Objective To evaluate the different analgesia mode for pain control in patients who undergo a procedure for prolapse and hemorrhoids. Methods Sixty patients who were undergoing the procedure for prolapse and hemorrhoids with combined spinal epidural anesthesia were randomized into two groups (30 patients each group). Group PCIA had the patient-controlled intravenous analgesia with sufentanil 100 μg and tropisetron 10 mg with 0.9% sodium chloride soution to 100 mL, the input background dose was 2 mL·h-1, the single PCA was 1 mL, the time interval was 15 min. Group PCEA had the patient-controlled epidural analgesia with 0.179% ropivacaine mesylate and sufentanil 40 μg with 0.9% sodium chloride soution to 200 mL, the input background dose was 4 mL·h-1, the single PCA was 2 mL, the time interval was 15 min, daily intravenous administration of tropisetron 5 mg. Recorded the Ramsay sedation score (RSS), the visual analogue scale (VAS), the comfortable satisfaction score (BCS) well as the improved Bromage classification at 6, 12, 24 and 48 hours after surgery. The frequencies of actual and effective pressing were also observed at the time point of 24 and 48 hours after surgery. Postoperative complications, including pruritus, nausea, headaches, and urinary retention, were also recorded. Results Compare to group PCEA, the Ramsay sedation score and the VAS score were significantly higher and the comfortable satisfaction score was significantly lower in group PCIA at 12, 24 h after the surgery(P<0.05), the improved Bromage classification was significantly lower in group PCIA at 6 h after the surgery(P<0.05). At the time of 24, 48 h after the operation, the frequencies of actual and effective pressing were significantly higher in group PCIA than those in group PCEA(P<0.05). Complications were more common in group PCIA, five patients presented postoperative nausea and vomiting(P<0.05). Conclusion The PCEA could provide more comfortable better postoperative analgesia and more comfortable than the PCIA for patients undergoing the procedure for prolapse and hemorrhoids.
吻合器痔上黏膜环切术(procedure for prolapse and hemorrhoids,PPH)作为治疗Ⅲ、Ⅳ度内痔和混合痔的重要手段已广泛应用于临床,如何减轻术后疼痛成为PPH推广的重要环节,故采取安全有效的术后镇痛尤为重要。静脉自控镇痛(patient controlled intravenous analgesia,PCIA)和硬膜外自控镇痛(patient-controlled epidural analgesia,PCEA)是临床常用的患者自控镇痛(patient controlled analgesia,PCA)模式。2015年6月—2016年8月,笔者观察不同镇痛模式在经吻合器痔上黏膜环切术后镇痛的应用,为临床提供参考。
1 资料与方法
1.1 一般资料
本研究经我院伦理委员会同意,患者及家属签署知情同意书。选择拟于腰硬联合麻醉下择期行PPH术患者60例,男女不限,年龄20~60岁,体质量指数18~25 kg·(m2)-1,美国麻醉医师协会(American Society of Anesthesiologists,ASA)分级为Ⅰ或Ⅱ级。根据术后不同镇痛模式,完全随机均分为PCIA组与PCEA组,每组30例。均无严重系统性疾病,无长期使用镇静药及阿片类药物等,精神、智力、听力正常。排除椎管内肿瘤、穿刺部位感染、近期服用抗凝药物等具有椎管内麻醉禁忌证者。 两组患者性别构成、年龄、体质量指数、ASA分级、手术时间等一般情况差异无统计学意义(表1)。
表1
Tab.1
表1
表1
两组患者一般资料比较
Tab.1
Comparison of baseline data between two groups of patients $\bar{x}\pm{s}$,n=30
组别
例数
性别
年龄/ 岁
男/例
女/例
PCIA组
30
16
14
37±9
PCEA组
30
15
15
38±7
组别
体质量指数/ [kg·(m2)-1]
ASA
手术时间/ min
Ⅰ级/例
Ⅱ级/例
PCIA组
23±2
18
12
45±10
PCEA组
22±3
19
11
43±11
表1
两组患者一般资料比较
Tab.1
Comparison of baseline data between two groups of patients $\bar{x}\pm{s}$,n=30
TIXIERS,BONNINM,BOLANDARDF,et al.Continuous patient-controlled epidural infusion of levobupivacaine plus sufentanil in labouring primipraous women:effects of concentration[J].Anaesthesia,20l0,65(6):573-580.
The effects of two different concentrations of epidural levobupivacaine were compared when used to provide analgesia for labour. Primiparous women in spontaneous uncomplicated labour were enrolled in a prospective, randomised and partially double-blinded study. The study solutions were either 0.568 mg.ml 611 levobupivacaine (low concentration group) or 1.136 mg.ml 611 levobupivacaine (high concentration group), with sufentanil 0.45 μg.ml 611 added to both solutions. Epidural analgesia was initiated with 20 ml of the study solution, followed by a standardised algorithm of top-up bolus injections. Epidural analgesia was then continued by self-administered boluses of 5-ml plus a continuous infusion of 5 ml.h 611 . Analgesia was found to be more efficacious in the high-concentration group. The dose of levobupivacaine administered was higher and sometimes overstepping recommended limits in the high concentration group, but with no observed increase in side-effects. The choice between these two concentrations may still be made according to the patient's and the practitioner's preferences. The effects of an intermediate concentration should be studied in the future.
KOSOROKP.Our criteria for PPH procedure in one day surgery practice[J].Tech Coloproctol,2010,14(1):9-11.
Background The aim of this report is to analyse our results and to underline our criteria for day surgery practice. Patients and methods Our patients are selected according to ASA criteria. Occasionally, the patients with some risk factors are selected but only when their concomitant diseases are well controlled. Results We have treated 673 patients with the third and early fourth degree haemorrhoids. We have had patients with several minor problems causing no influence on the success of the procedure. Good haemostasis, preventing postoperative bleeding, is the most important factor. Conclusion Among proctological procedures in haemorrhoid treatment, the PPH technique has firm and well-accepted position even in ambulatory surgery.
NIESTERSM,DAHANA.Pharmacokinetic and pharmaco-dynamic considerations for NMDA receptor antagonists in the treatment of chronic neuropathic pain[J].Expert Opin Drug Metab Toxicol,2012,8(11):1409-1417.
ABSTRACT Introduction: Chronic neuropathic pain is a debilitating disease caused by a lesion of the somatosensory nervous system. The N-methyl-D-aspartate receptor (NMDAR) plays an important role in the development of this pain state. Proof of efficacy of NMDAR inhibitors in treating neuropathic pain is limited, with the non-selective NMDAR antagonist ketamine being most effective. Areas covered: This review discusses the efficacy of subanesthetic doses of ketamine in alleviating chronic neuropathic pain, and highlights its pharmacokinetics and dynamics. The reader will understand under which treatment conditions ketamine is most effective, and through which mechanisms ketamine acts to induce long-term pain relief. The reader will gain an understanding of ketamine's complex metabolism and the role of its metabolite norketamine. Possible future alternatives for ketamine are discussed aimed at blockade of the subunit of the NMDAR involved in spinal and supraspinal pain pathways (NR2B). Expert opinion: More proof from good-quality randomized clinical trials on the efficacy of NMDAR inhibitors is required. A major advantage of ketamine therapy is the ability of the molecule to induce rapid and potent antidepressant effects. This is relevant taken the fact that chronic pain and depression are closely linked and are often present in the same patient.
FEENSTRAP,BRUNSTEINERM,KHINASTJ.Prediction of drug-packaging interactions via molecular dynamics(MD)simulations[J].Int J Pharm,2012,431(1/2):26-32.
The interaction between packaging materials and drug products is an important issue for the pharmaceutical industry, since during manufacturing, processing and storage a drug product is continuously exposed to various packaging materials. The experimental investigation of a great variety of different packaging material rug product combinations in terms of efficacy and safety can be a costly and time-consuming task. In our work we used molecular dynamics (MD) simulations in order to evaluate the applicability of such methods to pre-screening of the packaging material-solute compatibility. The solvation free energy and the free energy of adsorption of diverse solute/solvent/solid systems were estimated. The results of our simulations agree with experimental values previously published in the literature, which indicates that the methods in question can be used to semi-quantitatively reproduce the solid-liquid interactions of the investigated systems.
GULCIN US,YENERO,SAHINH,et al.The comparison of analgesic effects of various administration methods of diclofenac sodium,transdermal,oral and intramuscular,in early postoperative period in laparoscopic cholecystectomy operations[J].Pak J Med Sci,2014,30(1):96-100.
Objective:The aim of this study was to compare the efficacy of oral, intra muscular and transdermal diclofenac sodium for pain treatment in patients undergoing laparoscopic cholecystectomy, and their effect on postoperative opioid consumption. Methods:Following informed consent, 90 ASA I-II patients scheduled for laparoscopic cholecystectomy were randomized into three groups. Group PO got oral diclofenac sodium 1 hour before the operation, Group IM 75 mg diclofenac sodium intra muscular and Group TD diclofenac sodium patch 6 hours before the operation. Patients were not premedicated. Routine anaesthesia induction was used. After the operation in post anaesthesia care unit tramadol HCl infusion was delivered by intravenous patient controlled analgesia (iv PCA). Ramsey Sedation Score (RSS), Modified Aldrete Score System(MASS) and Visual Analog Scale Pain Score (VAS) was used for postoperative evaluation. Postoperative opioid consumption was recorded. Results:Demographic characteristics, intraoperative and postoperative hemodynamics of the patients were similar between groups. Postoperative VAS were lower at all time points in Group IM and Group TD than in Group PO. Lowest Postoperative RSS were in Group IM and the highest were in Group PO, and the difference between groups was significant. There was no significant difference in Postoperative MASS between groups. Postoperative tramadol consumption was statistically different between groups. Tramadol consumption in Group IM and Group TD was lower than Group PO. Postoperative nausea and vomiting was not observed. Local complications related to transdermal and intra muscular applications was not reported. Conclusion:In patients undergoing ambulatory laparoscopic cholecystectomy, a noninvasive application transdermal diclofenac sodium is as effective as intramuscular diclofenac sodium and can be preferred in postoperative pain treatment.
RIVARDC,DICKSON EL,VOGEL RI,et al.The effect of anesthesia choice on post-operative outcomes in women undergoing exploratory laparotomy for a suspected gynecologic malignancy[J].Gynecol Oncol,2014,133(2):278-282.
61PCEA in gynecologic oncology patients undergoing laparotomy is associated with decreased narcotic use and pain scores.61TAP blocks are associated with decreased narcotic use on the day of surgery, but not on postop days 2–3.
目的观察芬太尼、舒芬太尼分别与瑞芬太尼联用在颅内动脉瘤栓塞手术中的应用效果。方法择期行颅内动脉瘤栓塞手术患者69例,采用随机数字表法随机分为芬太尼组（F组）、芬太尼＋瑞芬太尼组（FR组）和舒芬太尼＋瑞芬太尼组（SR组）,每组23例。所有患者均采用全凭静脉全身麻醉,麻醉诱导：F组和FR组患者静脉注射3μg·kg-1芬太尼,SR组患者静脉注射0.5μg·kg-1舒芬太尼,余依次静脉注射咪达唑仑、丙泊酚、顺苯磺酸阿曲库铵,插管后行间歇正压通气,并调整呼吸参数维持呼气末二氧化碳分压（PETCO2）在30~35 mm Hg（1 mm Hg=0.133 k Pa）。麻醉维持：3组患者均采用微量泵持续泵注丙泊酚6~8 mg·kg-1·h-1、顺苯磺酸阿曲库铵0.1 mg·kg-1·h-1,同时FR组和SR组患者持续泵注瑞芬太尼0.2μg·kg-1·min-1,手术结束前5 min停用顺苯磺酸阿曲库铵、丙泊酚,瑞芬太尼输注至手术结束时,诱导后每60 min F组、FR组患者静脉注射0.1 mg芬太尼,SR组患者静脉注射5μg舒芬太尼。监测麻醉诱导前（T0）、麻醉诱导后（T1）、气管插管后1 min（T2）、术中1 h（T3）、拔管后1（T4）、5 min（T5）时的平均动脉压（MAP）及心率（HR）。记录患者呼吸恢复时间、苏醒时间、拔管时间及拔管后1 min、拔管后10 min时的警觉/镇静（OAA/S）评分,观察不良反应发生情况。结果 3组患者T0时MAP、HR比较差异均无统计学意义（P〉0.05）。F组患者T1时MAP、HR较T0时降低,T2、T4时MAP、HR较T0时增高（P〈0.05）;FR组患者T1、T3时MAP、HR较T0时降低,T2、T4时MAP、HR较T0时增高（P〈0.05）;SR组患者T1、T2、T3、T4时MAP、HR均较T0时降低（P〈0.05）。FR组患者T3时及SR组患者T2、T3、T4时MAP、HR较F组同时点降低（P〈0.05）。SR组患者T2、T4时MAP、HR比FR组同时点显著降低（P〈0.05）。3组患者呼吸恢复时间及拔管后1、10 min OAA/S评分比较差异均无统计学意义17
The comparison of analgesic effects of various administration methods of diclofenac sodium,transdermal,oral and intramuscular,in early postoperative period in laparoscopic cholecystectomy operations
, 孟秀荣
