Objective To evaluate the analgesic effect of intra-articular ropivacaine with lidocaine. Methods A double-blind randomized controlled trial was conducted. Ninety patients receiving selective knee arthroscopy were randomized into three groups of 30 patients. At the end of the operation, before the release of the tourniquet, an intra-articular injection was administered to each patient through arthroscope, in accordance with their random allocation: 0.9% normal saline (normal saline group); 100 mg ropivacaine (ropivacaine alone group) and 100 mg ropivacaine and 100 mg 2% lidocaine (ropivacaine with lidocaine group). Pain intensity was assessed after the operation using the 100-mm visual-analog scale (VAS), and the amount of supplemental analgesics used within the following 24 hours were recorded. Results The VAS scores of 2 hours postoperatively at rest, and 1, 2, 4, and 8 hours postoperatively at motion, were significantly higher in the normal saline group than in ropivacaine alone group (Plt;0.05). The VAS scores 0.5, 1 and 2 hours postoperatively at rest, and at the awaking moment, 0.5, 1, 4, 8, and 24 hours postoperatively at motion, were significantly higher in the normal saline group than in ropivacaine with lidocaine group (Plt;0.05). Conclusion Intra-articular ropivacaine can reduce a patient’s pain after operation. The combination of lidocaine with intra-articular ropivacaine can reduce the patient’s pain severity immediately after the operation and achieve an early analgesic effect.
【摘要】 目的 比较单次股神经阻滞和关节腔内单次注射罗哌卡因对膝关节镜检术后镇痛效果，为临床应用提供试验依据。 方法 2009年1月-2010年7月，选择美国麻醉医师协会（ASA）Ⅰ～Ⅱ级、年龄18~65岁、拟行择期单侧下肢膝关节镜手术患者180例，随机分为股神经阻滞组和关节腔内用药组，每组90例，分别于术前1 h行股神经阻滞（0.15%罗哌卡因20 mL）和手术结束时在膝关节腔内注入0.6%罗哌卡因20 mL。于术后4、8、24 h采用视觉模拟评分法（visual analog scale，VAS）行静止和运动时疼痛评分，记录术后患者满意度、不良反应发生率，术后使用镇痛药物情况。 结果 关节腔内用药组术后镇痛药物使用率（41.11%）明显高于股神经阻滞组（20.00%）（Plt;0.005）。两组患者术后24 h静止时及术后8、24 h运动时的VAS评分关节腔内用药组均明显高于股神经阻滞组（Plt;0.001），其余各时点差异无统计学意义（Pgt;0.05）。 结论 股神经阻滞可提供更加有效的术后镇痛效果，并且用药量小，安全系数高，值得临床推广。【Abstract】 Objective To compare the effect of single-injection femoral nerve block and local anesthetic intraarticular injection for analgesia after knee arthroscopy, in order to provide the experimental base for clinical application. Methods From January 2009 to July 2010, 180 American Society of Anesthesiologists (ASA) physical status I-II patients, aged from 18 to 65 years old, and scheduled for elective single knee arthroscopy were randomly divided into two groups: femoral nerve block group and local anesthetic intraarticular injection group with 90 patients in each group. For the patients in the former group, 20 mL of 0.15% ropivacaine was injected 1 hour before operation. For the latter group, 20 mL of 0.6% ropivacaine was injected into the articular cavity after operation. Pain intension scores at rest and in motion were measured 4, 8, and 24 hours after operation by visual analog scale (VAS). The degree of patients’ satisfaction, adverse reaction incidence rate and information of taking pain-killers were also recorded. Results The rate of using pain-killers in the intraarticular injection group (41.11%) was dramatically higher than the femoral nerve block group (20.00%) (Plt;0.005). The VAS scores of patients in the intraarticular injection group at rest 24 hours after operation and in motion 8 hours and 24 hours after operation were significantly higher than the femoral nerve block group (Plt;0.001), while there was no significant difference at other points between the two groups. Conclusions Femoral nerve block is more efficient for analgesia after knee arthroscopy compared with local anesthetic intraarticular injection. It is a safe procedure requiring only a relatively small dose of medicine, and is worth being popularized.
[Abstract]The number of lung transplantation is gradually increasing worldwide, which brings new challenges to the multi-disciplinary team of lung transplantation. The prognosis of lung transplant recipients is seriously affected by the pathophysiological state of specific lung diseases and perioperative risk factors. It is of great significance for these patients to optimize perioperative management according to these factors. Recently, several expert consensus have been published regarding anesthesia management of lung transplantation. Based on the current evidence and clinical practice of West China Hospital, this review summarizes the key points of anesthesia management for lung transplant recipients to guide anesthesiologists' clinical practice.
ObjectiveTo systematically review the efficacy of paravertebral block (PVB) versus thoracic epidural block (TEB) for post-thoracotomy analgesia. MethodsWe electronically searched databases including The Cochrane Library (Issue 9, 2013), PubMed, EMbase, Springer, CNKI, CBM, VIP and WanFang Data from 1980 to September 2013, to collect randomized controlled trials (RCTs) of PVB versus TEB for post-thoracotomy pain management. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data and assessed the methodological quality of included studies. Then, meta-analysis was performed using RevMan 5.2 software. ResultsThirteen RCTs involving 608 patients were included. The results of meta-analysis showed that:the PVB group got higher VAS score at 48 h than the TEB group (WMD=-0.36, 95%CI -0.54 to -0.71), but more patients of the PVB group chosen remedial method to release pain in epidural than in paravertebral. In addition, there were no differences in VAS scores at 6 h and 24 h between two groups. As for the analgesia related complication:compared with the TEB group, the PVB group has lower rate of hypotension (RR=0.18, 95%CI 0.08 to 0.41), urinary retention (RR=0.24, 95%CI 0.11 to 0.54), nausea and vomiting (RR=0.42, 95%CI 0.25 to 0.70). There were no significant differences between two groups in postoperative pulmonary complication (RR=0.52, 95%CI 0.10 to 2.76), postoperative FEV1 level (WMD=2.93, 95%CI -4.52 to 10.38) and duration of hospital stay (WMD=-0.19, 95%CI -0.89 to 0.50). The PVB group had lower risk of chronic pain than that of the TEB group (RD=-0.12, 95%CI -0.23 to -0.01). ConclusionCurrent evidence shows PVB has the similar efficacy as TEB in post-thoracotomy pain management, with lower risk of analgesia related complication and lower risk of post-thoracotomy chronic pain. Due to limited quality and quantity of the included studies, more high quality and large-scale RCTs are needed to verify the above conclusion.
ObjectiveTo explore the effectiveness of traditional Chinese medicine (TCM) acupuncture analgesia after laparoscopic total extraperitoneal inguinal hernia repair (TEP), aiming to reduce the use of analgesics post-surgery. MethodsPatients who underwent unilateral TEP in the Department of Hernia and Abdominal Wall Surgery at our hospital from May 2022 to May 2023 were selected as research subjects. Those who met the inclusion and exclusion criterias were randomly assigned to three groups: TCM acupuncture analgesia group, traditional Chinese medicine acupuncture analgesia plus western medicine analgesia group (referred to as Chinese and western medicine analgesia group), and western medicine analgesia group. The basic information, postoperative numerical rating scale (NRS) pain scores, postoperative recovery indicators, and complication rates of the three groups were analyzed and compared.ResultsThere was no statistically significant differences in the basic data of patients across the three groups (P>0.05). There were significant differences in NRS score, recovery time of intestinal function, first urination time after operation and first ambulation time after operation at each time point after analgesia (6 h, the next morning, 48 h, 72 h and 96 h after operation) among the three groups (P<0.05). The NRS scores in both the TCM acupuncture analgesia group and the Chinese and western medicine analgesia group were lower than those in the western medicine analgesia group (P<0.05), Additionally, postoperative recovery outcomes were better in the TCM acupuncture analgesia group and the Chinese and western medicine analgesia group compared with the western medicine group (P<0.05). There was no significant difference of the above results compared between the TCM acupuncture analgesia group and the Chinese and western medicine analgesia group (P>0.05). There was no significant difference in postoperative complications among the three groups (P>0.05). ConclusionTCM acupuncture analgesia following TEP surgery is effective and leads to improved postoperative recovery compared with the use of oral analgesics alone, without an increase in adverse reactions.
ObjectivesTo systematically evaluate the efficacy and safety of dezocine combine with sufentanil (DS) versus sufentanil (S) for postoperative analgesia.MethodsCNKI, WanFang Data, VIP, PubMed, Wiley Online Library and ScienceDirect databases were searched online to collect randomized controlled trials (RCTs) of DS versus S for postoperative analgesia from January 2011 to July 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using Stata13.0 software.ResultsA total of 39 RCTs were included. The results of meta-analysis showed that: DS group had higher scores on VAS at 2 h, 6 h, 12 h, 24 h and 48 h points than S group at the dezocine level of 0.2 mg/kg. At the dezocine level of 0.3 mg/kg, there were no significant differences in scores on VAS at 2 h and 4 h. However, DS group had higher scores at 6 h, 12 h, 24 h and 48 h points. At the dezocine level of 10 mg/kg, there were no significant differences in scores on VAS at each time point in both groups. DS group was superior to S group in " excellent rate” and " good rate” of the analgesic satisfaction of patients. For safety, the incidence of postoperative nausea and vomiting of DS group was lower than S group.ConclusionsThe current evidence shows that dezocine combine with sufentanil have more effects of postoperative analgesia than sufentanil alone, and its incidence of adverse reactions is lower. Due to limited quality and quantity of the included studies, more high-quality studies are needed to verify above conclusions.
As a novel analgesic method, erector spinae plane block is increasingly widely used during perioperative period. This technique mainly injects local anesthetic drugs into the connective tissue between the deep fascia of the erector muscle and the transverse process of the vertebral body to achieve a blocking effect. Its role in postoperative analgesia in adult patients has been verified. Currently, case reports have shown that it also has a certain analgesic effect in pediatric patients, which can reduce postoperative pain scores and opioid consumption. Therefore, this article explores the application of erector spinae plane block in pediatric patients from various aspects, summarizes existing research results, and aims to provide more evidence for clinicians to reasonably use this block technique in the pediatric population.
ObjectiveTo systematically review the efficacy of opioid-sparing analgesic techniques in terms of analgesic potential, incidence of complications and quality of recovery in liver surgery. MethodsThe PubMed, Embase and Cochrane Library databases were electronically searched to collect randomized controlled trials (RCTs) related to the objectives from inception to August 2023. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies. Meta-analysis was then performed by using RevMan 5.3 software. ResultsA total of 20 RCTs involving 1 347 patients were included. The results of meta-analysis showed that opioid-sparing techniques could significantly reduce pain scores at rest and during movement from 2h to 48h postoperatively, opioid consumption within 24h (MD=−11.17, 95%CI −14.62 to −7.71, P<0.01) and 48h (MD=−7.19, 95%CI −10.06 to −4.33, P<0.01), postoperative nausea and vomiting (PONV) (OR=0.68, 95%CI 0.50 to 0.91, P=0.01) and wound infection (OR=0.42, 95%CI 0.18 to 0.98, P=0.04), as well as reduced time to bowel recovery (MD=−12.92, 95%CI −21.24 to −4.61, P<0.01) and decreased length of hospital stay (LOS) (MD=−0.90, 95%CI −1.32 to −0.49, P<0.01). No significant difference was observed between the two groups in the incidence of excessive sedation, pruritus, hypotension, headache and respiratory depression. Time to out-of-bed activity and patient satisfaction were also similar between groups. ConclusionOpioid-sparing techniques are effective in relieving postoperative pain and reducing opioid use, with additional potential in reducing postoperative nausea or vomiting, wound infection, time to bowel recovery and length of hospital stay.