Intranasal hydromorphone for treatment of acute pain in children: A pilot study

ObjectivesWe aimed to describe the analgesic efficacy, duration of analgesia, and adverse event profile associated with intranasal hydromorphone in children with acute pain presenting to an emergency department.MethodsProspective dose titration pilot study of otherwise healthy children 4 to 17-years-old with moderate to severe pain who required a parenteral opioid. All patients received an initial intranasal hydromorophone dose of 0.03 mg/kg. The need for additional analgesia was assessed at 15 and 30 min; an additional 0.015 mg/kg was given at each assessment, if required. Need for rescue analgesic, pain intensity and adverse events were assessed until 6 h after hydromorphone administration or until patients were discharged, underwent a procedure to treat their painful condition, or received a rescue analgesic.ResultsWe enrolled 35 children. Fifteen, 11, and 9 children required a total dose of 0.03, 0.045, and 0.06 mg/kg, respectively. Patients in each dose group experienced an absolute decrease in pain score of ≥3/10 and percent reduction >40% within 5–15 min of completing dose-titration administration of hydromorphone. Duration of analgesia (i.e. time until rescue analgesic administered) >1 h was observed in 85.7% of patients. Patients not requiring rescue analgesics had mild or no pain until discharged or their painful conditions were treated. Three (8.6%) patients required a rescue analgesic <1 h after hydromorphone administration. There were no major adverse events.ConclusionsIntranasal hydromorphone led to rapid, clinically significant and frequently sustained decreases in pain intensity in children. No major adverse events were observed in this preliminary sample.Clinical Trials Registration Number: NCT02437669     

Bloqueo bilateral del grupo de nervios pericapsulares (PENG) como analgesia en cirugía de cadera infantil

Effective management and control of peri- and postoperative pain in hip surgery is essential in order to minimize the use of opioids and their adverse effects. Effective regional analgesia for hip pain is made particularly challenging by the complex innervation of the hip joint. Standard regional techniques can be associated with complications, including incomplete anesthesia, hypotension, or lower limb weakness. We present the case of a 5-year-old girl with a history of infantile cerebral palsy who underwent bilateral varus derotation osteotomy and adductor tenotomy due to paralytic dislocation. She received bilateral PENG block and femoral cutaneous nerve block - a simple technique that covers all the nerves involved in the sensory innervation of the joint capsule without the need for multiple injections.     

吗啡镇痛对晚期肝癌患者血清TNF-α及IL-6水平影响的分析

目的考察吗啡镇痛对晚期肝癌患者血清TNF-α及IL-6水平影响。方法将120例晚期肝癌患者随机分为曲马多缓释片组和吗啡组,每组60例。曲马多缓释片组给予曲马多缓释片片口服治疗,吗啡组给予口服硫酸吗啡缓释片治疗。比较两组患者镇痛效果、不良反应和血清TNF-α及IL-6水平。结果吗啡组镇痛效果显著优于曲马多缓释片组(P<0.05)。吗啡组患者不良反应发生率显著高于曲马多缓释片组(P<0.05)。吗啡组患者镇痛后1周和1个月时血清TNF-α及IL-6水平显著低于曲马多缓释片组(P<0.05)。结论吗啡镇痛可有效降低晚期肝癌患者血清TNF-α及IL-6水平。     

腕踝针对肩关节周围炎急性期的镇痛效果及其对血清P物质的影响

目的 观察腕踝针治疗急性期肩周炎的临床疼痛改善效果及体内血清P 物质的变化,并进行分析。方法 随机选取我科62 例肩周炎急性期患者,随机数字表法分为治疗组与对照组,每组各31 例,对照组予口服双氯芬酸钠缓释胶囊,治疗组予利多卡因行星状神经节阻滞后加腕踝针治疗,两组均连续治疗4 周后进行主动、被动功能锻炼,共治疗4 周。比较两组临床疗效、视觉模拟评分（Visual analogue scale score,VAS）及血清内P 物质水平变化。结果 ①疗程结束后,治疗组临床总有效率为100.00%,与对照组的77.42%比较,差异有统计学意义（χ2＝4.348,P＜0.05）;②治疗组治疗4 周后VAS 为（2.07±0.44）分,与治疗前（8.24±1.52）分比较,差异有统计学意义（P＜0.05）;对照组治疗后VAS 为（4.22±0.65）分,与治疗前（8.36±1.14）分比较,差异有统计学意义（P＜0.05）;治疗后治疗组VAS 评分低于对照组,差异有统计学意义（P＜0.05）。③治疗组治疗4 周后P 物质浓度为（33.07±6.74）pg/mL,与治疗前（69.24±7.52）pg/mL 比较,差异有统计学意义（P＜0.05）;对照组治疗后P 物质浓度是（40.22±6.65）pg/mL,与治疗前（70.36±8.02）pg/mL 比较,差异有统计学意义（P＜0.05）;治疗后治疗组P 物质浓度低于对照组,差异有统计学意义（P＜0.05）。结论 腕踝针治疗肩关节周围炎,可改善疼痛症状,且安全有效。     

消痔栓抗炎消肿、镇痛作用的实验研究

通过动物实验研究消痔栓抗炎消肿、镇痛的作用机制。采用小鼠冰醋酸致痛观察消痔栓的镇痛作用,同时测定新鲜鸡蛋清致小鼠后足跖肿胀炎性组织中PGE2、NO、Pr含量。结果显示,消痔栓能显著抑制冰醋酸致痛小鼠扭体次数,明显降低新鲜鸡蛋清致小鼠后足跖肿胀炎性组织中PGE2、NO、Pr含量。结果表明,消痔栓的抗炎消肿、镇痛机制之一可能与降低炎性组织中的PGE2、NO、Pr的含量有关。