丁丙诺啡伍用氟哌利多和咪达唑仑术后镇痛的疗效观察

目的 :比较丁丙诺啡用于术后病人皮下自控镇痛 (PCSA)伍用不同剂量的氟哌利多和咪达唑仑的疗效观察。方法 :选择ASAⅠ～Ⅲ级手术病150例 ,随机分成3组 :A组50例镇痛药液为咪达唑仑20mg加丁丙诺啡1mg;B组50例镇痛药液为咪达唑仑10mg加氟哌利多5mg加丁丙诺啡1mg;C组50例镇痛药液为咪达唑仑10mg加氟哌利多8mg加丁丙诺啡1mg加负荷量 (0.1mg丁丙诺啡加2mg氟哌利多 )。所有病人均采用100ml舒贝康一次性PCSA泵 ,术毕用套管针穿刺于三角肌皮下固定持续用药剂量2ml/h ,PCSA每次0.5ml ,锁定时间15分钟 ,实施PCSA后24小时专人巡视评估镇痛效果并记录患者的不良反应 (恶心、呕吐、头晕、尿潴留、呼吸抑制等 )。结果 :不良反应 :A～C组出现不同程度头晕、恶心、呕吐分别为50 %、30 %、10 % ,组间比较 (P<0 05)。镇痛效果 :采用视觉模拟评分法 (VAS0～10)评分 ,三组病人镇痛当天评为0～3分的分别为40 %、38 %、60 % ,A组与B组比较 (P>0.05) ,C组与A、B组比较 (P<0.05)。结论 :氟哌利多可明显减少丁丙诺啡术后镇痛的不良反应 ;实施PCSA前给负荷量可改善丁丙诺啡的镇痛效果 ,丁丙诺啡PCSA的最佳配伍是C组     

盐酸右美托咪定用于膝关节镜手术患者腰硬联合麻醉的临床研究

目的:分析盐酸右美托咪定对膝关节镜手术患者行腰硬联合麻醉的效果.方法:选取所在医院106例膝关节镜手术患者,所有患者接受腰硬联合麻醉,观察组给予盐酸右美托咪定镇痛,对照组采用咪达唑仑,对两组麻醉效果进行比较.结果:观察组术后皮质醇、去甲肾上腺素、肾上腺素水平、VAS疼痛评分均低于对照组(P<0.05);观察组呼吸抑制、术中呼吸循环紊乱发生率(5.66%、1.89%)均低于对照组(18.87%、16.98%),两组差异明显(P<0.05).结论:在为膝关节镜手术患者行腰硬联合麻醉时,选择盐酸右美托咪定作为镇静镇痛药物,可减少疼痛感,稳定身体机能,减少麻醉风险.     

罗哌卡因复合右美托咪定关节腔内应用对膝关节镜术后镇痛的影响

目的：评价关节腔内给予罗哌卡因复合右美托咪定对膝关节镜术后镇痛的影响。方法：行膝关节镜手术患者60例,随机均分为两组（n=30）：罗哌卡因组（R组）给予0.25%罗哌卡因19 mL+1 mL生理盐水;罗哌卡因复合右美托咪定组（RD组）给予0.25%罗哌卡因19 mL+1 mL右美托咪定（100 mg）。记录患者术后VAS评分,以及术毕至首次使用镇痛药时间,术后24 h镇痛药芬太尼用量和不良反应。结果：术后1~8 h,罗哌卡因复合右美托咪定组（RD组）VAS评分明显低于罗哌卡因组（R组）;首次使用镇痛药时间,罗哌卡因复合右美托咪定组（RD组）明显长于罗哌卡因组（R组）;术后24 h镇痛药芬太尼用量,罗哌卡因复合右美托咪定组（RD组）明显少于罗哌卡因组（R组）;不良反应两组无区别。结论：关节腔内给予罗哌卡因复合右美托咪定可提供膝关节镜术后良好镇痛,延长术后首次使用镇痛药时间,减少术后24 h镇痛药芬太尼用量并且无不良反应。     

静脉注射咪达唑仑和右旋美托咪啶对经尿道前列腺切除患者罗哌卡因腰部麻醉作用的影响

目的：探讨咪达唑仑和右旋美托咪啶对经尿道前列腺切除患者罗哌卡因腰部麻醉阻滞平面及镇痛的影响。方法随机将硬膜外麻醉下行经尿道前列腺切除术患者48例分为咪达唑仑组、右旋美托咪啶组各24例,48例患者在实施麻醉操作前15 min分别给予咪达唑仑0.6 mg/kg、右旋美托咪啶0.6 mg/kg静脉注射,采用针刺试验记录神经阻滞最高水平面及术后镇痛药物量。结果咪达唑仑组的阻滞最高平面为T（6.1±0.7）,低于右旋美托咪啶组的T（4.7±0.8）,差异有统计学意义（P〈0.05）。与右旋美托咪啶组相比,咪达唑仑组延迟镇痛药首次使用时间,差异有统计学意义（P〈0.05）。结论右旋美托咪啶相对于咪达唑仑可延长经尿道前列腺切除患者罗哌卡因腰部麻醉的阻滞作用时间,术后镇痛效果优于咪达唑仑。     

超前应用氯诺昔康复合咪达唑仑 对乳房肿块切除术患者的镇痛镇静效果

［摘要］目的观察氯诺昔康复合咪达唑仑对乳房肿块切除术的超前镇痛效应及镇静效果。方法选择ASA Ⅰ或Ⅱ级在局麻下行乳房肿块切除手术的患者60例，随机分成氯诺昔康组（A组），氯诺昔康复合咪达唑仑组（B组）和对照组（C组），各20例，分别于术前30 min静脉注射氯诺昔康16 mg，氯诺昔康16 mg和咪达唑仑0.06 mg&;#8226;kg 1及0.9%氯化钠溶液4 mL，用视觉模拟评分（VAS）法进行镇痛评分，记录术中局麻药总用量及加药次数、呼吸循环指标、Ramsay镇静评分及术后镇痛药的使用情况和不良反应。结果与C组比较，A、B组VAS较低，术中局麻药总用量及加药次数、术后镇痛药次数较少（P＜0.05）；B组术中血流动力学稳定，Ramsay镇静评分较A、C组高（P＜0.05）。结论乳房肿块切除术术前使用氯诺昔康复合咪达唑仑能取得良好的超前镇痛效应和满意的镇静效果。     

多模式镇痛在妇科腹腔镜手术中的应用

目的 观察多模式镇痛对妇科腹腔镜手术患者术后痛的影响.方法 60例择期行妇科腹腔镜手术患者完全随机分为3组:超前镇痛组采用0.125％布比卡因50 ml进行切口浸润和腹腔内注射喷洒,麻醉诱导前静脉注射2ml曲马多2 mg/kg;术后镇痛组同等剂量的0.125％布比卡因50 ml在手术结束前使用,手术结束前静脉注射2 ml曲马多2 mg/kg;对照组采用相同的布比卡因,并静脉注射2ml的生理盐水.分别于术后1、4、8、12、和24 h采用视觉模拟评分(VAS)、舒适度评分(BCS)评分评价3组患者疼痛程度,记录需要镇痛药物时间和镇痛药物用量以及不良反应的发生.结果 与对照组相比,术后1、4、8h超前镇痛组和术后镇痛组的VAS及BCS舒适度评分明显降低(对照组:5.3±1.3、4.6±1.2、4.6±1.1;超前镇痛组:3.4±0.7、3.1±0.6、2.8±0.6;术后镇痛组:3.2±0.6、3.3±0.7、3.1±0.8;P＜0.01),而12、24 h则差异无统计学意义;超前镇痛组和术后镇痛组相比,除24 h2组的VAS差异有统计学意义(2.4±0.7比3.1±0.5,P ＜0.05)外,之前各时点2组之间VAS及BCS评分无统计学意义(P＞0.05).术后24h内镇痛药需求例数、超前镇痛组与术后镇痛组差异无统计学意义,但均明显低于对照组(P＜0.01).3组患者术后不良反应发生率差异无统计学意义(P＞0.05).结论 多模式术后镇痛可明显减轻妇科腔镜手术患者术后切口疼痛.     

不同剂量咪达唑仑对麻醉前后遗忘程度的影响

目的评估不同剂量咪达唑仑对中国患者麻醉前后遗忘程度的影响及相关不良反应。方法选择150例ASAⅠ~Ⅱ级择期行全麻手术的患者,随机分为5组,每组30例:生理盐水组(NS组)、2 mg咪达唑仑组(2M组)、3 mg咪达唑仑组(3M组)、5 mg咪达唑仑组(5M组)、8 mg咪达唑仑组(8M组),每组30例。于麻醉诱导前8 min静脉注射给予实验药物。观察患者从PACU回病房4 h后对麻醉诱导前12 min至苏醒后60 min之间的记忆。结果各组患者均未观察到逆行性遗忘表现(P>0.05)。给药前咪达唑仑组照片和事件回忆率、镇静评分和BIS值与NS组比较差异无统计学意义(P>0.05)。给药后,咪达唑仑组的照片(P=0.001)及事件回忆率(P<0.001)均低于NS组,镇静程度(P<0.001)均强于NS组,且呈剂量依赖效应。术后48 h谵妄评定结果显示,各组患者均未发现明显的精神状态异常表现(P>0.05)。结论诱导前静注3 mg和5 mg咪达唑仑,能使患者产生满意的镇静效果和顺行性遗忘效应,不影响术后苏醒时间及产生术后谵妄。     

咪达唑仑口服溶液比右美托咪定喷鼻更有效缓解儿童术前焦虑

目的：比较咪达唑仑口服溶液与右美托咪定喷鼻对儿童术前焦虑的影响。方法：选取2022年6～12月在我院拟行择期手术患儿90例，采用随机数字表法分为咪达唑仑口服溶液组、右美托咪定喷鼻组和生理盐水滴鼻组，麻醉前30 min，咪达唑仑口服溶液组0.5 mg/kg咪达唑仑口服溶液口服，右美托咪定喷鼻组2μg/kg右美托咪定喷鼻，生理盐水滴鼻组2 m L生理盐水滴鼻。记录3组患儿药物接受度。记录3组患儿给药前(T₁)、与父母分开时(T₂)、麻醉诱导时(T₃)、术后24 h(T₄)改良耶鲁术前焦虑量表(modified Yale preoperative anxiety scale-short form,m-YPAS-SF)评分。记录3组患儿麻醉诱导时的麻醉诱导期合作度量表(induction compliance checklist,ICC)评分。记录3组患儿苏醒时间和PACU停留时间。结果：与右美托咪定喷鼻组和生理盐水滴鼻组比较，咪达唑仑口服溶液组药物接受度评分较低(P<0.05),T₂     

不同浓度罗哌卡因配伍咪达唑仑、舒芬太尼对胸外科老年患者术后硬膜外镇痛效果的临床比较

目的 比较不同浓度罗哌卡因配伍咪达唑仑、舒芬太尼用于东台市人民医院胸外科老年患者术后硬膜外镇痛的临床效果.方法 选择2010年9月～ 2013年9月胸外科老年手术患者100例,随机分为A、B、C和D4组,分别给予0.3μg/mL咪达唑仑、0.2 μg/mL舒芬太尼和不同浓度罗哌卡因(0.100％、0.125％、0.150％、0.175％),进行硬膜外镇痛,记录4组患者术后4h、8h、12h、24 h和48 h的视觉模拟评分法(visual analogue scale,VAS)疼痛评分、Bromage运动神经阻滞评分分级以及不良反应等指标进行组间比较.结果 A组镇痛效果欠佳,术后4h、8h、12h、24 h和48 h时VAS评分高于其他3组,差异有统计学意义(P＜0.05),B、C、D3组间差异无统计学意义;D组有1例发生运动神经阻滞,术后4h、8h、12 h、24 h和48 h时Bromage评分高于其他3个组,差异有统计学意义(P＜0.05);4组不良反应比较,差异无统计学意义.结论 0.125％ ～0.150％罗哌卡因与0.3μg/mL咪达唑仑及0.2μg/mL舒芬太尼联合使用能够提供安全可靠的胸外科术后镇痛效果.     

右美托咪啶联合舒芬太尼对老年患者膝关节镜术后镇痛的疗效观察

目的观察分析右美托咪啶联合舒芬太尼对老年患者膝关节镜术后的镇痛效果。方法选择我院2012年7月至2014年12月收治的86例行膝关节镜手术的老年患者,随机分为观察组和对照组,每组43例。对照组术后采用舒芬太尼、托烷司琼镇痛,观察组采用舒芬太尼、托烷司琼、右美托咪定镇痛。比较两组术后4、12、48 h视觉模拟评分(VAS)以及不良反应发生率。结果观察组术后4、12、48 h的VAS评分均明显低于对照组,差异有统计学意义(P<0.05);观察组不良反应发生率明显低于对照组(9.30%VS 27.91%),差异有统计学意义(P<0.05)。结论对老年膝关节镜术后患者采用右美托咪啶联合舒芬太尼具有较好的镇痛效果,且不良反应较少。     

Addition of intrathecal midazolam to bupivacaine produces better post-operative analgesia without prolonging recovery.

OBJECTIVE: The administration of midazolam by centroneuraxis route has been shown to produce segmental antinociception. This midazolam analgesia was found to enhance the effects of local anesthetics given in combination epidurally without any adverse effects. The present study was designed to evaluate the post-operative analgesic effect of intrathecal midazolam-bupivacaine mixture in patients undergoing knee arthroscopy. METHODS: Thirty healthy patients scheduled for knee arthroscopy were divided into two groups to receive either midazolam-bupivacaine mixture (group M; n = 15) or bupivacaine alone (group B; n = 15) intrathecally. Level of sensory block, sedation score, assessment of pain using visual analogue score were recorded in both groups at regular time intervals. Time to block regression, recovery to ambulation and ability to void were recorded and noted before discharge. RESULTS: A significantly higher VAS score was seen in group B patients as compared to the score observed in group M patients before discharge (p<0.05). All patients received rescue analgesia in group B at a mean duration of 258 +/-46.8 minutes whereas only one patient in group M required supplemental analgesia within this period. Time to regression of sensory analgesia to L5-S1 level was longer in group M (267+/-67.38) as compared to group B (229.8+/-41.4) (p<0.05). Blood pressure, heart rate, oxygen saturation and sedation score showed no differences between the groups. Neither motor block nor time to void were prolonged with the addition of midazolam to bupivacaine. CONCLUSION: The results suggest that addition of midazolam to bupivacaine intrathecally provided better post-operative analgesia without any adverse effects.     

膝关节腔内注射罗哌卡因复合芬太尼用于膝关节镜术后镇痛的临床观察

目的 观察膝关节镜手术后关节腔内注射不同浓度罗哌卡因复合芬太尼的镇痛效果.方法 40例在腰麻-硬膜外联合阻滞下行单侧膝关节镜手术患者,随机分为四组,每组10例.术毕向关节腔内注入等容量（ 10 ml）的不同药物.F组芬太尼10μg;R组0.5％罗哌卡因;FR组芬太尼10μg＋0.5％罗哌卡因;N组0.9％氯化钠注射液.记录术后第2、4、8、12、24h患者在静息及运动状态（主动弯曲膝关节）的视觉疼痛评分（VAS）及不良反应.结果 2h时各组VAS评分均较低,差异无统计学意义;4、8、12、24h时F组、R组、FR组的VAS评分与N组相比均明显降低（均P＜0.05）,其中FR组与F组和R组相比,VAS评分又有明显降低（均P＜0.05）,而F组与R组差异无统计学意义.结论 关节腔内注射罗哌卡因复合芬太尼镇痛效果优于两者单独应用,而且并发症少,值得临床推广.     

Analgesic efficacy of amfenac, aspirin and placebo after extraction of impacted teeth

Amfenac, an arylacetic acid derivative, is a new investigational, nonsteroidal antiinflammatory agent that has exhibited analgesic properties superior to those of phenylbutazone in animals. This double-blind, randomized, parallel study was an early clinical trial to evaluate the analgesic efficacy of one oral dose of amfenac 100 mg compared to aspirin 600 mg and placebo in 120 subjects with moderate to severe pain after extraction of impacted molar teeth. Self-evaluated subjective pain intensity and relief reports for 4 hours were used as indexes of response. Analgesic effects of amfenac were significantly superior to those of placebo (p less than 0.001) and aspirin (p less than 0.05) by most measurements. Aspirin 600 mg was superior to placebo based on total pain relief and global scores (p less than 0.05). Compared with aspirin 600 mg, amfenac 100 mg provided greater and faster analgesia, lasting at least for 4 hours. Ordinal pain intensity scores correlated well with the visual pain analog scale. Seven (17.5%) patients taking amfenac compared to 5 (12.5%) taking placebo reported minor adverse effects).     

Oral ciramadol: a new analgesic for postoperative pain

Ciramadol, a new synthetic narcotic agonist-antagonist analgesic, was compared in 30 and 60 mg doses with pentazocine 50 mg, aspirin 650 mg, and placebo in the treatment of 153 patients with postoperative pain. All drugs were administered between six and 72 hours after surgery. Analgesic efficacy was assessed for six hours after study drug administration using verbal pain intensity, analog pain intensity, and verbal pain relief scales. Significantly (P less than .05) higher analgesic efficacy scores were seen with ciramadol 30 mg than with pentazocine 50 mg and placebo at most of the evaluation points. Doses of ciramadol 30 mg were significantly (P less than .05) more effective than aspirin 650 mg at several time periods, and ciramadol 60 mg was better than pentazocine and placebo at several evaluation times. The 30-mg dose of ciramadol was generally more effective than the 60-mg dose. The mean six-hour cumulative sum of pain intensity difference scores, total pain relief scores, and sum of pain analog intensity difference scores showed that the best analgesic response occurred in the ciramadol 30 mg group, followed by the ciramadol 60 mg, aspirin 650 mg, pentazocine 50 mg, and placebo groups. Side effects were rare and mild. There were no medically important changes in vital signs in any treatment group.     

Analgesic efficacy of acetaminophen sustained release

The analgesic efficacy of acetaminophen sustained release (SR) and acetaminophen immediate plus sustained release (IR + SR) was evaluated in 200 outpatients with pain after oral surgery. Under double-blind conditions SR high dose (2000 mg) or low dose (1000 mg), IR + SR high dose (500 + 1500 mg) or low dose (250 + 750 mg), or acetaminophen standard tablet high dose (1000 mg) or low dose (500 mg) were randomly administered after removal of a lower third molar. The hourly pain intensity was rated on a visual analog scale during 12 hours. The efficacy was based on peak effect (maximum pain intensity difference in percent), pain reduction (mean percentage pain intensity difference), duration of effect (time to remedication) and pain reduction index (pain reduction multiplied by duration of effect). Pain reduction was 37% with the 500-mg tablet and 54% with SR 2000 mg. The peak effect increased from 53% after 1.9 hours for the 500-mg tablet to 67% after 2.6 hours for SR 2000 mg. The SR formulation significantly increased the duration of effect without reduction in peak effect.     

不同浓度的罗哌卡因关节腔内注射对膝关节镜手术后镇痛效果的观察

目的观察膝关节镜手术后关节腔内注射不同浓度罗哌卡因的镇痛效果。方法120例在联合阻滞麻醉下行膝关节镜手术患者,随机分为4组,每组30例,术毕向关节腔内注入等容量(10mL)不同浓度的罗哌卡因。Ⅰ组0.25%的罗哌卡因;Ⅱ组0.375%的罗哌卡因;Ⅲ组0.5%罗哌卡因;Ⅳ组生理盐水对照组。记录术后第2、4、8、12h的视觉疼痛评分(VAS)及副作用。结果与Ⅳ组相比,Ⅰ、Ⅱ、Ⅲ组VAS评分有显著性差异(P<0.01);Ⅰ、Ⅱ组术后第2、4、8、12hVAS评分均显著高于Ⅲ组,有显著性差异(P<0.05);Ⅰ、Ⅱ组组间无显著性差异(P>0.05)。Ⅰ、Ⅱ、Ⅲ组均无副作用。结论关节腔内注射0.50%罗哌卡因镇痛效果优于其他浓度,而且并发症少,值得临床推广。     

腹腔内注射罗哌卡因对妇科腹腔镜术后镇痛效果观察（附60例报告）

目的观察妇科腹腔镜手术后腹腔内注射罗哌卡因用于术后镇痛的可行性和效果。方法采用随机、安慰剂对照和双盲的研究方法,将120例择期行腹腔镜下妇科手术患者分为A、B两组,A、B组术毕腹腔内分别注入0.5%罗哌卡因20ml、生理盐水20ml,术后4、8、12、24、48h对切口、内脏、肩部三个部位通过视觉模拟评分法(VAS)评估疼痛程度,VAS>4者予镇痛药处理。记录两组患者额外镇痛药的需要量并观察比较两组病人围手术期肺功能改变及术后恶心呕吐(PONV)等不良反应的发生情况。结果术后各时段各部位A组病人VAS评分均小于B组(P<0.05)。A组术后额外镇痛药用量小于B组。两组病人在围手术期肺功能及恶心呕吐等方面差异无统计学意义(P>0.05)。结论妇科腹腔镜手术后腹腔内注射0.5%罗哌卡因镇痛安全、有效、并发症少。     

Analysis of the analgesic efficacy of acetaminophen 1000 mg, codeine phosphate 60 mg, and the combination of acetaminophen 1000 mg and codeine phosphate 60 mg in the relief of postoperative pain

Patients who experienced pain after surgery were administered a single dose of 1 of 3 treatments: acetaminophen 1000 mg, codeine phosphate 60 mg, or a combination of these. Patients rated their pain intensity on ordinal and visual analog scales just prior to medication and at intervals thereafter for up to 5 hours. They also rated pain relief, pain half gone, and any adverse effects. Sum of pain intensity difference and total pain relief scores were analyzed using Dunnett's procedure. The drug combination was statistically superior to codeine as measured by SPID, TOTPAR, pain half gone, and time to remedication. The combination achieved better mean scores than acetaminophen on all efficacy measures, but was (marginally) statistically superior only in pain half gone. No appreciable differences in adverse effects were noted among the treatments. The difficulty of showing the analgesic efficacy of codeine in a single dose trial is discussed.     

膝关节局部注药复合股神经阻滞在全膝关节置换术后镇痛中的应用

目的观察膝关节局部注药联合股神经阻滞镇痛方式用于膝关节置换术（TKA）后康复镇痛的效果。方法将30例ASAⅠ-Ⅲ级拟行单侧全膝关节置换术的患者随机分为3组,每组10例,A组镇痛措施采用股神经阻滞,B组采用关节腔局部阻滞,C组采用股神经阻滞加关节腔局部阻滞。观察3组患者静息、活动时的疼痛视觉模拟评分（VAS）、关节活动度、肌力分级和并发症发生率。结果C组术后4、12、24、36、48h静息痛和被动活动痛VAS评分均低于A和B组（P〈0．05）,C组在术后的第3天膝关节屈伸活动度较A、B组有较好恢复（P〈0．05）。两组副作用无差别。结论TKA关节周围注药联合股神经阻滞可在术后早期减轻疼痛、改善关节活动度、促进康复,且不会增加副作用。     

A comparative study of caudal bupivacaine and midazolam-bupivacaine mixture for post-operative analgesia in children undergoing genitourinary surgery

OBJECTIVE: This study was designed to evaluate the analgesic efficacy of caudal midazolam-bupivacaine combination in providing post-operative pain relief in children undergoing genitourinary surgery and to study the occurrence of adverse effects. SUBJECTS AND METHODS: Thirty children, aged 2 to 8 years, scheduled for genitourinary surgery were allocated randomly to receive either 0.25% bupivacaine 0.5 ml/kg (group B; n = 15) or 0.25% bupivacaine 0.5 ml/kg with 50 microg/kg midazolam (group BM; n = 15) by the caudal route immediately after induction of general anesthesia. Heart rate, arterial blood pressure and oxygen saturation were monitored throughout the study period. Postoperative pain was assessed at regular intervals for 12 hours using an objective pain score. Analgesia was supplemented whenever the pain score was > or = 4. Duration of analgesia, as well as the requirement of additional analgesics, were noted. RESULTS: Lowest pain scores were observed with the addition of midazolam to caudal bupivacaine (p < 0.01). Duration of analgesia was longer in group BM (11 +/- 0.5 h) as compared to group B (7.4 +/- 2.1 hours) (p < 0.05). Fewer children (26.6%) required additional analgesia in the combination group whereas in group B, 60% of the children received analgesic supplements within 6 hours after surgery (p < 0.05). There were no significant changes in heart rate, blood pressure and oxygen saturation in both groups. We observed no untoward event in either of the groups. CONCLUSION: Caudal administration of bupivacaine-midazolam mixture prolongs post-operative analgesia compared to bupivacaine alone without causing any adverse effects.