Ketorolac plus Lidocaine vs Lidocaine for pain relief following core needle soft tissue biopsy: A CONSORT-compliant double-blind randomized controlled study

Backgrounds:The main objective of this study was to compare the pain control efficacy of local administration of Lidocaine with or without the nonsteroidal anti-inflammatory drug, Ketorolac, and local conventional Lidocaine injection in core needle biopsy of the musculoskeletal tumor.Methods:The current study was a randomized, double-blind controlled clinical trial that included 128 patients with suspected musculoskeletal tumors. Patients were randomly assigned to either the Ketorolac plus Lidocaine (n = 64) or Lidocaine group (n = 64). The Ketorolac – Lidocaine combination syringe contained 30 mg Ketorolac and 2% Lidocaine – adrenaline dosage, and the Lidocaine syringe contained 2% Lidocaine – adrenaline dosage. The level of pain after core needle biopsy was evaluated for each patient at 1, 6, 12, 24, 48, and >48 hours by a Visual Analog Scale (VAS). The mean VAS changes over time were compared between the Ketorolac plus Lidocaine and Lidocaine groups using a linear mixed model.Results:baseline information including mean age of patients in Lidocaine group (51.5 ± 19.4 years) and in Lidocaine – Ketorolac combination group (50.1 ± 18 years), diagnosis (malignant, benign, metastatic, infection), tumor location (upper and lower extremities, back), VAS score 1-hour post-operation (mild and moderate pain) were noted. The VAS score ratings were significantly lower in Lidocaine – Ketorolac combination group when compared to the Lidocaine group during the 1 to 24 hours post-operation time period.Conclusion:Patients receiving Lidocaine – Ketorolac combination dosage had significantly lower VAS scores, and these results confirm that local injection of Lidocaine – Ketorolac combination had a superior pain-controlling effect during the first 24 hours after the biopsy procedure in comparison to Lidocaine injection alone, as measured by VAS score scale.     

The Newborn Infant Parasympathetic Evaluation (NIPE™) monitor predicts post-operative pain in children undergoing day-procedures: A prospective observational study

BackgroundPain assessment is essential for the administration of appropriate analgesia. Currently, clinicians use surrogate methods, such as heart rate or behavioural pain scales, to estimate pain in neonates and infants. The Newborn and Infant Parasympathetic Evaluation (NIPE™) monitor aims to provide an objective numeric value (NIPE index) of pain through a continuous assessment of the patient's parasympathetic activity. The aim of this study was to determine if the intraoperative NIPE index monitoring could predict postoperative pain in neonates and infants.MethodsThis prospective observational pilot study included neonates and infants undergoing elective day-surgical procedures (n = 50). Intraoperatively, NIPE indices at 0 (NIPE₀), 10 (NIPE₁₀), 20 (NIPE₂₀), 30 (NIPE₃₀) minutes and at completion of surgery (NIPEe), were recorded; the median NIPE index (NIPEm) was calculated for the entire procedure. Postoperative Face, Legs, Activity, Cry, Consolability (FLACC) scale scores were calculated by the nursing staff blinded to the intraoperative NIPE indices.ResultsLinear regression documented an association between the NIPEm and postoperative FLACC score at 0 (r = 0.31, p = 0.03) and 10 min (r = 0.36, p = 0.01). No significant associations were observed for FLACC scores at 20 (r = 0.21, p = 0.2) and 30 min (r = 0.36, p > 0.9). Multiple regression analysis revealed that intraoperative NIPE₁₀, NIPE₂₀, NIPE₃₀ and NIPEe also predicted the FLACC score at 0 min (p = 0.003).ConclusionThe intraoperative NIPE index is predictive of pain in the immediate postoperative period. This association was lost at 20 min likely due to nursing intervention to administer analgesia. NIPE monitoring could be useful in facilitating postoperative pain management in infants.Level of evidenceII.Type of studyStudy of Diagnostic Test.     

电针复合TCI靶控输注在单肺通气食管癌开胸手术麻醉中的应用与安全性＊

目的 探讨电针复合靶控输注（Target Controlled Infusion， TCI）在单肺通气食管癌开胸手术麻醉中的应用价值。方法 选取于我院拟行单肺通气食管癌开胸切除手术患者60例作为研究对象。随机将其分为试验组与对照组，对照组30例采取气管插管全麻及TCI靶控输注维持麻醉深度，试验组30例则在对照组方案基础上辅助电针麻醉，记录两组患者手术麻醉时间、药物用量、苏醒时间、并发症；以及术前（T_Ⅰ）、插管前即刻（T_Ⅱ）、插管后1 min（T_Ⅲ）、切皮即刻（T_Ⅳ）、去骨时（T_Ⅴ）、拔管即刻（T_Ⅵ）时平均动脉压（MAP）、平均心率（HR）、BIS值；术前、术后1天、术后3天简易智能精神状态检查量表（MMSE）；并于麻醉诱导前（T₀）、手术开始2 h（T₁）、术后1天（T₂）、术后3天（T₃）时抽取患者外周静脉血检测IL-1β、IL-6、IL-10、TNF-α浓度。结果 试验组手术用时、麻醉时间略低于对照组，但差异无统计学意义（P>0.05），试验组异丙酚、舒芬太尼用量以及苏醒时间均明显低于对照组（P<0.05）；T_Ⅱ时两组平均动脉压（Mean Arterial Pressure， MAP）、心率（Heartrate， HR）较术前明显降低，且试验组MAP明显低于对照组（P<0.05），但两组T_Ⅱ时HR比较无显著差异（P>0.05）；T_Ⅲ、T_Ⅵ时对照组MAP、HR明显高于T_Ⅰ时，而试验组MAP、HR与T_Ⅰ比较无显著差异（P>0.05）。术后1天、3天试验组简易智能精神状态检查量表（Mini-Mental State Examination， MMSE）评分低于对照组，有显著性差异（P<0.05）。T₁、T₂、T₃时试验组白介素-1β（IL-1β）、白介素-6（IL-6）、肿瘤坏死因子（Tumor Necrosis Factor-α， TNF-α）水平明显低于对照组（P<0.05），白介素-10（IL-10）水平明显高于对照组（P<0.05）。结论 采用电针复合TCI靶控输注麻醉方案可有效提升单肺通气食管癌开胸手术麻醉效果，能够降低患者术后认知功能障碍发生风险。     

EEG power spectral density under Propofol and its association with burst suppression,a marker of cerebral fragility

ObjectiveUnder General Anesthesia (GA), age and Burst Suppression (BS) are associated with cognitive postoperative complications, yet how these parameters are related to per-operative EEG and hypnotic doses is unclear. In this prospective study, we address this question comparing age and BS occurrences with a new score (BP_TIVA) based on Propofol doses, EEG and alpha-band power spectral densities, evaluated for SEF₉₅ = 8–13 Hz.Methods59 patients (55 [34–67] yr, 67% female) undergoing neuroradiology or orthopedic surgery were included. Total IntraVenous Anesthesia was used for Propofol and analgesics infusion. Cerebral activity was monitored from a frontal electrodes montage EEG.ResultsBP_TIVA was inversely correlated with age (Pearson r = −0.78, p < 0.001), and was significantly lower (p < 0.001) when BS occurred during the GA first minutes (induction). Additionally, the age-free BP_TIVA score was better associated with BS at induction than age (AUC = 0.94 versus 0.82, p < 0.05).ConclusionWe designed BP_TIVA score based on hypnotics and EEG. It was correlated with age yet was better associated to BS occurring during GA induction, the latter being a cerebral fragility sign.SignificanceThis advocate for an approach based on evaluating the cerebral physiological age (« brain age ») to predict postoperative cognitive evolution.     

超声引导下幼儿骶管麻醉在小儿疝手术中的应用

目的探讨超声引导下幼儿骶管麻醉在小儿疝手术中的应用价值。 方法回顾性分析2016年1至12月，陆军特色医学中心行小儿疝手术的100例患儿的临床资料。根据麻醉方式不同，将其分为观察组（52例）与对照组（48例）。观察组患儿行超声引导下骶管麻醉，对照组患儿行阻力消失技术定位骶管穿刺，比较2组患儿的麻醉效果。 结果（1）观察组患儿穿刺时间、穿刺次数及术后苏醒时间、氯胺酮使用剂量、术毕离开手术室时间均明显低于对照组，差异均有统计学意义（P均<0.05）。（2）观察组患儿骶管阻滞成功率明显高于对照组，差异有统计学意义（P<0.05）。（3）观察组患儿术后镇痛效果明显优于对照组，差异有统计学意义（P<0.05）。（4）观察组患儿苏醒期躁动评分与术后（2、4、8 h）疼痛评分明显低于对照组，差异均有统计学意义（P均<0.05）。（5）气腹前，2组患儿心率、平均动脉压（mean artery pressure，MAP）、呼气末二氧化碳分压（end-tidal carbon dioxide partial pressure，PetCO₂）比较，差异无统计学意义（P>0.05）；气腹后，观察组心率、MAP、PetCO₂水平明显高于对照组，差异均有统计学意义（P均<0.05）。2组患儿治疗前后血压、血氧饱和度、pH值比较，差异均无统计学意义（P均>0.05）。（6）观察组不良反应发生情况明显低于对照组，差异有统计学意义（P<0.05）。 结论超声引导下幼儿骶管麻醉应用于小儿疝手术，定位准确，患儿苏醒时间短，镇痛效果好，并减少其苏醒期躁动，改善患儿血气与循环，安全有效。     

氯胺酮静脉全身麻醉复合罗哌卡因骶管阻滞对腹股沟疝患儿术中应激反应的影响

目的探讨氯胺酮静脉全身麻醉复合罗哌卡因骶管阻滞对腹股沟疝患儿术中应激反应的影响。 方法选取2015年11月至2017年12月，保定市儿童医院82例腹股沟疝患儿的临床资料，通过随机数字表法分为对照组与试验组，每组患儿41例。对照组采用氯胺酮静脉全身麻醉，试验组采用氯胺酮静脉全身麻醉复合罗哌卡因骶管阻滞。统计2组麻醉前（T1）、麻醉后10 min（T2）、术后即刻（T3）、术后8 h（T4）应激反应指标[皮质醇、白细胞介素-6（interleukin 6，IL-6）]水平、氯胺酮用量、苏醒时间、术后5、60、120 min时疼痛的改良面部表情评分（facial expression scoring，FLACC）及苏醒期躁动评分（awakening period score，AS）、不良反应发生率。 结果T2时2组血清皮质醇、IL-6水平较T1时期增高，但试验组低于对照组（P<0.05），T3及T4时2组血清皮质醇、IL-6水平较T2时期降低，但试验组低于对照组（P<0.05）；试验组氯胺酮用量少于对照组、苏醒时间短于对照组（P<0.05）；术后5、60、120 min试验组FLACC及AS分值低于对照组（P<0.05）；试验组呕吐（7.32%）、躁动（12.20%）、嗜睡（9.76%）发生率低于对照组（P<0.05）。 结论腹股沟疝患儿手术治疗过程中采取氯胺酮静脉全身麻醉复合罗哌卡因骶管阻滞，可减少氯胺酮用量，缩短苏醒时间，减轻术中应激反应程度，还有利于减轻术后疼痛感及躁动程度，且可降低不良反应发生率。     

超声引导腹横肌平面阻滞联合喉罩全身麻醉在小儿疝囊高位结扎术的镇痛效果

目的探究超声引导下腹横肌平面阻滞联合喉罩全麻下小儿疝囊高位结扎术的镇痛效果。 方法选取2016年1月至2018年1月，湖北省洪湖市人民医院150例接受疝囊高位结扎术的患儿，随机分为观察组（75例）和对照组（75例）。对照组采用单纯喉罩全身麻醉，而观察组在对照组基础上进行超声引导下腹横肌平面阻滞。比较2组患儿的平均动脉压（MAP）、心率（HR）、躁动及疼痛评分、苏醒时间、手术时间及并发症发生状况。 结果观察组的并发症发生率（6.7%）低于对照组（17.3%），差异有统计学意义（P<0.05）。观察组患儿手术时间、苏醒时间、躁动评分、12 h小儿疼痛量表（12 h FLACC）评分均低于对照组（P<0.05）。观察组插入喉罩后、手术开始时、拔除喉罩时与麻醉诱导前比较，MAP、HR差异均无统计学意义（P>0.05）；对照组插入喉罩后、拔除喉罩时与麻醉诱导前比较，MAP、HR差异均无统计学意义（P>0.05），手术开始时MAP、HR高于麻醉诱导前（P<0.05）。麻醉诱导前、插入喉罩后、拔除喉罩时2组间的MAP、HR差异均无统计学意义（P>0.05），手术开始时，观察组的MAP、HR均低于对照组（P<0.05）。 结论小儿疝囊高位结扎术中应用超声引导下腹横肌平面阻滞联合喉罩全麻的麻醉效果较好，术后苏醒快，可以缓解患儿术后疼痛及躁动，降低并发症的发生率，具有临床应用价值。     

超声引导下腹横肌平面阻滞联合喉罩通气全身麻醉在小儿腹股沟斜疝修补术中的应用

目的探究喉罩通气全身麻醉联合超声引导下腹横肌平面阻滞（TAPB）在小儿腹股沟斜疝手术中的应用。 方法选取2018年1至10月，成都市妇女儿童中心医院行疝囊高位结扎100例腹股沟斜疝患儿的临床资料，按随机数字表法将其分2组，每组患儿50例。对照组术中给予喉罩通气全身麻醉，观察组术中给予超声引导下TAPB联合喉罩通气全身麻醉。观察2组手术相关指标、血流动力学指标、小儿疼痛量表评分（FLACC）及不良反应发生情况。 结果观察组术后拔管时间、麻醉苏醒时间及住院时间分别为（6.27±1.86）min、（13.34±3.17）min及（2.26±0.14）d，与对照组（13.31±2.05）min、（19.86±3.48）及（3.15±1.17）d比较，差异有统计学意义（t=17.984、9.259、5.341，P均<0.001）。与T₁相比，观察组患儿T₂、T₃时段HR、SBP、DBP无显著变化，差异无统计学意义（P>0.05）；对照组HR无显著变化，差异无统计学意义（P>0.05），SBP、DBP逐渐升高，差异有统计学意义（P<0.05）。观察组T₁时段HR与对照组相比，差异无统计学意义（P>0.05），T₂、T₃时段显著低于对照组，差异有统计学意义（P<0.05）。观察组T₁时段SBP、DBP与对照组比较，差异无统计学意义（P>0.05），T₂、T₃时段显著低于对照组，差异有统计学意义（P<0.05）。观察组患儿在苏醒时、术后2 h、4 h及8 h FLACC评分分别为（2.3±0.6）分、（2.0±0.4）分、（1.6±0.5）分、（1.2±0.3）分，均低于对照组（3.0±0.5）分、（2.7±0.6）分、（2.2±0.3）分、（1.7±0.4）分，差异有统计学意义（t=40.170、47.114、57.940、49.999，P均<0.05）。观察组呕吐、咽痛、喉痉挛的发生情况分别为3（6.00%）、3（6.00%）、2（4.00%），均低于对照组10（20.00%）、11（22.00%）、9（18.00%），差异有统计学意义（χ²=4.332、5.316、5.005，P=0.037、0.021、0.025）。 结论在疝囊高位结扎术中采用超声引导下TAPB联合喉罩通气全身麻醉，能够更好地维持患儿血流动力学的稳定性，降低疼痛及不良反应的发生，值得临床推广应用。     

Delirium do despertar após anestesia com sevoflurano em adultos: estudo observacional prospectivo

Background and objectivesEmergence delirium after general anesthesia with sevoflurane has not been frequently reported in adults compared to children. This study aimed to determine the incidence of emergence delirium in adult patients who had anesthesia with sevoflurane as the volatile agent and the probable risk factors associated with its occurrence.Design and methodsA prospective observational study was conducted in adult patients who had non‐neurological procedures and no existing neurological or psychiatric conditions, under general anesthesia. Demographic data such as age, gender, ethnicity and clinical data including ASA physical status, surgical status, intubation attempts, duration of surgery, intraoperative hypotension, drugs used, postoperative pain, rescue analgesia and presence of catheters were recorded. Emergence delirium intensity was measured using the Nursing Delirium Scale (NuDESC).ResultsThe incidence of emergence delirium was 11.8%. The factors significantly associated with emergence delirium included elderly age (>65) (p = 0.04), emergency surgery (p = 0.04), African ethnicity (p = 0.01), longer duration of surgery (p = 0.007) and number of intubation attempts (p = 0.001). Factors such as gender, alcohol and illicit drug use, and surgical specialty did not influence the occurrence of emergence delirium.ConclusionsThe incidence of emergence delirium in adults after general anesthesia using sevoflurane is significant and has not been adequately reported. Modifiable risk factors need to be addressed to further reduce its incidence.