笑气吸入用于镇痛分娩的观察与护理

目的 探讨笑气吸入用于镇痛分娩的效果及对母儿的影响。方法 随机抽取50例产妇实施镇痛分娩(实验组),50例产妇给予氧气吸入作为对照组。观察2组产妇及新生儿出生时Apgar评分等各项指标。结果 2组产妇镇痛效果、第一产程时间比较,差异有显著性。2组产妇及新生儿出生时Apgar评分等各项指标差异无显著性。结论 笑气吸入用于分娩镇痛对母儿均无不良影响,是安全、有效、简便的镇痛分娩方法。同时,高质量的护理更能有效提高无痛分娩的效果。     

导乐分娩联合水针镇痛的临床研究

目的　探索导乐分娩联合水针镇痛后对产程的影响及减痛效果。方法　对 15 0例初产妇采用随机的方法分为 3组 ,第 1组 :传统方法待产 ;第 2组 :导乐护士一对一陪产 ;第 3组 :导乐护士一对一陪产联合水针镇痛。结果　第 3组第一产程和总产程明显缩短 ,统计学有差异 (P <0 .0 5 ) ,镇痛有效率 10 0 %。结论　导乐分娩联合水针镇痛安全有效 ,能加速产程进展     

Long term depression of human nociceptive skin senses induced by thin fibre stimulation.

We have recently shown that stimulation, through a multi-electrode array, of thin nerve fibres close to the dermo-epidermal junction in the skin, produces powerful inhibition of itch and, to a lesser degree, cutaneous pain in humans. Here, we have studied the induction time and frequency dependency (range 1-10Hz) of the inhibitory effects of such stimulation on itch, mechanical, and thermal pain, in 20 healthy subjects. Sixteen electrodes applied on the skin were consecutively stimulated using a method termed cutaneous field stimulation (CFS). The results show that different treatment periods with CFS were required for the induction of significant inhibitory effects on different nociceptive qualities: 1st heat pain (1 min), itch (3 min), 2nd heat pain (6 min), pinch evoked pain (8 min). Six to ten minutes stimulation sufficed to induce peak inhibitory effects on all these sensory qualities while longer stimulation (up to 40 min) did not cause significantly stronger inhibition. The effects on itch, 1st and 2nd heat pain lasted over 55 min after termination of CFS. There was no effect on prickle. No significant difference in inhibitory effects of different stimulation frequencies (1, 4 and 10Hz/electrode) was found. The induction time and effective stimulation frequencies may suggest that the underlying mechanisms are similar to those of long term depression (LTD) previously described in the spinal cord in animal experiments.     

Dor radicular causada por nódulo de Schmorl: relato de caso

Schmörl's node is focal herniation of intervertebral disc through the end plate into the vertebral body. Most of the established Schmörl's nodes are quiescent. However, disc herniation into the vertebral marrow can cause low back pain by irritating a nociceptive system. Schmörl's node induced radicular pain is very rare condition. Some cases of Schmörl's node which generated low back pain or radicular pain were treated by surgical methods. In this article, authors reported a rare case of a patient with radicular pain cause by Schmörl's node located inferior surface of the 5 th lumbar spine. The radicular pain was alleviated by serial 5 th lumbar transforamnial epidural blocks. Transforamnial epidural block is suggested as first conservative option to treat radicular pain due to herniation of intervertebral disc. Therefore, non‐surgical treatment such as transforamnial epidural block can be considered first treatment option of radicular pain caused by Schmörl's node.     

Bloqueo interfascial serrato-intercostal como estrategia ahorradora de opioides en cirugía supraumbilical abierta

Introduction

The administration of local anaesthetic in the serratus-intercostal space provides adequate analgesia in non-reconstructive breast surgery. The aim of this study was to evaluate whether the blockage of the last intercostal nerves (T7-T11) can lead to opioid savings in supra-umbilical open surgery procedures.

Pain control with continuous infusion preperitoneal wound catheters versus continuous epidural analgesia in colon and rectal surgery: A randomized controlled trial

Objective

To compare continuous infusion preperitoneal wound catheters (CPA) versus continuous epidural analgesia (CEA) after elective colorectal surgery.

地佐辛用于儿童术后镇痛有效性和安全性的随机对照试验

背景：新型阿片受体激动 拮抗剂地佐辛用于儿童术后镇痛的研究报道甚少,且没有公认的儿童用药参考剂量。 目的：探讨地佐辛应用于儿童术后镇痛的有效性和安全性,为其用于儿童术后镇痛提供合适的参考剂量。 设计单中心RCT。 方法：纳入在重庆医科大学附属儿童医院行先天性心脏病（CHD）手术后直接转入PICU的患儿,手术时年龄>28 d,术前美国麻醉医师协会（ASA）分级Ⅲ～Ⅳ级。按随机数字表法生成随机分组方案,装入密闭信封保存;由当班的PICU医生负责入组,由管床护士执行干预。随机分为5组,试验组患儿在术后持续静脉泵入低剂量（D1组）、中剂量（D2组）或高剂量（D3组）地佐辛,对照组泵入舒芬太尼（SF组）或吗啡（M组）,观察术后疼痛评分和镇静评分。未对结局指标观察人员和数据分析人员施盲。共同干预措施：入PICU后使用有创呼吸机辅助通气,予对症处理和咪达唑仑镇静。D1、D2、D3组分别予地佐辛20、30、40 μg·kg-1·h-1,SF组予舒芬太尼0.08 μg·kg-1·h-1,M组予吗啡20 μg·kg-1·h-1,均为静脉泵注。疼痛评分包括脸谱疼痛评分法（FPS）和CRIES评分法,镇静评分包括Ramsay评分法和舒适行为量表（Comfort B评分）,均由PICU专科护士完成。 主要结局指标:术后1 h、4 h、8 h、12 h和24 h的镇痛/镇静满意度百分比。 结果:共152例CHD患儿入组,D1、D2、D3、SF和M组分别为30、30、31、31和30例,均完成设计的干预和观察。5组患儿年龄、体重、性别、体外循环时间、危重症评分（PCIS）和术前ASA分级差异均无统计学意义。①FPS评分：D2组术后24 h,D3组术后4 h、24 h镇痛满意度高于M组;CRIES评分：D1、D2组术后1 h、4 h,D3组术后4 h、24 h镇痛满意度高于M组;Ramsay评分： D2、D3组术后1 h、4 h镇静满意度高于M组;Comfort B评分： D1组术后4 h、12 h,D2组术后1 h、4 h,D3组术后1 h、4 h、12 h镇静满意度高于M组;差异均有统计学意义。4种评分D组和SF组的镇痛/镇静满意度差异均无统计学意义。②5组术后各时间点生命体征及相关指标差异均无统计学意义;D1、D2组追加镇静/镇痛药物的比例低于M组和SF组,差异均有统计学意义。M组观察到2例低血压及1例呼吸抑制。 结论:地佐辛应用于儿童CHD术后的镇痛效果优于吗啡,与舒芬太尼效果相当,且不良反应少。     

利多卡因超声雾化吸入用于扁桃体术后的镇痛效果分析

目的探讨利多卡因超声雾化吸入用于扁桃体摘除手术后患者的镇痛效果.方法: 将扁桃体摘除手术患者65例随机分成两组,观察组33例,对照组32例,分别给予0.5%的利多卡因超声雾化和0.9% NS超声雾化治疗.结果: 观察组疼痛明显减轻,术后首次进食时间提前,24h睡眠质量提高,咽部异物感减轻(P<0.01).结论: 扁桃体术后利多卡因超声雾化吸入是一种安全、有效、简便、无创的镇痛方法.     

不同方式超声引导连续髂筋膜阻滞在髋关节置换术后镇痛效果

目的 对两种不同方式超声引导连续髂筋膜间隙阻滞在髋关节置换术后镇痛效果进行评价。方法 采用前瞻性随机对照研究,纳入新疆医科大学第六附属医院于2016年3月至2017年10月收治的腰-硬联合阻滞麻醉下人工全髋关节置换术（total hip arthroplasty, THA）术后病人60例,男29例,女31例,年龄为65~83岁,平均（66.78±9.32）岁。按照数字随机法分为：①腹股沟韧带上髂筋膜阻滞组（上髂筋膜组）30例,男17例,女13例,年龄为65~84岁,平均（66.13±9.16）岁;②腹股沟韧带下髂筋膜阻滞组（下髂筋膜组）30例,男12例,女18例,年龄为65~82岁,平均（65.80±8.13）岁。在超声引导下行髂筋膜连续神经阻滞后镇痛,设置两组镇痛泵的局部麻醉药物均为0.2%的罗哌卡因200 ml,负荷量20 ml,置管成功后注入,背景量为0。病人自控镇痛（patient controlled analgesia, PCA）10 ml/次,锁定时间为1 h。对病人的静息疼痛、持续性被动疼痛和主观性疼痛等疼痛视觉模拟量表（visual analogue scale, VAS）评分进行记录,对病人的阻滞效果、曲马多用量以及病人满意度进行评价。结果 上髂筋膜组的手术时间为（70.4±12.1） min,下髂筋膜组为（70.8±10.3） min,两组比较差异无统计学意义（P＞0.05）。在静息状态、主被动VAS评分方面,上髂筋膜组均优于下髂筋膜组;上髂筋膜组病人阻滞后各时间点股外侧皮神经支配区的感觉阻滞程度和曲马多使用量优于下髂筋膜组,以上指标比较,两组差异均有统计学意义（均P＜0.05）。两组病人阻滞后各时间点股神经阻滞率和术后镇痛满意度比较,差异均无统计学意义（均P＞0.05）。结论 THA术后采用超声引导下浓度为0.2%罗哌卡因,在THA术后镇痛效果上,腹股沟韧带上连续髂筋膜阻滞明显优于腹股沟韧带下连续髂筋膜神经阻滞。