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Intercostals Nerve Freezing Technique for Analgesia on Post-operative Chest: A Randomized Controlled Trial

ObjectiveTo discuss the clinical effects of intercostals nerve freezing technique for analgesia on post-operative chest. MethodsWe included 80 patients with thoracotomy in Zhongshan Hospital in Xiamen University between June 2013 and June 2014. The patients were divided into a trial group (30 males and 10 females at average age of 59.90± 10.62 years) and a control groups (28 males and 12 females at average age of 59.85± 10.52 years) by random digital table. The patients in the trial group were treated with frozen the intercostals nerve roots located in the incision and next intercostals before closing the chest by cryotherapy therapy apparatus (K520 type, Beijing Kulan Company). The patients in the control group were treated with self-control intravenous analgesia pump post-operation. We compared the postoperative incision pain and cough, sputum reflection score, and pulmonary complications between the two groups. ResultsThe pain degree in the trial group was significantly weaker than that in the control group on the first day, the second day and the seventh day after operation (t=-6.45, -4.95, -3.14, P < 0.05). Cough, sputum reflection score were significantly higher than those in the control group (P < 0.01). Pulmonary complications were significantly lower (t=3.023, P < 0.05). There were 4 patients with pneumonia and no pulmonary atelectasis in the trial group. While there were 8 patients with pneumonia in the control group and 1 patient with pulmonary atelectasis. ConclusionIntercostals nerve freezing technique can drastically reduce postoperative pain in the patients with open thoracic operation, effectively promote patient cough and expectoration, and reduce pulmonary complications rate.

全膝关节置换术围手术期疼痛管理

全膝关节置换术是治疗膝关节终末期病变的重要方式，但术后疼痛严重影响患者的术后康复训练和手术疗效，甚至导致许多并发症。如何有效缓解术后疼痛已经成为临床医生所关注的重要难题。该文将对膝关节置换术后镇痛策略及镇痛方法进行综述。

三种分娩镇痛方法的临床比较

【摘要】目的 观察全程陪伴分娩、罗哌卡因复合芬太尼患者自控硬膜外镇痛、潜伏期陪伴分娩加罗哌卡因复合芬太尼患者自控硬膜外镇痛分娩临床效果及对母婴的影响。方法 足月单胎头位初产妇(美国麻醉师协会ASAⅠ～Ⅱ级)150例,随机分为3组,A组(对照组,n=50)由助产士全程陪伴分娩,不使用镇痛药；B组(n=50)为活跃期后使用罗哌卡因1 g/L加芬太尼1.5 mg/L；C组(n=50)为潜伏期陪伴分娩加活跃期后使用罗哌卡因1 g/L加芬太尼1.5 mg/L。观察镇痛效果、用药量、分娩方式、产后出血量、对产程、新生儿的影响及产妇满意度。结果 3组镇痛质量分数为A组＜B组＜C组(Plt;0.01),用药总量为B组gt;C组(Plt;0.05),产妇满意率为A组＜B组＜C组,剖宫产率为A组＞B组＞C组。新生儿Apgar评分及产后出血量各组间比较差异均无统计学意义。结论 潜伏期陪伴分娩加罗哌卡因复合芬太尼患者自控硬膜外镇痛分娩镇痛效果好,用药量少,可缩短产程,降低剖宫产率,产妇满意度高。

Clinical Effect Observation of Advance Balance Analgesia in Anorectal Operation During Perioperative Period

目的　探讨围手术期超前平衡镇痛在肛肠手术中止痛的临床效果。方法　回顾性分析2009年11月至2010年10月期间巴中市中医院肛肠科123例采用腰俞穴麻醉的肛肠手术患者的临床资料，患者被分成超前平衡镇痛组（60例）和传统镇痛组（63例）2组。2组术前准备相同，术后均口服布洛芬缓释胶囊300mg止痛，2次/d。对Ⅲ～Ⅳ度内痔及内括约肌痉挛的患者术中均常规行内括约肌松解术，对VAS评分6分以上的患者选择使用盐酸曲马多注射止痛。超前平衡镇痛组术前0.5h肌注安定10mg，口服布洛芬缓释胶囊300mg，术中采用2%盐酸利多卡因5ml、0.75%盐酸布比卡因5ml、芬太尼50 μg、地塞米松5mg用生理盐水稀释成20ml行腰俞穴麻醉并止痛，术毕肛内塞用双氯芬酸钠栓1枚。传统镇痛组术中采用2%盐酸利多卡因5ml、0.75%盐酸布比卡因5ml用生理盐水稀释成20ml行腰俞穴麻醉。比较2组术后4、6、8、12、24及48 h VAS评分、盐酸曲马多使用率及恶心、呕吐及尿潴留的发生率。结果　术后4、6、8、12、24及48 h VAS评分超前平衡镇痛组均明显低于传统镇痛组（P＜0.01），术后盐酸曲马多使用率超前平衡镇痛组明显低于传统镇痛组（P＜0.05），恶心、呕吐及尿潴留的发生率2组比较差异均无统计学意义（P＞0.05）。结论　围手术期超前平衡镇痛用于肛肠手术止痛是一种疗效肯定、安全、不良反应少而又简单易行的镇痛方法。

Application of LowDose Ketamine during the Local Anesthesia in Cesarean Section Assisted by Analgestic and Amnestic Anesthesia

【摘要】 目的 观察小剂量氯胺酮在健忘镇痛麻醉辅助局部麻醉（局麻）剖宫产中的应用。方法 选择1200例剖宫产的孕妇,随机分为单纯局麻组(L组)、氟芬强化局麻组(F组)和健忘镇痛麻醉组(J组),每组400例。L组单纯局麻;F组局麻术中辅以氟哌利多500 mg,芬太尼015 mg;J组在F组基础上辅以氯胺酮,观察各组患者麻醉诱导至胎儿娩出时间;新生儿1、5 min Apgar评分;手术中血压相对于基础值的波动情况;手术中及手术后出血情况及麻醉满意度。 结果 J组与L组和F组比较,胎儿娩出时间无显著差别;Apgar评分提高;手术中孕妇血压波动不明显;手术中及手术后出血量无明显增加,麻醉满意度明显提高。 结论 由小剂量氯胺酮辅助实施的健忘镇痛麻醉在局麻剖宫产中优于单纯局麻和氟芬强化局麻,在剖宫产中尤其急诊剖宫产中值得推广。【Abstract】 Objective To observe the application of lowdose ketamine during the local anesthesia in cesarean section assisted by analgestic and amnestic anesthesia. Methods A total of 1200 cases who need cesarean section were randomly divided into 3 groups (400 cases in each group): simple local anesthesia group (group L), droperidolfentanyl strengthen local anesthesia group (group F) and analgestic and amnestic anesthesia group (group J). Group L was only local anesthesia. Group F was local anesthesia supplemented by droperidol 500 mg, fentanyl 015 mg. Group J was supplemented with ketamine on the basis of group F. Then the time from anesthesia to the fetus delivery, Neonatal Apgar score of one and five minutes, the blood pressure fluctuations, amount of bleeding in or after surgery and the satisfaction of anesthesia were all observed. Results Compared with group L and F, the delivery time was no significant difference, Apgar score increased, blood pressure fluctuations in pregnant women was not obviously varied, amount of bleeding in or after surgery had no significantly increase, and the satisfaction of anesthesia improved markedly all in group J. Conclusions The analgestic and amnestic anesthesia assisted by lowdose ketamine, in cesarean section, is better than local anesthesia and strengthen local anesthesia by droperidolfentanyl, which is worthy to be popularized, especially in emergency caesarean section.

Analysis on the analgesic effect of Chinese medicine acupuncture in daytime operation oftotal extraperitoneal inguinal hernia repair

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.

自控静脉镇痛在剖宫产产妇术后镇痛中的效果评价

目的观察自控静脉镇痛（PCIA）在剖宫产产妇术后镇痛中的效果。 方法选取2013年6月－12月行剖宫产且术后疼痛视觉模拟评分（VAS）＞4分需进行药物止痛产妇79例，其中自愿选取肌肉注射哌替啶镇痛的29例产妇纳入对照组，其余50例采用PCIA（舒芬太尼150μg+托烷司琼5 mg+生理盐水共150 mL）镇痛方式的产妇纳入观察组，分别在术后2、4、6、12、24 h对两组产妇疼痛程度、24 h睡眠质量、不良反应、镇痛满意度进行比较。 结果两组产妇术后不同时点的疼痛程度，24 h睡眠质量、不良反应比较，观察组优于对照组，差异有统计学意义（P＜0.05），观察组镇痛满意率优于对照组，差异有统计学意义（P＜0.05）。 结论PCIA能长久持续地减轻剖宫产产妇术后的疼痛，有效提高产妇术后睡眠质量，降低不良反应。

下肢手术后吗啡、罗哌卡因和地塞米松配伍镇痛效果比较

【摘要】 目的 总结吗啡、罗哌卡因和地塞米松三种药物复合在下肢手术后硬膜外单次给药维持镇痛的时间及并发症。方法 2006年3月—2009年8月收治ASAⅠ~Ⅱ级骨科下肢手术患者120例,随机分为两组,每组60例。A组吗啡2.5 mg加罗哌卡因20 mg,B组吗啡2.5 mg加罗哌卡因20 mg加地塞米松5 mg,均用生理盐水稀释至10 mL,于手术后分两次注入硬膜外腔。观察两组患者术后6、12、24 h VAS评分情况；术后镇痛(VAS≤3分)维持时间及另一侧下肢运动功能恢复时间；术后呼吸抑制、恶心呕吐和皮肤瘙痒的副作用发生情况。结果 两组患者术后6、12 h VAS评分均＜3分,但24 h A组VAS评分(＞4分)明显高于B组；B组患者术后无痛时间明显长于A组,术后另一侧下肢运动功能恢复时间两组基本相同；两组患者均未发生呼吸抑制,恶心呕吐发生率相似,但A组皮肤瘙痒发生率高于B组(Plt;0.05)。结论 吗啡加罗哌卡因加地塞米松硬膜外给药可维持下肢手术患者术后镇痛24 h以上,且并发症少。

Application of infiltration between the popliteal artery and capsule of the knee block in analgesia after total knee arthroplasty

Effective postoperative pain management in patients undergoing total knee arthroplasty is an important part of the realization of enhanced recovery after surgery. Peripheral nerve block is of great significance to the control of postoperative pain, and clinicians are committed to finding a nerve block that has little impact on muscle strength and is conducive to the early recovery of motor function after total knee arthroplasty. Infiltration between the popliteal artery and capsule of the knee block can selectively block the sensory branch of the posterior end of the knee joint without affecting the motor branch of the common peroneal nerve, so that the muscle strength can be minimally affected under the condition of adequate analgesia. This article reviews the proposal of infiltration between the popliteal artery and capsule of the knee block, the approach and method of the block, and the advantages of combining with different nerve blocks for analgesia after total knee arthroplasty.

微创玻璃体切割手术中表面麻醉的镇痛效果观察