Continuous epidural analgesia with bupivacaine-fentanyl versus patient-controlled analgesia with i.v. morphine for postoperative pain relief after knee ligament surgery

BACKGROUND: Both epidural analgesia and intravenous patient-controlled analgesia (PCA) have been found efficacious after various types of surgery. We compared the efficacy, safety, side effects and patient satisfaction of these methods in a randomized double-blind fashion after elective anterior cruciate ligament reconstruction of the knee. METHODS: Fifty-six patients had an epidural catheter placed at the L2-L3 interspace. Spinal anaesthesia with 15 mg of plain bupivacaine 5 mg/ml was performed at the L3-L4 interspace. After surgery the patients were randomly divided into three groups: 19 received a continuous epidural infusion with bupivacaine 1 mg/ml and fentanyl 10 mg/ml (F10), 19 patients received bupivacaine 1 mg/ml and fentanyl 5 microg/ml (F5) and 18 patients received saline (S). The rate of the epidural infusions was 0.1 ml kg(-1) h(-1). Each patient could also use an intravenous (i.v.) PCA device with 40 microg/kg bolus doses of morphine with a lockout period of 10 min and a maximum dose 240 microg kg(-1) h(-1). At the end of surgery ketoprofen 100 mg i.v. was given and continued orally three times a day. Patients were assessed for pain with a visual analogue scale (VAS) at rest and during activity, side effects and satisfaction at 3, 9 and 20 h. RESULTS: Both epidural infusions (F10, F5) provided better analgesia than epidural saline plus i.v. PCA (S) (P<0.05). There was slightly less nausea in the S group (NS). In spite of the difference in the quality of pain relief, there was no difference between the groups in patient satisfaction regarding analgesic therapy. CONCLUSION: Epidural infusion of fentanyl (1 microg kg(-1) h(-1) or 0.5 microg kg(-1) h(-1)) and bupivacaine (0.1 mg kg(-1) h(-1)) provided better pain relief but more side effects than intravenous morphine patient-controlled analgesia after knee ligament surgery. Almost all patients in all groups were satisfied with their pain relief.     

Patient-controlled intranasal diamorphine for postoperative pain: an acceptability study

A patient acceptability study was conducted using patient-controlled intranasal diamorphine. Patients undergoing nonemergency orthopaedic or gynaecological surgery self-administered intranasal diamorphine for 24 h postoperatively. Pain, pain relief, sedation, respiratory rate, nausea and vomiting were assessed regularly. After 24 h, patients and their attending nurses completed a questionnaire assessing satisfaction and practical aspects of the technique. Satisfaction was reported as good or complete by 69% of patients and 69% of nurses. Pain relief was assessed as better than expected by 45% of patients and better than normal by 50% of nurses. Seventy-nine per cent of patients would be pleased to use patient-controlled intranasal diamorphine again and 89% of nurses would be happy for their patients to use it again. Sedation was uncommon and mild and there were no episodes of significant respiratory depression. Fifty-three per cent of patients reported no nausea and 74% did not vomit at any stage. There were seven withdrawals, four due to problems with the device and three due to therapeutic problems. The nasal spray may need modification to improve reliability. However, we found patient-controlled intranasal analgesia an effective technique, which was well tolerated by patients and nurses and was without unpleasant side-effects. Further work to determine how it performs compared with intramuscular or intravenous analgesia is now needed.     

乳铁蛋白在大鼠坐骨神经慢性束缚损伤模型产生镇痛作用

目的:研究乳铁蛋白在大鼠坐骨神经慢性束缚损伤模型的镇痛作用。方法:30只成年SD大鼠被制作为坐骨神经慢性束缚损伤模型,用辐射热刺激法诱发鼠后腿回缩试验测定痛阈,实验动物分为5组,分别腹腔注射生理盐水及乳铁蛋白30mg/kg、100mg/kg、300mg/kg、1000mg/kg。药物效应以最大可能效应百分数(MPE%)表示。以t检验法分析乳铁蛋白各剂量组与对照组之间的差异。结果:腹腔注射乳铁蛋白剂量依赖性地延长大鼠后腿回缩潜伏期;乳铁蛋白的峰值作用时间在用药后60分钟;乳铁蛋白各剂量组的最大可能效应百分数与生理盐水组相比差异有显著性。结论:腹腔注射乳铁蛋白在大鼠坐骨神经慢性束缚损伤模型产生剂量依赖性镇痛作用。     

针灸镇痛在德国的临床疗效观察

目的观察在德国针刺治疗多种疼痛的临床疗效.方法873例患者均采用针刺疗法,辨证取穴,手法为平补平泻法,每周2次,10次为1疗程.结果多种疼痛经针刺治疗后症状明显改善,差异具有极显著性意义(P<0.01).结论针刺疗法是治疗多种疼痛的有效治疗方法.     

探讨人工流产术镇痛方法的应用

目的:探讨一种安全、有效、简便使用供选择的无痛人流。方法:将ASAI级198例中止妊娠者随机分为笑气组、笑气联合利多卡因局部浸润麻醉组、宫术安栓组、对照组。结果:笑气联合利多卡因局部浸润麻醉镇痛完全(P<0.01),无人流综合征发生,局部用药组能减轻疼痛,但不能避免人流综合征的发生。而笑气组虽然避免人流综合征的发生,但不能完全消除疼痛。结论:笑气联合利多卡因局部浸润麻醉用于人工流产安全有效。     

硬膜外阻滞对产程及母儿预后的影响

目的 探讨硬膜外阻滞对产程进展及母儿的影响.方法 采用回顾性方法,将施行分娩镇痛的168例作为硬膜外组,另选择同期172例条件相似,未行任何镇痛措施的自然临产产妇为对照组,记录两组产妇产程时间、新生儿1分钟和5分钟Apgar评分及产妇第三产程和产后2小时出血量.结果 ①产程时间比较,硬膜外组第一产程活跃期、第二产程时间比对照组延长,两组具极显著性差异(Ρ＜0.01),第三产程时间两组比较无显著性差异.②硬膜外组新生儿Apgar评分＜7分者高于对照组,两组比较无显著性差异.③两组产妇产后出血量比较无显著性差异.结论 硬膜外阻滞对产妇产程有延长作用,但对新生儿出生结局及产妇产后出血无明显影响.     

国产左旋布比卡因硬膜外镇痛的临床效果观察

目的评估不同浓度国产左旋布比卡因硬膜外镇痛的疗效及安全性。方法选择妇产科手术患者90例，随机分A、B、C三组，分别用0．10％、0．15％、0．20％左旋布比卡因，各组均加入3μg／ml芬太尼，用M—J镇痛泵以3ml／h速度泵入。观察手术情况、术后1h、5h、10h、20h、40h测VAS镇痛评分及采用Bromage法评价下肢运动阻滞情况，同时观察瘙痒、恶心等副作用。结果B、C组术后各时段VAS评分明显低于A组（P〈0．01）；A、B组下肢运动阻滞明显低于C组（P〈0．05），患者满意度B、C组优于A纽，其它无明显差异。结论0．15％的国产左旋布比卡因术后镇痛效果确切，下肢运动影响小。     

笑气联合利多卡因用于无痛人工流产的临床研究

目的:探讨笑气吸入联合利多卡因宫颈注射用于早孕人工流产镇痛的临床效果。方法:将150例自愿行人工流产的早孕者随机分为A组(笑气吸入)、B组(笑气吸入联合利多卡因)及C组(常规人工流产术),每组50例。对3 组镇痛效果、扩宫情况、术中出血量、子宫收缩幅度及呼吸、循环系统情况进行比较。结果:3组镇痛及扩宫效果有显著性差异(P<0．05),B组镇痛和宫颈扩张效果最佳。子宫出血量及子宫收缩幅度3组无显著性差异(P>0．05)。结论:笑气联合利多卡因宫颈注射用于无痛人工流产, 镇痛效果及宫颈松弛良好,副反应少且操作简单安全, 值得临床推广使用。     

复方吲哚美辛栓与卡孕栓在人工流产术中镇痛及扩宫疗效的临床对照研究

目的:比较复方吲哚美辛栓与卡孕栓在人工流产术中止痛和扩张宫颈作用。方法:将322例早孕要求终止妊娠妇女,分为复方吲哚美辛栓组(n=140),卡孕栓组(n=182),观察两组对象术中疼痛程度、扩宫效果及副反应发生情况。结果:复方吲哚美辛栓组术中镇痛、扩张宫颈效果优于卡孕栓组(P<0·01,P<0·05),血卡孕栓组较复方吲哚美辛栓组术中、术后出血量少(P<0·05),卡孕栓组术后恶心、呕吐及腹泻例数明显多于复方吲哚美辛栓组(P<0·01),其他副反应则无明显差异(P>0·05)。结论:复方吲哚美辛栓较卡孕栓在人工流产术中具有明显的扩张宫颈、减轻疼痛的作用,且术后副反应少。     

剖宫产术后罗哌卡因复合吗啡硬膜外镇痛对泌乳素的影响

目的观察剖宫产术后病人硬膜外连续注射罗哌卡因与吗啡对泌乳素的影响。方法60例健康足月初产妇，择期在联合椎管内麻醉下施行剖宫产术。术毕随机分为镇痛组和对照组各30例：镇痛组行硬膜外镇痛，注入0．075％罗哌卡因和0．009％吗啡复合液（2ml／h）持续48h镇痛；对照组术毕拔出硬膜外导管。采用放射免疫法测定血浆泌乳素（PRL），视觉模拟评分（VAS）估计镇痛效果。结果镇痛组VAS明显低于对照组（P〈0．01），镇痛组术后PRL较术前升高（P〈0.05），术后24～48h镇痛组PRL高于对照组（P〈0．05或P〈0．01）；镇痛组初乳时间较对照组提前（P〈0．01），镇痛组肠蠕动恢复时间明显快于对照组（P〈0．01），术后生命征平稳，无恶心、呕吐、头痛、肢体麻木发生。结论剖宫产术后低浓度罗哌卡因复合吗啡持续硬膜外镇痛效果确切安全，能促进PRL分泌，初乳时间提前，加快肠蠕动恢复。