地佐辛联合帕瑞昔布钠用于垂直斜视矫正术局部麻醉的镇痛效果研究

目的 研究地佐辛联合帕瑞昔布钠经静脉注射在垂直斜视的斜视矫正术中局部麻醉的镇痛效果.方法 选取山东省眼科研究所择期行斜视矫正术的垂直斜视患者80例,完全随机分为4组,每组20例,分别于术前15 min经静脉注射注射用帕瑞昔布钠40 mg（P组）、注射用地佐辛5 mg（D组）、注射用帕瑞昔布钠20 mg＋注射用地佐辛2.5 mg（PD组）、注射用等剂量0.9％氯化钠注射液（N组）.观察患者在术中5 min（T1）、术中15 min（T2）、术毕前5 min（T3）、术后2 h（T4）的疼痛数字模拟评分（NRS）、眼心反射及恶心呕吐、出汗等不良反应.因行上斜肌及下直肌手术的例数较少,故未对其在不同用药组间的NRS及眼心反射发生情况行统计学分析.结果 T1时点P、D、PD组NRS均较N组低,差异有统计学意义[（2.3±0.9）、（2.4±0.8）、（0.8±0.7）分比（5.2±0.7）分]（P＜0.05）;PD组NRS较P、D组低,差异有统计学意义（P＜0.05）;P、D组间差异无统计学意义（P＞0.05）.P组和D组患者各有1例呕吐,PD组患者无呕吐,N组患者发生呕吐3例（15.0％）,但组间差异无统计学意义（P＞0.05）.T2时点P、D、PD组NRS均较N组低[（3.2±1.1）、（2.4±0.7）、（1.5±0.8）分比（6.9±1.0）分],PD组NRS较P、D组低,D组NRS较P组低,差异均有统计学意义（均P＜0.05）.4组间恶心呕吐症状,N组较P、D、PD组明显,差异有统计学意义（P＜0.05）;P、D组较PD组明显,差异均有统计学意义（均P＜0.05）;P、D组差异无统计学意义（P＞0.05）.T3时点P、D、PD组NRS均较N组低,差异有统计学意义[（0.9±0.5）、（0.7±0.4）、（0.3±0.4）分比（1.9±0.9）分]（P＜0.05）;P、D、PD组间差异无统计学意义（P＞0.05）.4组间恶心呕吐症状,N组较P、D、PD 3组明显,差异有统计学意义（P＜0.05）;P、D、PD组间差异无统计学意义（P＞0.05）.T4时点4组间NRS差异无统计学意义（P＞0.05）.4组间恶心     

经皮穴位电刺激镇痛在乳腺癌根治术中的应用

目的 观察经皮穴位电刺激(Transcutaneous electrical acupoint stimulation,TEAS)用于乳腺癌根治术的镇痛效果.方法 择期行乳腺癌根治术患者60例,ASA分级Ⅰ或Ⅱ级,年龄30～60岁,体重50～80kg,采用随机数字表法,按1∶1比例分为对照组(GA组)和经皮穴位电刺激组(EA组),各30例.GA组在进行手术操作前,选择双侧合谷穴(LI4)、内关穴(PC6)和足三里(ST36)连接华佗电子治疗仪(V型),不进行穴位电刺激;EA组连接华佗电子治疗仪(V型)进行穴位电刺激30min.麻醉诱导:靶控输注异丙酚,血浆靶浓度4μg/ml,静脉注射芬太尼3μg/kg和维库溴铵0.1mg/kg.喉罩插管后行机械通气,维持PETCO2 35～45mmHg.麻醉维持:靶控输注异丙酚,血浆靶浓度2～4μg/ml,微量泵输注瑞芬太尼10～25μg·kg-1·h-1,维持Narcotrend在D2～E1 (46～20)之间,根据Narcotrend监测结果及血流动力学调整异丙酚和瑞芬太尼泵注速度.分别于电针前(T0)、电针结束时(T1)、诱导前(T2)、插管后5min(T3)、切皮前即刻(T4)、手术结束(T5)、拔管后即刻(T6)、拔管后5min (T7),记录HR、MAP、PETCO2、SpO2、Narcotrend数值.记录患者苏醒时间、拔管时间、术中麻醉药物瑞芬太尼和异丙酚用量、术后VAS评分及术后恶心呕吐(PONV)的发生率.结果 与GA组比较,EA组T3～T5时HR、MAP更平稳,瑞芬太尼用药量明显减少,苏醒时间、拔管时间缩短,PONV发生率降低(P＜0.05).结论 在乳腺癌改良根治手术中,TEAS复合全麻有良好的镇痛镇静作用,能减少麻醉药用量,减轻全麻术后的不良反应.     

地佐辛硬膜外与静脉用药在产科术后镇痛中的效果比较

目的：探讨地佐辛在产科术后镇痛中,静脉用药与硬膜外用药镇痛的效果比较。方法选择2014年6~12月于本院就诊的90例接受手术的产妇,随机分为A组、B组和对照组C组,每组30例。 A组采用术后静脉应用地佐辛5 mg镇痛,B组采用术后硬膜外应用地佐辛5 mg镇痛,对照组C组给予硬膜外推注生理盐水10 ml;比较3组术后各时间点的VAS评分,药物不良反应和术后满意度。结果3组患者术后2 h的VAS评分比较,差异无统计学意义(P>0.05);A组患者VAS评分在术后4 h明显低于对照组C组(P<0.05);B组患者VAS评分在术后4、8、12 h时均低于对照组C组(P<0.05);术后8、12 h时,B组患者VAS评分明显低于A组患者评分(P<0.05),术后24 h时,3组患者VAS评分比较,差异无统计学意义(P>0.05);A、B组患者术后无明显不良反应,C组患者出现2例术后寒战;A、B组术后镇痛满意度好于C组;B组满意度好于A组。结论地佐辛在产科术后镇痛中,硬膜外用药镇痛效果在时效方面较静脉用药更有优势,且患者满意度高。     

Epidural analgesia versus intravenous patient-controlled analgesia following minimally invasive pectus excavatum repair: a systematic review and meta-analysis

Background/Purpose

The minimally invasive pectus excavatum repair (MIPER) is a painful procedure. The ideal approach to postoperative analgesia is debated. We performed a systematic review and meta-analysis to assess the efficacy and safety of epidural analgesia compared to intravenous Patient Controlled Analgesia (PCA) following MIPER.

Methods

We searched MEDLINE (1946–2012) and the Cochrane Library (inception–2012) for randomized controlled trials (RCT) and cohort studies comparing epidural analgesia to PCA for postoperative pain management in children following MIPER. We calculated weighted mean differences (WMD) for numeric pain scores and summarized secondary outcomes qualitatively.

Results

Of 699 studies, 3 RCTs and 3 retrospective cohorts met inclusion criteria. Compared to PCA, mean pain scores were modestly lower with epidural immediately (WMD − 1.04, 95% CI − 2.11 to 0.03, p = 0.06), 12 hours (WMD − 1.12; 95% CI − 1.61 to − 0.62, p < 0.001), 24 hours (WMD − 0.51, 95%CI − 1.05 to 0.02, p = 0.06), and 48 hours (WMD − 0.85, 95% CI − 1.62 to − 0.07, p = 0.03) after surgery. We found no statistically significant differences between secondary outcomes.

Conclusions

Epidural analgesia may provide superior pain control but was comparable with PCA for secondary outcomes. Better designed studies are needed. Currently the analgesic technique should be based on patient preference and institutional resources.     

Antihyperalgesic effects of ginseng total saponins in a rat model of incisional pain

Background

The aim of this study was to assess whether intraperitoneal administration of ginseng total saponins (GTS) has antihyperalgesic effects in a rat model of incisional pain. The proinflammatory responses and reversal of the antihyperalgesic effect of GTS by N-methyl-d-aspartate (NMDA) or naloxone were also evaluated.

Materials and methods

Rats were injected intraperitoneally with 0.9% saline vehicle or various doses of GTS before or after a plantar incision. Paw withdrawal in response to application of the von Frey filament with the lowest bending force marked the mechanical withdrawal threshold (MWT). Blood samples were collected for the assessment of serum interleukin (IL)-1β and IL-6 levels. The IL levels were measured using an enzyme-linked immunosorbent assay kit. Rats were injected intraperitoneally with NMDA or naloxone before the GTS injection to assess the reversal of the antihyperalgesic effect of GTS.

Results

The MWT measured 2 h after the plantar incision increased significantly after the postincision administration of 50, 100, or 200 mg/kg of GTS compared with the MWT at 2 h after plantar incision. The MWT also increased significantly after the preincision injection of 100 or 200 mg/kg of GTS compared with the MWT of the vehicle control. Administration of GTS suppressed the postincision rise in serum IL-1β levels and NMDA inhibited the increase in the MWT compared with GTS alone.

Conclusions

Intraperitoneal administration of GTS before or after surgery induces antihyperalgesic effects in a rat model of incisional pain. The effects on mechanical hyperalgesia may be associated with anti-inflammatory cytokines and NMDA signaling.     

帕瑞昔布钠超前镇痛在骨科下肢手术中的应用

目的观察帕瑞昔布钠超前镇痛对不同年龄骨科下肢手术患者的镇痛效果。方法选择在该院接受治疗的骨科下肢择期手术患者80例为研究对象,根据年龄分为A组与B组,再按帕瑞昔布钠使用时间进一步分为A1、A2、A3、B1、B2、B3组,A1、B1组：术前30 min给予40 mg帕瑞昔布钠静脉推注;A2、B2组：手术结束后给予40 mg帕瑞昔布钠静脉推注;A3、B3组：在术前、术后均不使用帕瑞昔布钠,观察两组的疼痛程度（VAS评分）、镇静深度（RSS评分）等。结果使用帕瑞昔布钠比未使用帕瑞昔布钠的术后VAS评分要低;帕瑞昔布钠使用总量比较A1组0.05）。结论在骨科下肢手术中利用帕瑞昔布钠镇痛,具有良好的临床效果,对于成年、老年患者,超前使用帕瑞昔布钠镇痛效果更佳。     

地佐辛复合不同剂量布托啡诺用于下肢术后静脉镇痛的研究

目的比较地佐辛复合不同剂量布托啡诺用于下肢术后静脉镇痛的临床效果。方法择期骨科手术患者90例,美国麻醉医师协会（ASA）Ⅰ或Ⅱ级,年龄20～55岁,按随机数字表法分为A、B、C三组,每组30例,术毕按三种方案施行患者自控静脉镇痛（PCIA）。每组用地佐辛0．2mg／kg分别复合布托啡诺0．14,0．16,0．18mg／kg加0．9％氯化钠稀释至100ml。在术后2,4,8,12,24h观察并记录视觉模拟量表（VAS）评分、Ramsay评分、PCIA给药次数、不良反应,计算出综合满意度。结果B组和C组PCIA方案能达到满意的镇痛效果,B、C组在术后4,8,12hVAS和Ramsay评分均优于A组（P〈0．05）,A组在术后4,8h按压PCIA次数多于B、C组（P〈0．01）,C组嗜睡人数多于A组和B组。B、C组满意度高于A组（P〈0．01）。结论地佐辛0．2mg／kg复合布托啡诺0．16mg／kg可以较好地用于下肢术后静脉镇痛。     

超声引导下腹横肌平面阻滞对腹股沟斜疝患儿术后疼痛的影响

目的 评价超声引导下腹横肌平面（TAP）阻滞用于腹股沟斜疝手术患儿术后镇痛的效果.方法 选择2012年6月至2013年1月在福建中医药大学附属人民医院择期行单侧腹股沟斜疝手术患儿80例为研究对象.其年龄为1～5岁,美国麻醉医师协会分级为Ⅰ级,按照计算机生成的随机种子表将其随机分为超声引导下TAP阻滞组（研究组）和骶管阻滞组（对照组）,两组患儿均为40例,均采用七氟烷吸入诱导并维持,喉罩维持自主呼吸的麻醉方法.研究组行超声引导下TAP阻滞,并注入0.25%罗哌卡因0.5 mL/kg;对照组行单次骶管阻滞,并注入0.25%罗哌卡因1 mL/kg.两组患儿年龄、体质量等一般临床资料比较,差异无统计学意义（P〉0.05）.比较2种神经阻滞方法术后有效镇痛时间,需要追加镇痛药的病例数,疼痛评分及不良反应（本研究遵循的程序符合福建中医药大学附属人民医院人体试验委员会制定的伦理学标准,得到该委员会批准,分组征得受试对象监护人知情同意,并与之签署临床研究知情同意书）.结果 研究组术后有效镇痛持续时间为18.5 h[95%CI（16.4～20.5）];对照组术后有效镇痛持续时间为8.7 h[95%CI（6.3～11.1）].与对照组比较,研究组术后有效镇痛持续时间明显延长,差异有统计学意义（P＜0.001）.两组根据麻醉效果需要追加镇痛药的病例数分别为17例（42.5%）和32例（80.0%）,差异亦有统计学意义（P＜0.05）.对照组有5例（12.5%）患儿发生下肢运动阻滞.两组患儿恶心、呕吐等不良反应发生率比例,差异无统计学意义（P〉0.05）.结论 超声引导下TAP阻滞,在减少局部麻醉药用量同时,可以延长腹股沟斜疝手术患儿术后镇痛时间,减少不良反应.     

Comparison of interventions for pain control with tenaculum placement: a randomized clinical trial

Objective

Although previous studies have demonstrated that a variety of local anesthetics are effective to decrease pain associated with tenaculum placement, no studies directly compare an injection with a topical anesthetic. The objective of this study was therefore to compare mean pain scores with tenaculum placement after an intracervical lidocaine injection or topical lidocaine gel.

Study Design

A randomized, single-blinded trial of women presenting for office gynecologic procedures that required a tenaculum. Women aged 18 years or older were randomized to receive either a 1% lidocaine intracervical injection or topical application of 2% lidocaine gel to the cervix immediately prior to tenaculum placement. The primary outcome was pain at the time of tenaculum placement, measured on a 100 mm Visual Analog Scale. Secondary outcomes included pain with the intervention and satisfaction with tenaculum placement.

Results

Seventy-four women were enrolled and randomized; 35 subjects in each group met criteria for analysis. The two groups had similar socio-demographic characteristics. Women who received the injection had lower mean pain levels at tenaculum placement [12.3 mm (S.D. 17.4 mm) versus 36.6 mm (S.D. 23.0 mm), p<.001] but higher mean pain levels with study drug application [20.4 mm (S.D. 19.4 mm) versus 5.9 mm (S.D. 8.6 mm), p<.001]. Satisfaction with tenaculum placement was similar for the two groups.

Conclusion

Mean pain with tenaculum placement is lower after receiving a lidocaine injection than after receiving a topical lidocaine gel. Satisfaction with tenaculum placement is similar with both interventions.     

Src family kinases involved in CXCL12-induced loss of acute morphine analgesia

Functional interactions between the chemokine receptor CXCR4 and opioid receptors have been reported in the brain, leading to a decreased morphine analgesic activity. However the cellular mechanisms responsible for this loss of opioid analgesia are largely unknown. Here we examined whether Src family-kinases (SFK)-linked mechanisms induced by CXCR4 contributed to the loss of acute morphine analgesia and could represent a new physiological anti-opioid signaling pathway. In this way, we showed by immunohistochemistry and western blot that CXCL12 rapidly activated SFK phosphorylation in vitro in primary cultured lumbar rat dorsal root ganglia (DRG) but also in vivo in the DRG and the spinal cord. We showed that SFK activation occurred in a sub population of sensory neurons, in spinal microglia but also in spinal nerve terminals expressing mu-(MOR) and delta-opioid (DOR) receptor. In addition we described that CXCR4 is detected in MOR- and DOR-immunoreactive neurons in the DRG and spinal cord. In vivo, we demonstrated that an intrathecal administration of CXCL12 (1 μg) significantly attenuated the subcutaneous morphine (4 mg/kg) analgesia. Conversely, pretreatment with a potent CXCR4 antagonist (5 μg) significantly enhanced morphine analgesia. Similar effects were obtained after an intrathecal injection of a specific SFK inhibitor, PP2 (10 μg). Furthermore, PP2 abrogated CXCL12-induced decrease in morphine analgesia by suppressing SFK activation in the spinal cord. In conclusion, our data highlight that CXCL12-induced loss of acute morphine analgesia is linked to Src family kinases activation.