scale(VAS)scores for pain,supplemental analgesic use,and incidence of agitation.RESULTS The observation group showed significantly lower cortisol and glucose concentrations at various time points post-operation compared to the control group,indicating reduced stress responses.Moreover,MAP and HR levels were lower in the observation group during and after surgery.VAS scores were significantly lower in the observation group at 1 h,4 h,6 h,and 12 h post-surgery,and the rates of analgesic supplementation and agitation were significantly reduced compared to the control group.CONCLUSION Ultrasound-guided SAPB significantly improves postoperative analgesia and reduces agitation in patients undergoing thoracoscopic surgery.This technique stabilizes perioperative vital signs,decreases the need for supplemental analgesics,and minimizes postoperative pain and stress responses,underscoring its high application value in enhancing patient recovery and rehabilitation post-thoracoscopy.

Spinal Analgesia with Intrathecal Morphine versus Conventional Analgesia after Laparoscopic Colectomy: A Retrospective Cohort Study

Objective: Postoperative pain (POP) following abdominal surgery can vary from a few hours to several days. This acute, unrelieved pain can become chronic, requiring patients to take analgesics on an almost daily basis for comfort. Analgesia using general opioids has many side effects and intrathecal morphine is a good alternative. This study was conducted to evaluate the efficacy of intrathecal morphine (ITM) versus conventional analgesia in the management of postoperative pain in colectomy performed by laparoscopic surgery. Methods: Cohort study conducted at the Hôpital Nord in Marseille, from 01 January to 31 July 2021 in patients aged at least 18 years undergoing anaesthesia for scheduled colectomy by laparoscopic surgery. The primary endpoint was postoperative pain intensity and the secondary endpoints were morphine consumption, treatment side effects and length of hospital stay. Statistical analysis was performed using XLSTAT software. Results: We included 193 patients: 131 in the control group (conventional analgesia) and 62 in the ITM group. We observed: a significant decrease in pain (assessed by numerical scale) in favour of the ITM group in the post-anaesthetic care room, i.e. 3 (±4) vs 1 (±2), p 0 and H2: 2 (±2) vs. 1 (±2);p Conclusion: These results suggest that intrathecal morphine (ITM) in laparoscopic colectomy provides effective postoperative analgesia with low morphine consumption, and a reduction in morphine side-effects compared with conventional analgesia.

Postoperative Analgesia and Cesarean Section under General Anesthesia: Multicenter Study

Background: Neuraxial anesthesia with intrathecal morphine is the reference technique in cesarean section anesthesia for the management of postoperative analgesia. If there is a contraindication to this, general anesthesia is required. The objective of the study was to evaluate the analgesic effectiveness of 4 analgesic techniques performed during cesarean section under general anesthesia in two centers with different anesthetic practices (North Franche Comté Hospital and Omar Bongo Ondimba Army Training Hospital). Method: This is a retrospective and descriptive study over 2 years, from January 1, 2019 to December 31, 2020. It involved evaluating the analgesic effectiveness and tolerance of morphine in the epidural catheter, wound infiltration, intravenous analgesia and Transversus Abdominous Plane block (TAP block) from the post-anesthesia care unit (PACU) until the 4th post-operative day. Results: Of the 354 cesarean sections performed, 84 (11.14%) received general anesthesia. The average age was 32.27 years. Acute fetal distress was the first indication for cesarean section (45.2%), followed by hemorrhagic placenta previa (10.7%) and prolapse of the cord (8.33%). Morphine in the epidural catheter was the most used (47.6%) followed by parietal infiltration (36.9%), intravenous analgesia (13.1%) and TAP block (2.38%). The analgesic effectiveness was comparable between the techniques from postoperative day 0 to day 4. No difference in side effects. Postoperative morphine consumption was significantly reduced (p = 0.011) in the infiltration (9 mg) and TAP block (9mg) groups compared to the epidural catheter (16 mg) and intravenous analgesia (17 mg). No difference in 02 rehabilitation criteria (ambulation, first bowel movement). No difference in the occurrence of chronic pain. Conclusion: In the event of a cesarean section under general anesthesia, there are effective and well-tolerated alternatives to neuraxial anesthesia, particularly regional anesthesia techniques (nerve blocks), particularly in countries with low availability of morphine.

Ultrasound-guided Transversus Abdominis Plane Block Improves Postoperative Analgesia and Early Recovery in Patients Undergoing Retroperitoneoscopic Urologic Surgeries:A Randomized Controlled Double-blinded Trial

Objective To evaluate the effects of ultrasound-guided transversus abdominis plane(TAP) block on postoperative analgesia and early recovery in patients undergoing retroperitoneoscopic urologic surgeries.Methods This was a randomized,controlled,double-blinded trial.Eligible patients scheduled for retroperitoneoscopic urologic surgeries were randomly assigned to two groups.Group TAP received ultrasound-guided TAP block with 0.5% ropivacaine 20 ml at 30 minutes before surgery,and Group C received TAP sham block with normal saline.All patients received retroperitoneoscopic urologic surgeries under general anesthesia.The primary outcome was the severity of pain after surgery.Secondary outcomes included opioids consumption,analgesics,postoperative nausea and vomiting,time to Foley catheter removal and to passage of flatus,length of post-anesthesia care unit stay and hospital stay.Results Eighty patients completed the study,forty cases in each group.Compared to the Group C,the Group TAP had lower visual analogue scale pain scores within two postoperative days(all P<0.05).They also had less consumption of intraoperative fentanyl(2.0±0.5 vs. 3.8±0.7 μg/kg,P<0.05),reduced incidence of postoperative rescue analgesic usage(12.5% vs. 45.0%,P<0.05),and lower incidence of postoperative nausea and vomiting within postoperative 48 hours(12.5% vs. 25.0%,P<0.05) when compared to the Group C.In addition,Group TAP had a shortened post-anesthesia care unit stay(25±8 vs. 49±12 minutes,P<0.05),and a greater proportion of patients discharged within postoperative three days(57.5% vs. 35.0%,P<0.05).Conclusion Preoperative ultrasound-guided TAP block is an effective technique to improve postoperative analgesia and early recovery in patients undergoing retroperitoneoscopic urologic surgeries.

Erector Spinae Plane Block Combined with Serratus Anterior Plane Block Versus Thoracic Paravertebral Block for Postoperative Analgesia and Recovery After Thoracoscopic Surgery:A Randomized Controlled Non-inferiority Clinical Trial

Objective This study aimed to compare the postoperative analgesia and recovery of ultrasound-guided erector spinae plane block combined with serratus anterior plane block(ESPB combined with SAPB)versus thoracic paravertebral block(PVB)after thoracoscopic surgery.Methods Ninety-two patients who underwent video-assisted thoracoscopic surgery(VATS)were randomly divided into group S(n=46)and group P(n=46).After anesthesia induction,the same anesthesiologist performed ultrasound-guided ESPB at T5 and T7 levels combined with SAPB at the level of the fifth rib in the midaxillary line in group S and ultrasound-guided PVB at T5 and T7 levels in group P.Patients in both groups were given 40 mL of 0.4%ropivacaine.Eighty-six patients completed the study(group S,n=44;group P,n=42).The morphine consumption,visual analogue scale(VAS)scores at rest and coughing,and frequency of remedial analgesia were recorded at 1,2,4,8,and 24 h postoperatively.Pulmonary function parameters were recorded at 1,4,and 24 h postoperatively,and the quality of recovery(QoR)-15 score at 24 h postoperatively.The adverse effects,duration of chest tube drainage and length of stay were also recorded.Results The morphine consumption at postoperative 4 and 8 h and the incidence of ipsilateral shoulder pain(ISP)were significantly lower in group S than in group P.The QoR-15 questionnaire score at postoperative 24 h was significantly lower in group P than in group S(P<0.05).The morphine consumption was lower at 24 h postoperatively in group S than in group P,with no significant difference found yet.The morphine consumption at other observed times,VAS scores,pulmonary function parameters,frequency of remedial analgesia,duration of chest tube drainage,length of stay,and incidence of other adverse events were comparable between group S and group P.Conclusion Ultrasound-guided ESPB combined with SAPB is non-inferior to PVB in terms of morphine consumption at postoperative 24 h and postoperative recovery.But,this approach can significantly reduce morphine consumption in the early postoperative period(0–8 h)after thoracoscopy with lower incidence of ISP.It is a simpler and safer operation.

Comparative efficacy of ketamine,lidocaine,acetaminophen,and dexmedetomidine combined with morphine patient-controlled analgesia in treating opium-addicted patients undergoing tibia fracture surgery:A randomized clinical trial

Objective:To compare the effect of ketamine,lidocaine,acetaminophen,and dexmedetomidine combined with morphine patient-controlled analgesia for opium addicts after tibial fracture surgery.Methods:This double-blind clinical trial included opium-addicted patients undergoing tibia fracture surgery.Patients were recruited and randomized to four different groups including the ketamine group,the lidocaine group,the acetaminophen group,and the dexmedetomidine group.The hemodynamic parameters such as heart rate(HR),mean arterial pressure,and arterial SaO2,alongside visual analog scale pain scores,sedation assessed by Ramsay score,nausea and vomiting,and opioid use were recorded and compared among the four groups.Results:This study included 140 patients,aged 37(32,41)years,with 92 males and 48 females,and each group had 35 patients.Dexmedetomidine-sedated subjects had the lowest blood pressure from 1 to 24 h after surgery,decreased HR at 12 and 24 h after surgery,and more satisfactory sedation(P<0.05).Notwithstanding no significant difference was noted in the pain scores,or nausea and vomiting among the groups(P>0.05).Conclusions:Dexmedetomidine has a better sedation effect compared to ketamine,lidocaine,and acetaminophen for pain control,but the final choice hinges on the patients’physical condition and the anesthesiologist's preference.Clinical registration:It is registered in Iranian Registry Clinical Trial by code IRCT20141209020258N146.

Effect of thoracic epidural analgesia and sympathetic nerve block on postoperative hypertension in patients with patent ductus arteriosus

Objective To investigate the effects of thoracic epidural analgesia on postoperat ive hypertension in patients with PD A.Methods48cases of PDA were randomly divided into NTEA group(n =22)and TEAgroup(n =26).General anesthesia was used for NTE Agroup,and intramuscular injection of peth idine 1mg /kg was used when postopera tive pain occurs;general anesthesia combined with thoracic epidural anesthesia were used for TEAgroup,a nd thoracic epidural analgesia was u sed for postoperative analgesia.BP,HR,RR,SpO 2 ,EKG were monitored during and after operatio n,angiotenic was used when the BP ele vated more than 20%compared with before operation.Results Analgesia effect on TEA group was better than that of NTEA group(P <0.05),also postoperative BP was signific antly higher than that of before operation in NTEA group(P <0.01),and 18cases need nitroglycerin or s odium nitroprusside therapy;there was no significantly in-crease of BP in TEA group,only 2cases need nitroglycerin therapy.Conclusion TEA had an excellent effect of postop erative pain-relief and blocked sympathetic nerve in patien ts with PDA,so it could reduce postoperative hypertension effectively.

NEIMADIAN-POINT ACUPUNCTURE AND AURICULAR-POINT PRESSING USED FOR ORTHOPAEDIC POSTOPERATIVE ANALGESIA

The authors have treated 64 cases of orthopaedic postoperative pains by Neimadian-point acupuncture and auricular-ponit pressing with satisfactory results. In this paper, therapeuticmethods, therapeutic-effect observations and typical cases are reported, and the analgetie mechanismis preliminarily explored as well.

Three Different Doses of Intrathecal Morphine as Part of a Multimodal Regimen for Post-Cesarean Delivery Analgesia: A Randomized Double-Blinded Trial

Brazil is one of the countries that carry out cesarean delivery in the world. The pain after cesarean delivery (CD) is one of the main concerns of parturient. Intrathecal Morphine (ITM) is widely used for the treatment of pain after CD;however, the optimal dose with minimal side effects is to be established. Objectives: To compare the analgesia and side effects resulted by three different doses of ITM as part of a multimodal regimen for post-cesarean delivery analgesia. Methods: One hundred ninety-four patients were sampled in this randomized, double-blinded, three-arm study (group 0.075: ITM 0.75 mg;group 0.1: ITM 0.1 mg and group 0.15: ITM 0.15 mg). All patients received intravenous dexamethasone, dipyrone and ketoprofen. The primary endpoint was pain intensity measured at rest and on movement, while the secondary endpoint was overall satisfaction with pain relief, the incidence of nausea and vomiting, intensity of pruritus, and the use of additional tramadol, antipruritic and antiemetic use within 24 hours after postoperation. Results: The three groups showed similar pain intensity at rest and on movement. The pain intensity on movement was significantly higher than at rest in the groups (p 0.001). There were no significant differences among the groups regarding secondary endpoint. Conclusions: Our findings suggest that in cases of an elective CD, 0.075 mg of ITM produces postoperative analgesia of similar quality that provided by 0.1 or 0.15 mg ITM. The patients should have a multimodal analgesia approach that includes: ITM, anti-inflammatory agents and access to additional systemic analgesic if necessary.

COMPARISON OF PATIENT-CONTROLLED ANALGESIA WITH TRAMADOL VS MORPHINE IN PATIENTS UNDERGOING ABDOMINAL GYNECOLOGICAL SURGERY

Objective.To c ompare the analgesic efficacy and adverse effects of patient-controlled analges iawith tramadol and with morphine for postoperative middle or severe pain .Methods.Fifty-nine patients,scheduled for elective hysterectomy or hystero myomectomy ,were ran-domly divided into Group Tand Group M.The2drugs were administered intravenously v ia a patient-controlled analgesia device till24h postoperatively.Efficacy wa s assessed by comparing total pain reliefand the sum of pain intensity differencevalues over24h.Results.Statistically significant equival ence of tramadol and morphine was shown by TOTPAR values(15.9±4.4and1 6.4±3.5,respectively)and SPID values(9.2±4.7and9.0±2.0, respectively).Tramadol caused fewer adverse events than morphin e(16.7%and26.7%of patients,respectively).Conclusion.The analgesic efficacy of PCA with tramadol and with morphine were equivalent in the treatme nt of postoperative pain,and tramadol can cause slighter gastrointestinal adve rse effects.

Morphine analgesia in male inbred genetic diversity mice recapitulates the among-individual variance in response to morphine in humans

Morphine is a widely used analgesic, but its use in clinical precision medicine is limited by the variance in response among individuals. Although previous studies have shown that individual differences in morphine can be explained in terms of pharmacodynamics and pharmacokinetics, genetic polymorphisms also play an important role. However, the genetic basis of different sensitivity and tolerance susceptibility to morphine remains ambiguous. Using 15 strains of inbred Genetic Diversity(GD) mice,a new resource with wide genetic and phenotypic variation, we demonstrated great variance in sensitivity to morphine analgesia and susceptibility to morphine tolerance between different GD strains. Among-i ndividual variance in response to morphine analgesia in the population can be modeled in GD mice. Two loci respectively may be associated with the among-i ndividual variance in morphine sensitivity and tolerance,confirming the role of genetic factors in among-i ndividual different responses to morphine. These results indicate that GD mice may be a potential tool for the identification of new biomarkers to improve the clinical administration of morphine.

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.

Effect of hydromorphone hydrochloride postoperative analgesia on the stress reaction and hemorheology in elderly patients after total hip replacement

Objective:To explore the effect of hydromorphone hydrochloride postoperative analgesia on the stress reaction and hemorheology in elderly patients after total hip replacement (THR). Methods:A total of 70 patients who were admitted in our hospital from June, 2015 to June, 2016 for THR were included in the study and randomized into the observation group and the control group with 35 cases in each group. After operation, the patients in the two groups were immediately given patient-controlled analgesia. The patients in the observation group were given hydromorphone hydrochloride, while the patients in the control group were given sufentanil. The peripheral venous blood before operation, 12 and 24 h after operation in the two groups was collected. RIA was used to detect BG and Cor. ELISA was used to detect NE. The peripheral venous blood before operation, 24 and 72 h after operation was collected. The full automatic hematology analyzer was used to detect the plasma PV, BV, and RWBV. Results:Cor and NE levels in the observation group, and BG, Cor, and NE levels in the control group 12 and 24 h after operation were significantly elevated when compared with before operation (P<0.05), but the above indicators at each timing point in the control group were significantly higher than those in the observation group (P<0.05). PV, BV (low-shear, middle-shear, and high-shear), and RWBV (low-shear, middle-shear, and high-shear) levels 24 and 72 h after operation in the two groups were significantly elevated when compared with before operation (P<0.05), but the above indicators at each timing point in the control group were significantly higher than those in the observation group (P<0.05). Conclusions:Application of hydromorphone hydrochloride in the postoperative analgesia in elderly patients with THR has a preferable analgesia effect, can effectively alleviate the postoperative stress reaction, stabilize the hemorheology, and contribute to the rehabilitation.

Effect of hydromorphone hydrochloride postoperative analgesia on the inflammatory cytokines, S-100β, and NSE in elderly patients after total hip replacement

Objective:To explore the effect of hydromorphone hydrochloride postoperative analgesia on the inflammatory cytokines, S-100β, and NSE in elderly patients after total hip replacement (THR).Methods: A total of 100 patients who were admitted in our hospital from January, 2015 to July, 2016 for THR were included in the study and randomized into the observation group and the control group with 50 cases in each group. After operation, the patients in the two groups were immediately given patient-controlled analgesia. The patients in the observation group were given hydromorphone hydrochloride (0.3 mg) + dexamethasone (5 mg) + normal saline (100 mL), while the patients in the control group were given sufentanil (150 μg) + dexamethasone (5 mg) + normal saline (100 mL). The morning fasting peripheral venous blood before operation, 24 h and 3 d after operation in the two groups was collected. ELISA was used to detect the serum CRP, IL-6, and TNF-α, and the plasma S-100β and NSE levels.Results:The serum CRP, TNF-α, and IL-6 levels 24 h and 3 d after operation in the two groups were significantly elevated when compared with before operation, and were reduced 3d after operation. CRP, TNF-α, and IL-6 levels at each timing point after operation in the observation group were significantly lower than those in the control group. The plasma S-100βand NSE levels 24 h and 3 d after operation in the two groups were significantly elevated when compared with before operation, and were reduced 3 d after operation. The plasma S-100β and NSE levels at each timing point after operation in the observation group were significantly lower than those in the control group.Conclusions:Hydromorphone hydrochloride can relieve the postoperative pain in elderly patients with THR, effectively alleviate the inflammatory reaction, reduce the plasma S-100β and NSE levels, and alleviate the cerebral injury, whose pathogenesis remains a further deep study.