Effect of intrathecal fentanyl dose on the duration of labor analgesia.

The short duration of effective analgesia produced by intrathecal fentanyl (ITF) at doses ranging from 5 to 25 micrograms limits the drug's use for the management of labor pain. The understanding of the potential of ITF related to duration of analgesia in the labor patient is derived from studies of and clinical experience with ITF at doses not exceeding 25 micrograms and less. We hypothesized that by increasing the dose beyond 25 micrograms, a prolonged duration of analgesia could be achieved. The purpose of the present study was to compare the difference in duration of effective analgesia and adverse effects produced by 25, 37.5, and 50 micrograms of ITF. A sample population of 60 term parturient women with uncomplicated singleton pregnancies who were in active labor and requesting pain control were randomly assigned to 1 of 3 groups: group 1, 25 micrograms (n = 20); group 2, 37.5 micrograms (n = 20); and group 3, 50 micrograms (n = 20). The ITF was then administered by an anesthesia provider blinded to the dose via a combined spinal epidural technique. The time from injection to the time of request for subsequent pain control (considered the duration of effective analgesia), maternal and fetal vital signs, and adverse effects were recorded at specific intervals until the patient requested activation of the epidural catheter or delivery occurred, ending participation in the study. Statistical analysis using a 1-way analysis of variance and considering a P value of < .05 to be significant revealed no difference in duration of effective analgesia between the groups. Statistical differences in the incidence of adverse effects, particularly uterine hyperstimulation, hypotension, pruritus, nausea, and fetal heart rate decelerations were not evident using the Fisher Irwin test and a significance of P < .05. The findings of the present study demonstrate that there is no real advantage of using doses of ITF greater than 25 micrograms in quality and duration of effective labor analgesia.     

Combination of ultra-low dose bupivacaine and fentanyl for spinal anaesthesia in out-patient anorectal surgery

This study investigated whether the addition of 25 microg fentanyl to an ultra-low (sub-anaesthetic) dose of intrathecal bupivacaine provides adequate anaesthesia for out-patient anorectal surgery, without increasing side-effects or delaying hospital discharge. Patients were randomly allocated to receive 2.5 mg 0.5% bupivacaine plus 25 microg fentanyl (group BF, n = 18) or 5 mg 0.5% bupivacaine alone (group B, n = 17). There were no significant differences in intra-operative outcomes, but mean recovery and discharge times were significantly shorter in group BF. There were no between-group differences in hypotension, bradycardia or respiratory depression and post-operative complications were comparable, apart from pruritus which was significantly more frequent in group BF. Fewer patients requested analgesic medication in the early post-operative period in group BF than in group B. In conclusion, 25 microg intrathecal fentanyl added to ultra-low dose (2.5 mg) bupivacaine provided good-quality spinal anaesthesia and reduced post-operative analgesic requirement in patients undergoing ambulatory anorectal surgery.     

三种镇痛方法对胸部术后镇痛效果和通气功能影响的比较

目的:比较静脉、硬膜外及肋间神经阻滞合并静脉3种镇痛方法用于胸部手术后的镇痛效果及其对通气功能的影响。方法:45例择期开胸手术患者随机数字表法分为静脉镇痛组(Ⅰ组)、肋间神经阻滞合并静脉镇痛组(II组)及硬膜外镇痛组(Ⅲ组)。术后镇痛:Ⅰ组持续以2.5mL/h静脉泵入芬太尼(15mg/L)+咪唑安定(0.3g/L);Ⅱ组关胸前以2.5g/L布比卡因行切口及上下各2个肋间的肋间神经阻滞,术后以2.5mL/h持续静脉泵入芬太尼(10mg/L)+咪达唑仑(咪唑安定)(0.3g/L);Ⅲ组以2.5mL/h持续硬膜外泵入1.8g/L布比卡因+芬太尼(3mg/L)+咪唑安定(0.2g/L)。患者术后以视觉模拟评分法行痛觉评分(VAS);测量心率、平均动脉压、动脉血氧分压(PaO2)及二氧化碳分压(PaCO2);测定用力肺活量和第一秒用力呼出气量(FEV1)。结果:Ⅰ组术后3h及6hVAS明显高于Ⅱ组(P<0.05),术后0,3,6,12hVAS明显高于Ⅲ组(P<0.05,0.01);Ⅱ组术后12hVAS明显高于Ⅲ组(P<0.05);Ⅱ组术后3,6hFVC及FEV1显著高于Ⅰ组(P<0.01,0.05);Ⅲ组患者术后3hFVC、术后6,12hFVC和FEV1及术后24hFEV1显著高于Ⅰ组(P<0.05);Ⅰ组患者术后0h的PaO2明显低于另外二组(P<0.05),而其PaCO2明显高于Ⅲ组(P<0.05)。结论:硬膜外输注布比卡因和芬太尼或肋间神经阻滞合并静注芬太尼用作开胸手术患者的术后镇     

CPM机在膝关节镜术后康复中的应用

目的探讨膝关节镜术后应用CPM进行早期持续被动活动的临床疗效及应用价值。方法将60例行膝关节镜治疗的骨性关节炎及半月板损伤合并韧带损伤、断裂患者,随机分为试验组30例,对照组30例。试验组术后24小时开始使用CPM进行患膝关节持续被动屈曲训练,对照组沿用传统的方法,实行常规的治疗与护理加个人行为的功能锻炼。记录患者膝关节活动度、关节肿胀变化,研究时间为2周。结果术后2周试验组膝关节屈曲度为(91.22±21.39)度,关节周径为(44.35±9.23)cm。对照组膝关节屈曲度为(80.14±21.60)度,关节周径为(46.57±10.62)cm。2组比较,试验组膝关节活动度明显大于对照组(p<0.05),肿胀度明显小于对照组(p<0.05)。结论膝关节镜术后早期应用CPM机进行持续被动活动训练在预后及康复时间上均有明显优势,能防止关节粘连僵硬,有利于功能恢复,缩短康复时间。     

Effects of pulse duration on neuromuscular blockade monitoring: Implications for supramaximal stimulation

Questions have been raised concerning the reliability of surface electrodes in achieving supramaximal stimulation during the monitoring of neuromuscular blockade; needle electrodes are considered reliable in this respect. This study compares interelectrode impedances of needle and surface electrodes during neuromuscular blockade monitoring and suggests those characteristics of the stimulation pulse that can ensure reliable supramaximal stimulation with either type of electrode. Interelectrode voltage and current for surface and needle electrodes were measured by using 1.0-ms pulses at low, medium, and high stimulation levels on 22 surgical patients during anesthesia. Data were collected immediately after electrode application, and again at 10 minutes after application. Stimulation with surface electrodes produced an initial, transient surge of current, followed by a lower steady-state value. At high stimulation levels, the peak transient current was 87% higher than the steady-state current. Needle electrodes produced a constant high-current response. At high stimulation levels the transient impedance of the surface electrode and the impedance of the needle electrode were essentially equal (0.7 k and 0.75 k, respectively). The transient impedance was significantly lower (P<0.001) and was associated with less interpatient variation (P<0.001) and less sensitivity to the duration of electrode application than was the steady-state impedance of the surface electrode. These data suggest that high-current pulses with widths of less than 0.2 ms could provide reliable supramaximal stimulation with either type of electrode.     

膝关节镜手术中使用罗哌卡因、利多卡因和布比卡因脊髓麻醉效果的比较

目的探讨膝关节镜手术中使用罗哌卡因、利多卡因和布比卡因脊髓麻醉效果的比较。方法前瞻性双盲随机对照试验共纳入99例患者,随机分为3组,分别接受25.0 mg罗哌卡因、15.0 mg布比卡因及40.0 mg利多卡因进行脊髓麻醉。主要研究终点是感觉阻滞完全恢复所需的时间。次要研究终点包括运动阻滞的恢复时间、失败率、低血压/心动过缓发生率、术后疼痛、首次运动、排尿和出院时间以及短暂性神经系统症状(TNS)发生率。结果利多卡因组患者感觉阻滞恢复时间(3.1±1.7)h和布比卡因组患者感觉阻滞恢复时间(6.1±2.5)h均明显长于罗哌卡因组患者感觉阻滞恢复时间(2.6±1.2)h,差异有统计学意义(P=0.006;P=0.000)。与利多卡因和布比卡因组相比,罗哌卡因组患者运动阻滞恢复更快。罗哌卡因组患者首次下床活动、排尿和出院时间均较布比卡因组患者短,而与利多卡因组患者无差异。与利多卡因和罗哌卡因组患者相比,布比卡因组患者术后止痛药物使用更少。3组患者满意度、心律不齐/低血压发生率发生率无明显差异。结论在使用罗哌卡因、布比卡因和利多卡因对膝关节镜手术患者进行脊髓麻醉时,应用罗哌卡因麻醉患者感觉运动阻滞恢复时间最短。     

Neurological impairment during long-term intrathecal infusion of bupivacaine in cancer patients: a sign of spinal cord compression

Adequate pain relief in patients with far advanced cancer sometimes requires intrathecal (IT) administration of a combination of opioids and local anesthetics. Tumor progression as well as the IT administration of local anesthetics can lead to neurologic dysfunction during treatment. Five patients showed symptoms of compression of the cauda equina or spinal cord shortly after the start of combined IT administration of morphine and bupivacaine in a dosage usually not associated with neurologic symptoms. Unexpectedly, neurologic evaluation suggested compression of the cauda equina and spinal cord, which was confirmed radiographically. Manifestation of new neurologic symptoms during low dose bupivacaine infusion intrathecally might therefore be an early indicator of space-occupying processes within the spinal canal in cancer patients.     

膝关节腔内注射罗哌卡因复合新斯的明对膝关节镜术后镇痛效果观察

目的 研究膝关节腔内联合运用罗哌卡因和新斯的明对膝关节镜术后镇痛效果.方法 将40例膝关节镜手术患者分为Ⅰ组和Ⅱ组各20例,每组分别在术毕向膝关节腔内注入新斯的明0.5 mg+0.2%罗哌卡因30 ml(Ⅰ组),0.2%罗哌卡因30 ml(Ⅱ组),并进行镇痛效果评估.结果 术后4小时和8小时,Ⅰ组VAS评分均明显低于Ⅱ组(P<0.05).但在12、24、48小时VAS评分差异无显著性意义.结论 新斯的明与罗哌卡因联用可明显增强术后8小时左右的镇痛效果.加快了起效时间,极少发生不良反应,是一种安全有效的膝关节手术后镇痛方法.     

硬膜外芬太尼加左旋布比卡因超前镇痛在全麻中的应用

目的 观察硬膜外超前镇痛对全麻的影响及合理的用药方案.方法 60例手术患者分为3组, 每组各20例.硬膜外穿刺后经硬膜外导管注入芬太尼50 μg(Ⅰ组),左旋布比卡因加芬太尼超前镇痛组(Ⅱ组)、左旋布比卡因加芬太尼术后镇痛组(Ⅲ组),术后均采用硬膜外自控镇痛(PCEA).观察术后视觉模拟(VAS)评分和PCA次数,并比较瑞芬太尼及维库溴铵的用量和拔管时问(停用全麻药至拔除导管)以及苏醒质量.结果 瑞芬太尼及维库溴铵的用量、拔管时间、苏醒时期兴奋躁动发生率Ⅲ组＞Ⅰ组＞Ⅱ组;3组患者镇痛效果、镇痛用药量、24小时PCA总按压次数Ⅰ组＞Ⅲ组＞Ⅱ组,3组比较差异有显著性意义(P ＜ 0.01).结论 硬膜外使用小剂量的芬太尼加左旋布比卡因硬膜外超前镇痛,患者术后苏醒不受影响,而且减少了恢复期兴奋的发生,效果满意,值得临床推广.     

黄芪多糖预先给药对大鼠鞘内注入布比卡因脊神经毒性的影响

目的:探讨预先给予黄芪多糖是否可以减轻大鼠鞘内注入布比卡因所致脊神经毒性及其机制.方法:健康雌性SD大鼠,体重180～220 g,取鞘内置管成功大鼠30只,随机分成5组(n=6).对照组(N组):鞘内注射生理盐水30μL,腹腔注入生理盐水.2%与4%布比卡因组(2B组与4B组):鞘内分别注入2%与4%布比卡因30μL,腹腔注入生理盐水.2%与4%布比卡因黄芪多糖预处理组(2H组与4H组):鞘内分别注入2%与4%布比卡因30μL,腹腔注入黄芪多糖25 mg/kg,生理盐水稀释成2 mL,于鞘内给药前连续注药3 d.鞘内注药后10 min、20 min、30 min、1 h、2 h、4 h、1 d、2 d、3 d和4 d测定甩尾反应潜伏期(TFL),用最大效应百分比MPE表示.4 d后各组大鼠行断颈处死,分离背根神经节,western blot分析caspase-9蛋白表达水平,并行病理学观察.结果:(1)各组MPE比较差异有统计学意义(P<0.05):(2)鞘内注药后10min,2B组、4B组、2H组扣4H组MPE均达到峰值.2B组、2H组和4H组于鞘内注药后2 h恢复至基线水平,而4B组于注药后4 h方恢复至基线水平.与N组比较,2B组,4B组,2H组和4H组caspase-9蛋白表达均上调(P<0.05);与2B和4B组比较,2H组和4H组caspase-9蛋白表达降低(P<0.05);(3)病理学结果:N组大鼠背根神经节细胞形态和结构正常.2B组和4B组有部分神经细胞萎缩、空泡化.2H组和4H组神经细胞形态和结构基本正常.结论:预先给予黄芪多糖可减轻大鼠鞘内注入布比卡因的脊神经毒性,其机制可能与抑制caspase-9蛋白表达,抗神经细胞凋亡有关.     

硬膜多卜芬太尼加左旋布比卡因超前镇痛在全麻中的应用

目的观察硬膜外超前镇痛对全麻的影响及合理的用药方案。方法60例手术患者分为3组，每组各20例。硬膜外穿刺后经硬膜外导管注入芬太尼50肛g（I组），左旋布比卡因加芬太尼超前镇痛组（Ⅱ组）、左旋布比卡因加芬太尼术后镇痛组（Ⅲ组），术后均采用硬膜外自控镇痛（PCEA）。观察术后视觉模拟（VAS）评分和PCA次数，并比较瑞芬太尼及维库溴铵的用量和拔管时问（停用全麻药至拔除导管）以及苏醒质量。结果瑞芬太尼及维库溴铵的用量、拔管时间、苏醒时期兴奋躁动发生率Ⅲ组〉I组〉Ⅱ组；3组患者镇痛效果、镇痛用药量、24小时PCA总按压次数I组〉11组〉Ⅱ组，3组比较差异有显著性意义（P〈0．01）。结论硬膜外使用小剂量的芬太尼加左旋布比卡因硬膜外超前镇痛，患者术后苏醒不受影响，而且减少了恢复期兴奋的发生，效果满意，值得临床推广。     

膝关节半月板损伤磁共振成像诊断与关节镜检查对比研究

目的探讨MRI在膝关节半月板损伤诊断中的应用价值。方法回顾性分析70例同时接受MRI和关节镜检查的膝关节损伤患者的病历资料。共涉及86个膝关节,左膝27例,右膝40例,双膝同时发病19例。所有患者均有外伤史,主要表现为膝关节疼痛、肿胀、功能受限及绞锁。结果按照Stoller等半月板损伤MRI分级标准,0级8膝,Ⅰ级2膝,Ⅱ级16膝,Ⅲ级60膝。经关节镜检查,MRI检查诊断为0级的8膝膝关节中有2膝为外侧半月板边缘撕裂;MRI检查诊断为Ⅱ级和Ⅲ级半月板损伤的膝关节中分别有1膝经关节检查证实其异常高信号为滑膜增生而非半月板损伤。经Kappa检验,MRI检查和关节镜诊断半月板损伤结果的一致性较好（Kappa=0．724,P=0．000）。MRI诊断半月板损伤的敏感度为97．44％,特异度为75％,准确率为95．35％。结论MRI检查和关节镜诊断半月板损伤结果的一致性良好,敏感度和准确率高,安全无创,应作为临床诊断半月板损伤的首选方法。     

不同时期膝关节镜检+单髁关节置换对前内侧间室膝关节骨性关节炎患者膝关节功能的影响

目的 研究不同时期膝关节镜检+单髁关节置换对前内侧间室膝关节骨性关节炎患者膝关节功能的影响。方法 回顾性分析2015年10月－2019年10月该院收治的100例前内侧间室膝关节骨性关节炎患者的临床资料,所有患者均行膝关节镜检+单髁关节置换。其中,56例行同期手术治疗的患者作为观察组（Outerbridge分级为Ⅲ级或Ⅳ级）,44例行分期手术治疗的患者作为对照组（Outerbridge分级为Ⅰ级或Ⅱ级）。比较两组患者的临床疗效、手术相关指标、治疗前及治疗后3、6和12个月的膝关节活动度、治疗前后膝关节功能评分［疼痛视觉模拟评分（VAS）、牛津大学膝关节评分（OKS）和美国西安大略和麦克马斯特大学骨性关节炎指数（WOMAC）评分］,以及术后并发症发生情况。结果 观察组总有效率为94.64%,与对照组的88.64%比较,差异无统计学意义（P > 0.05）。观察组手术时间和住院时间短于对照组,差异有统计学意义（P < 0.05）。两组患者治疗后3、6和12个月膝关节活动度较治疗前增大,差异有统计学意义（P < 0.05）,但不同时期组间比较,差异无统计学意义（P > 0.05）。两组患者治疗后VAS、OKS和WOMAC评分较治疗前降低（P < 0.05）;观察组治疗后WOMAC和OKS评分较对照组低（P < 0.05）;两组患者VAS比较,差异无统计学意义（P > 0.05）。患者均未发生严重并发症,两组患者并发症发生率比较,差异无统计学意义（P > 0.05）。结论 同期与分期行膝关节镜检+单髁关节置换治疗前内侧间室膝关节骨性关节炎,临床疗效相当,但同期膝关节镜检 + 单踝关节置换可促进膝关节功能恢复,值得临床推广。     

膝关节镜术后肌力强化训练对膝关节骨性关节炎患者膝关节功能的影响

目的 探讨膝关节骨性关节炎(KOA)患者膝关节镜术后肌力强化训练的临床疗效,并分析其对膝关节功能的影响.方法 选择2018年12月至2020年12月于我院行膝关节镜手术治疗的86例KOA患者为研究对象,根据术后康复方案的不同将其分为对照组和观察组,每组43例.对照组术后进行常规康复训练,观察组在对照组基础上增加肌力强化...     

Effect of intrathecal fentanyl on oxytocin secretion in pregnant women not in labour

We studied the effects of spinal intrathecal fentanyl on oxytocin secretion in 20 healthy women prior to an elective caesarean delivery at term under spinal anaesthesia. The women were randomly allocated into two groups with respect to spinal anaesthesia. Group I (n=10) received intrathecal bupivacaine (15 mg) plus fentanyl (25 microgram), and Group II (n=10) received intrathecal bupivacaine (15 mg) alone, prior to caesarean section. The two groups were comparable demographically. Altogether, ten samples of 4.5 ml of blood (taken every 60 s) were obtained before and ten samples were obtained after the intrathecal administration of the drug and establishment of the T6 block, and plasma oxytocin concentrations were assayed for each subject. Oxytocin was measured by RIA. We found no significant differences in plasma oxytocin concentrations of individual subjects before and after intrathecal injection. In addition, there were no significant differences in plasma oxytocin concentrations between the two groups when pooled samples from the subjects were compared for the pre- and post-intrathecal injection phases. We conclude that the spinal intrathecal administration of fentanyl does not suppress oxytocin secretion in pregnant women who are not in labour at term.     

A comparison of oral transmucosal fentanyl citrate and oral oxycodone for pediatric outpatient wound care.

Analgesia for pediatric burn wound care in the outpatient clinic is constrained by time, personnel, and/or monitoring capabilities, yet may improve patient satisfaction and comfort, clinic efficiency, and patient throughput. The ideal analgesic in this increasingly common setting should be palatable, provide potent, rapid, and brief analgesia, and require minimal appropriate monitoring. Using a placebo-controlled, double-blind design we compared oral transmucosal fentanyl citrate (OTFC, approximately 10 microg/kg) and oral oxycodone (0.2 mg/kg) in 22 pediatric outpatient wound care procedures (ages 5-14 years). Pulse oximetry, vital signs, side effects, patient pain scores, and observer scores for cooperation, anxiety, and sedation were recorded. OTFC and oral oxycodone resulted in similar outcome measures and vital signs, and no significant side effects. The taste of OTFC was preferred. We conclude that OTFC and oral oxycodone are safe and effective analgesics in the setting of monitored outpatient wound care in children, and that OTFC offers the advantage of improved palatability.     

关节镜下诊治膝关节痛风性关节炎

目的探讨关节镜对膝关节痛风性关节炎的确诊率及疗效。方法选择17例膝关节痛风性关节炎患者,行膝关节镜下关节清理及滑膜切除术,术后常规服用降血尿酸药物、早期功能锻炼。结果所有患者均得到随访,随访时间6～24个月,平均13.2个月,术后末次随访时无明显复发的病例。根据Lysholm膝关节评分方法,术前患者功能评分平均43.2分;术后6个月复查评分平均87.4分,;术前和术后6个月Lyshol评分分数相比,差异有显著性(P<0.01)。结论关节镜对痛风性关节炎,尤其对于那些以膝、踝等大关节首发、血尿酸不高的非典型痛风性关节炎的诊断准确率高,关节镜下关节清理及滑膜切除术是治疗痛风性关节炎的一种见效快、创伤小、效果确切的新型微创治疗方法。