丁卡因加透皮吸收促进剂用于静脉穿刺困难患者输液效果观察

目的探讨丁卡因加透皮吸收促进剂用于静脉穿刺困难患者输液的效果。方法选取应用β-七叶皂苷钠等脱水剂静脉输液后静脉穿刺困难患者150例，随机分为观察组和对照组各75例。对照组先热敷需静脉输液的部位，再常规消毒穿刺；观察组选择静脉后先用75％乙醇消毒皮肤。再在需穿刺部位皮肤根据静脉走向外敷丁卡因加透皮吸收促进剂浸润的棉片，25～30min后再常规消毒静脉穿刺输液。结果观察组一次穿刺成功率显著高于对照组，穿刺时及输液后30min、60min疼痛程度显著轻于对照组（均P〈0．05）。结论丁卡因加透皮吸收促进剂溶液外敷穿刺静脉有助于提高静脉穿刺困难患者穿刺成功率，减轻患者痛苦。     

丁卡因加透皮吸收促进剂用于静脉穿刺困难患者输液效果观察

目的 探讨丁卡因加透皮吸收促进剂用于静脉穿刺困难患者输液的效果.方法 选取应用β-七叶皂苷钠等脱水剂静脉输液后静脉穿刺困难患者150例,随机分为观察组和对照组各75例.对照组先热敷需静脉输液的部位,再常规消毒穿刺;观察组选择静脉后先用75%乙醇消毒皮肤,再在需穿刺部位皮肤根据静脉走向外敷丁卡因加透皮吸收促进剂浸润的棉片,25～30 min后再常规消毒静脉穿刺输液.结果 观察组一次穿刺成功率显著高于对照组,穿刺时及输液后30 min、60 min疼痛程度显著轻于对照组(均P相似文献   

癌性疼痛病人静脉吗啡日消耗量与芬太尼透皮贴剂的转换关系

目的 研究癌性疼痛病人静脉吗啡日消耗量与芬太尼透皮贴剂之间的转换比例。方法晚期癌痛病人13例,先采用吗啡病人自控静脉镇痛(PCIA)48 h,随后逐渐转换为芬太尼透皮贴剂镇痛。根据病人疼痛评分及吗啡日消耗量调整芬太尼贴剂的剂量,直至转换成功。记录治疗前、后每天疼痛严重程度(VAS评分):持续痛VAS、爆发痛VAS,缓解爆发痛所需的吗啡用量、PCIA吗啡日消耗量、芬太尼透皮贴剂剂量,生命体征和副作用。结果 静脉对应吗啡日消耗量(mg/d)与芬太尼贴剂转换剂量(μg/h)之间的直线回归方程为:Y=1.3603X 6.5088。治疗期间病人持续痛强度VAS评分与爆发痛强度VAS评分比治疗前明显降低(P<0.01)。芬太尼贴剂治疗期间静脉吗啡日消耗量呈逐渐下降趋势,与治疗前相比明显减少(P<0.01)。未发现严重副作用。结论 静脉吗啡日消耗量(mg/d)与芬太尼贴剂(mg/d)的转换比例是31:1。吗啡PCIA有助于芬太尼贴剂镇痛的快速滴定,并可以有效治疗癌症病人的爆发性疼痛,即PCIA可以在芬太尼贴剂剂量滴定期间补救性镇痛,在芬太尼贴剂镇痛转换成功后用于控制爆发性疼痛。     

芬太尼透皮贴治疗肝癌介入术后疼痛的观察与护理

目的:探讨芬太尼透皮贴治疗肝癌介入术后肝区疼痛的有效性和护理方法。方法:选择2010年5月～2011年7月入院行介入治疗后出现中、重度疼痛的患者90例,将其随机分为实验组45例,和对照组45例,实验组给予芬太尼透皮贴止痛,对照组给予硫酸吗啡缓释片口服止痛,并记录治疗前后疼痛度记分,止痛药物起效与持续镇痛的时间。结果:实验组用药后疼痛完全缓解30例(66.7%),明显缓解14例(31.1%),总有效率达97.8%,平均止痛持续时间为72h。对照组用药后疼痛完全缓解10例(22.2%),明显缓解20例(44.4%),总有效率达66.6%,实验组患者疼痛缓解情况明显优于对照组(P<0.05)。结论:芬太尼透皮贴是治疗肝癌介入术后爆发性疼痛的有效药物,使用方便,副作用小,患者依从性好,值得临床推广使用。     

应用复方阿替卡因减轻老年患者静脉穿刺疼痛

目的探讨复方阿替卡因在控制老年患者静脉穿刺疼痛的应用效果。方法将60例行静脉输液治疗的老年慢性病患者随机分为观察组和对照组各30例。观察组穿刺前2 min给予复方阿替卡因涂搽,对照组给予生理盐水涂搽。采用Wong-Banker面部表情量表和VAS量表评价疼痛评分,并比较两组患者满意度。结果观察组疼痛评分显著低于对照组,满意度评分显著高于对照组(均P<0.01)。结论复方阿替卡因应用于老年患者静脉穿刺,可以有效降低患者疼痛,增加患者满意度,安全性良好。     

多感官干预对新生儿静脉穿刺疼痛的影响

目的 观察视、听、触、味觉多感官干预对新生儿静脉穿刺疼痛的影响,探讨减轻新生儿穿刺疼痛的有效方法。方法 将90例新生儿肺炎患儿随机分为对照组与观察组各45例,对照组实施静脉穿刺常规护理,观察组在此基础之上通过戴眼罩、听母亲语音与心音、抚触、舌前部滴24%蔗糖水分别进行视、听、触、味觉干预。比较两组新生儿疼痛评分、生理参数及一次静脉穿刺成功率。结果 观察组新生儿穿刺时疼痛评分显著低于对照组,心率、呼吸及血氧饱和度显著优于对照组（均P＜0.05）。一次性静脉穿刺成功率高于对照组,但两组比较差异无统计学意义（P>0.05）。结论 视、听、触、味觉多感官干预可有效减轻新生儿静脉穿刺疼痛,维持患儿生理参数稳定。     

两种镇痛方式改善静脉输液港无损伤针穿刺疼痛的效果比较

目的 观察Valsalva呼吸、复方利多卡因乳膏减轻输液港无损伤针穿刺疼痛感的效果。方法 采用便利抽样法选取148例接受抗肿瘤药物治疗患者作为研究对象,随机分为对照组、利多卡因组和Valsalva组,分别在无损伤针穿刺前1 h涂抹医用凡士林(安慰剂)、复方利多卡因乳膏和穿刺时采用Valsalva呼吸。观察患者穿刺疼痛程度。结果 利多卡因组疼痛评分显著低于Valsalva组和对照组(均P<0.05)。结论 涂抹复方利多卡因乳膏可缓解输液港无损伤针穿刺疼痛,提升患者舒适度。     

氯普鲁卡因、利多卡因、丁卡因剖宫产腰麻比较

目的：比较三种局麻药蛛网膜下腔麻醉用于剖宫产。方法：90例足月妊娠孕产妇拟剖宫产随机分成氯普鲁卡因（CP），利多卡因（Li）、丁卡因（Di）三组．每组30例。在腰2-3脊间隙做腰硬联合穿刺，腰麻分别给予CP30mg，Li40mg和Di7．7mg。然后硬膜外置管留作备用。分别观察和记录病人麻醉情况。结果：CP、Li和Di三组麻醉起效时间分别是23．85±6．89s、34．29±8．94s和28．32±9．84s。取得切口无痛、平面最高时间和下肢不能运动时间（min）以及取得的最高阻滞点三组均相似。麻醉完全消退时间CP、Li和Di三组分别是78．45±16．83min．160．74±56．89min和471．54±99．24min。三组腰麻效果均非常满意，未行硬膜外麻醉。CP组从麻醉中恢复最快。均未发现麻醉后神经并发症。新生儿评分均正常。结论：剖宫产用氯普鲁卡因腰麻相对合理。     

Derivation and Cross-validation of Pharmacokinetic Parameters for Computer-controlled Infusion of Lidocaine in Pain Therapy

Background: Lidocaine administered intravenously is efficacious in treating neuropathic pain at doses that do not cause sedation or other side effects. Using a computer-controlled infusion pump (CCIP), it is possible to maintain the plasma lidocaine concentration to allow drug equilibration between the plasma and the site of drug effect. Pharmacokinetic parameters were derived for CCIP administration of lidocaine in patients with chronic pain.

Methods: Thirteen patients (mean age 45 yr, mean weight 66 kg) were studied. Eight subjects received a computer-controlled infusion, targeting four increasing lidocaine concentrations (1-7 micro gram *symbol* ml sup -1) for 30 min each, based on published kinetic parameters in which venous samples were obtained infrequently after bolus administration. From the observations in these eight patients, new lidocaine pharmacokinetic parameters were estimated. These were prospectively tested in five additional patients. From the complete data set (13 patients), final structural parameters were estimated using a pooled analysis approach. The interindividual variability was determined with a mixed-effects model, with the structural model parameters fixed at the values obtained from the pooled analysis. Internal cross-validation was used to estimate the residual error in the final pharmacokinetic model.

Results: The lidocaine administration based on the published parameters consistently produced higher concentrations than desired, resulting in acute lidocaine toxicity in most of the first eight patients. The highest measured plasma concentration was 15.3 micro gram *symbol* ml sup -1. The pharmacokinetic parameters estimated from these eight patients differed from the initial estimates and included a central volume one-sixth of the initial estimate. In the subsequent prospective test in five subjects, the new parameters resulted in concentrations evenly distributed around the target concentration. None of the second group of subjects had evidence of acute lidocaine toxicity. The final parameters (+/-population variability expressed as %CV) were estimated as follows: V1 0.101+/-53% 1 *symbol* kg sup -1, V2 0.452 +/-33% l *symbol* kg sup -1, Cl1 0.0215+/-25% l *symbol* kg sup -1 *symbol* min sup -1, and Cl2 0.0589+/-35% l *symbol* kg sup -1 *symbol* min sup -1. The median error measured by internal cross-validation was +1.9%, and the median absolute error was 14%.     

更换针头法注射绒促性素减轻患者疼痛

目的 减轻肌内注射绒促性素带来的疼痛,提高患者生活质量.方法 将140例先兆流产患者随机分为对照组和观察组各70例.对照组用抽吸药液后的注射器直接注射(即常规方法 );观察组注射器抽吸药液后更换针头·再排气注射.结果 观察组患者疼痛程度显著轻于对照组.局部反应发生率显著低于对照组(均P<0.01).结论 更换针头注射绒促性素可减轻患者疼痛,减少局部反应发生.     

Intravenous Lidocaine for Effective Pain Relief After a Laparoscopic Colectomy: A Prospective,Randomized, Double-Blind,Placebo-Controlled Study

A perioperative intravenous lidocaine infusion has been reported to decrease postoperative pain. The goal of this study was to evaluate the effectiveness of intravenous lidocaine in reducing postoperative pain for laparoscopic colectomy patients. Fifty-five patients scheduled for an elective laparoscopic colectomy were randomly assigned to 2 groups. Group L received an intravenous bolus injection of lidocaine 1.5 mg/kg before intubation, followed by 2 mg/kg/h continuous infusion during the operation. Group C received the same dosage of saline at the same time. Postoperative pain was assessed at 2, 4, 8, 12, 24, and 48 hours after surgery by using the visual analog scale (VAS). Fentanyl consumption by patient-controlled plus investigator-controlled rescue administration and the total number of button pushes were measured at 2, 4, 8, 12, 24, and 48 hours after surgery. In addition, C-reactive protein (CRP) levels were checked on the operation day and postoperative days 1, 2, 3, and 5. VAS scores were significantly lower in group L than group C until 24 hours after surgery. Fentanyl consumption was lower in group L than group C until 12 hours after surgery. Moreover, additional fentanyl injections and the total number of button pushes appeared to be lower in group L than group C (P < 0.05). The CRP level tended to be lower in group L than group C, especially on postoperative day1 and 2 and appeared to be statistically significant. The satisfaction score was higher in group L than group C (P = 0.024). Intravenous lidocaine infusion during an operation reduces pain after a laparoscopic colectomy.Key words: Analgesics, Colectomy, Pain, LidocaineBecause of a substantial increase in the incidence of benign and malignant tumors of the colon, the number of laparoscopic colorectal surgeries has increased.¹ Laparoscopic colectomy appears to be less painful, involves less bleeding, and has a faster recovery than an open colectomy.² Further, laparoscopic colorectal surgery has been proven to be beneficial in comparison with robot-assisted laparoscopic colorectal surgery in many aspects.³ However, postoperative pain because of surgical incision is still an issue that requires resolution. Therefore, various clinical applications such as intrathecal morphine, epidural analgesia, patient-controlled analgesia (PCA), and nonsteroidal anti-inflammatory drugs (NSAIDs) are used to control pain after a laparoscopic colectomy.^4,5 However, optimal management has not yet been established. A regional block can have technical difficulties and complications. The epidural failure rate has been reported up to 40%, and other drugs, such as opioids or NSAIDs, have side effects or drug allergies.^5,6Intravenous lidocaine is inexpensive, easy to inject, and a relatively safe drug.⁷ A number of studies showed that intravenous lidocaine has analgesic, anti-hyperalgesic, and anti-inflammatory properties, as well as a fast recovery, reducing the hospital stay and the time for bowel function recovery.^8–10 In addition, lidocaine in a nontoxic concentration has been reported to decrease the variant volatile anesthesia requirement in an animal study.¹⁰ Therefore, the authors aimed to determine whether a continuous infusion of intravenous lidocaine would have an adequate postoperative analgesic effect for a laparoscopic colectomy. The hypothesis of this study was that an intravenous lidocaine infusion during an operation could decrease postoperative pain.     

Differential Effect of Ketamine and Lidocaine on Spontaneous and Mechanical Evoked Pain in Patients with Nerve Injury Pain

Background: The mechanisms underlying neuropathic pain are incompletely understood. Targeting specific molecular mechanisms in the pain signaling system may assist in understanding key features in neuropathic pains such as allodynia. This study examined the effect of systemically administered ketamine, an N-methyl-d-aspartate receptor antagonist and lidocaine, a sodium channel blocker, on spontaneous pain, brush-evoked pain, and pinprick-evoked pain in patients with nerve injury pain.

Methods: Twenty patients participated in two randomized, double-blinded, placebo-controlled, crossover experiments in which they, on four different days, received a 30-minute intravenous infusion of ketamine (0.24 mg/kg), lidocaine (5 mg/kg), or saline. Ongoing pain, pain evoked by brush and repetitive pinprick stimuli, and acetone was measured before, during, and after infusion.

Results: Ketamine significantly reduced ongoing pain and evoked pain to brush and pinprick, whereas lidocaine only reduced evoked pain to repetitive pinprick stimuli. In individual patients, there was no correlation between the pain-relieving effect of lidocaine and ketamine on ongoing or mechanically evoked pains.     

盐酸利多卡因局部热敷缓解静脉补钾致疼痛效果观察

目的观察盐酸利多卡因局部热敷缓解静脉补钾致局部疼痛的效果。方法将68例行静脉补钾患者随机分为观察组36例、对照组32例。对照组用热毛巾湿敷,观察组在此基础上加用2%利多卡因热敷。结果两组疼痛程度比较,P<0.05,差异有显著性意义。结论盐酸利多卡因局部热敷可缓解静脉补钾引起的局部疼痛。     

盐酸利多卡因局部热敷缓解静脉补钾致疼痛效果观察

目的观察盐酸利多卡因局部热敷缓解静脉补钾致局部疼痛的效果。方法将68例行静脉补钾患者随机分为观察组36例、对照组32例。对照组用热毛巾湿敷，观察组在此基础上加用2％利多卡因热敷。结果两组疼痛程度比较．P〈0．05，差异有显著性意义。结论盐酸利多卡因局部热敷可缓解静脉补钾引起的局部疼痛。