共查询到19条相似文献,搜索用时 93 毫秒
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目的 评价关节腔内注射不同剂量盐酸氢吗啡酮对膝关节镜手术术后镇痛的效果. 方法 择期硬膜外麻醉下行膝关节镜手术患者150例,按随机数字表法分为5组(每组30例):H1组、H2组、H3组、M组、C组.术毕H1组关节腔内注射盐酸氢吗啡酮0.1 mg(用生理盐水配制成10ml),H2组关节腔内注射盐酸氢吗啡酮0.2 mg,H3组关节腔内注射盐酸氢吗啡酮0.3 mg,M组关节腔内注射吗啡2 mg,C组关节腔内注射等量生理盐水10ml.记录术后4、6、8、12、24 h患者在屈膝关节90°状态下的VAS,记录术后24h内需要追加镇痛药物的患者例数以及术后副作用的发生情况. 结果 术后8h内H1组、H2组、H3组、M组VAS评分比较,差异无统计学意义(P>0.05);术后12 h VAS评分,H2组(2.5±0.6)分、H3组(2.1±0.7)分、M组(2.3±0.8)分低于H1组(3.1±0.6)分,差异有统计学意义(P<0.01);术后24 h VAS评分,H3组(2.2±0.5)分低于H2组(3.1±0.8)分和M组(3.0±0.6)分,差异有统计学意义(JP<0.05).术后需要追加镇痛药物的患者例数随盐酸氢吗啡酮剂量的增加而减少.结论 关节腔内注射不同剂量盐酸氢吗啡酮和吗啡用于膝关节镜均能获得良好的术后镇痛效果,0.3 mg盐酸氢吗啡酮的镇痛效果更佳. 相似文献
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小剂量吗啡和曲马多关节内注射用于膝关节镜术后镇痛的临床比较 总被引:2,自引:0,他引:2
目的 观察小剂量吗啡、曲马多关节内注射用于膝关节镜手术后的镇痛效果。方法 腰麻下行膝关节镜手术的病人 6 0例 ,双盲随机分为关节内注射吗啡组 (M组 ,n =2 0 )、曲马多组 (T组 ,n =2 0 )和生理盐水对照组 (C组 ,n =2 0 )。M组在术后关节内注射小剂量吗啡 (1mg) ,T组则在术后关节内注射小剂量曲马多 (10mg) ,C组则关节内注射等体积的生理盐水。给药后 8和 2 4小时 ,在病人双足站立膝关节伸展状态下进行视觉模拟评分。结果 M组评分平均为 1 7± 1 0和 1 5±1 1,T组评分为 2 0± 1 1和 1 7± 1 2 ,C组为 3 6± 1 5和 2 4± 1 3,M组与T组评分显著低于C组 (P <0 0 5 )。M组与T组评分有显著差异 (P <0 0 5 )。结论 小剂量的吗啡和曲马多关节内注射可以有效缓解膝关节镜手术的术后疼痛 ,尤以吗啡为佳 相似文献
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目的观察和比较地塞米松和小剂量吗啡配伍关节内注射用于膝关节镜手术后的镇痛效果。方法选择ASAⅠ~Ⅱ级择期腰麻下行单侧膝关节镜手术的病人90例,随机分为三组,每组30例。Ⅰ组手术后在关节内注射地塞米松5 mg+盐酸吗啡1 mg;Ⅱ组手术后在关节内注射盐酸吗啡1 mg;Ⅲ组手术后在关节内注射生理盐水5 mL。给药后8、24、36、48 h在病人双足站立、膝关节伸展状态下进行视觉模拟评分(visual analogue scales,VAS),观察三组膝关节手术后的镇痛效果以及不良反应,如呼吸抑制、恶心呕吐、尿潴留及搔痒等症状的发生率。结果给药后8、24、36、48 h,Ⅰ组VAS评分均显著低于Ⅱ组(P〈0.05或P〈0.01)和Ⅲ组(P〈0.01);Ⅱ组给药后8、24 h VAS评分显著低于Ⅲ组(P〈0.05),36、48 h VAS评分和Ⅲ组相比无显著性差异(P〉0.05);Ⅱ组36、48 h VAS评分和8、24 h相比显著升高(P〈0.05)。三组患者术后均未发生呼吸抑制、恶心呕吐、尿潴留及搔痒等不良反应。结论地塞米松和小剂量吗啡关节内注射或单纯小剂量吗啡关节内注射均可有效缓解膝关节镜手术后的疼痛,而前者效果更好,更持久。 相似文献
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<正> 芬太尼透皮贴剂(transder mal fentanyl,TDF)即多瑞吉(Durogesic)是一种新型强效缓释经皮吸收的麻醉镇痛药,是目前较理想的癌症止痛药物之一。在术后镇痛方面尚未见有关报道。2000年6月至2002年3月我院将它用于妇产科患者术后镇痛,并对其临床镇痛效果及不良反应进行了观察,现报告如下。 1 资料与方法 1.1 临床资料:选择行下腹部手术的妇产科病患者134例,年龄20~56岁,平均40.3岁,体重42~85kg,平均58.3kg,按美国麻醉协会(Anesthesia Society of American,ASA)分级为Ⅰ~Ⅲ级,无肝、肾及心脏功能障碍。手术种类:子宫全切术38例,广泛全子宫+盆腔淋巴结清扫术6例,肌瘤剥出术35例,卵巢良性肿瘤剥出术及输卵管手术23例,剖宫产32例。 相似文献
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芬太尼氯胺酮静脉麻醉的术后镇痛作用 总被引:1,自引:0,他引:1
芬太尼氯胺酮静脉麻醉的术后镇痛作用张兆平*鉴于阿片类药物和N-甲基-D天(门)冬氨酸(简称NMDA)受体拮抗药具有先发制痛或术后镇痛作用,氯胺酮属于一种非竞争性NMDA受体拮抗药。对此,我们将芬太尼或氯胺酮分别用于静脉诱导或麻醉维持,评价其术后镇痛效... 相似文献
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Kizilkaya M Yildirim OS Dogan N Kursad H Okur A 《Anesthesia and analgesia》2004,98(4):1062-5, table of contents
We studied the effect of intraarticular saline, sufentanil, or sufentanil plus methylprednisolone after knee arthroscopic meniscectomy. In a double-blind randomized study, 60 patients undergoing knee arthroscopic meniscectomy were allocated to groups receiving intraarticular saline, intraarticular sufentanil 10 microg, or sufentanil 10 microg plus methylprednisolone 40 mg at the end of arthroscopy during general anesthesia. Postoperatively, pain levels at rest and during movement (i.e., active flexion of the knee) were measured by a visual analog scale and were significantly decreased in the sufentanil and sufentanil plus methylprednisolone groups compared with the control group. Moreover, we found that there was a significant reduction in intraarticular sufentanil and sufentanil plus methylprednisolone in the postoperative consumption of analgesics. We also found that the use of intraarticular sufentanil or sufentanil plus methylprednisolone after knee arthroscopic meniscectomy decreases the amount of supplementary analgesic needed for pain relief during the early postoperative period. In addition, we detected that sufentanil provided prolonged pain relief up to 24 h when compared with control, whereas when we combined sufentanil plus methylprednisolone, we found that it further reduced pain and use of analgesics when compared with sufentanil. IMPLICATIONS: The combined use of intraarticular sufentanil (10 microg) and methylprednisolone (40 mg) in arthroscopic meniscectomy surgery reduced both postoperative pain scores and the use of additional analgesics. 相似文献
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Serum bupivacaine concentrations after intraarticular injection for pain relief after knee arthroscopy. 总被引:1,自引:0,他引:1
Intraarticular injection of local anesthetic drugs after arthroscopic knee surgery is used to provide postoperative analgesia. Toxic serum levels of bupivacaine have been reported after its use both in regional anesthesia and for intraarticular injection. The toxicity of the former is related to needle misplacement and the latter is presumed to be absorptive. This study evaluates the effect of tourniquet inflation and the addition of epinephrine on serum concentrations of bupivacaine after intraarticular injection. The results shows that the peak serum bupivacaine concentrations can be reduced by adding epinephrine and injecting it after tourniquet inflation. 相似文献
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In a double-blind, randomized, controlled study, 61 patients who received a standardized anaesthetic for day case arthroscopic knee surgery were studied. Group T (n = 31) received tramadol 1.5 mg kg-1, and group F (n = 30) received fentanyl 1.5 micrograms kg-1 at the induction of anaesthesia. All patients also received 20 mL of intra-articular bupivacaine 0.5% at the end of surgery. Assessments were made of pain at rest and on movement, analgesic requirements and side-effects at hourly intervals up to 6 h and by means of a postal questionnaire at 24 h and 48 h post-operatively. Group F had higher pain scores than group T at 4 h only [VAS 3.3 (1.6-5.5) vs. 2.4 (1-4), P = 0.039, respectively; median (interquartile range)]. There were no other significant differences between the groups in terms of pain scores, supplemental analgesic requirements or incidence of side-effects. We conclude that tramadol offers little benefit clinically compared with fentanyl when used at induction of anaesthesia for day case arthroscopic knee surgery. Further studies are indicated in patients with more severe pain to determine the role of tramadol in post-operative analgesia. 相似文献
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Pooni JS Hickmott K Mercer D Myles P Khan Z 《European journal of anaesthesiology》1999,16(10):708-711
A randomized double-blinded study consisting of 107 patients was conducted to compare the effect on post-operative pain relief of intra-articular fentanyl and intra-articular bupivacaine after knee arthroscopy. The results showed that intra-articular bupivacaine produced superior analgesia in the immediate post-operative period. At 2 h post-operatively, the intra-articular bupivacaine group had a mean pain score of 2.0 (standard deviation 2.1, P < 0.05) compared with the intra-articular fentanyl group which had a mean pain score of 3.2 (standard deviation 2.3, P < 0.05). After 2 h post-operatively, intra-articular bupivacaine and intra-articular fentanyl had a similar effect on pain scores. The mean pain score 18 h post-operatively was 2.7 for the intra-articular bupivacaine group (standard deviation 2.2, P value 0.6) compared with the intra-articular fentanyl group which had a mean pain score of 2.8 (standard deviation 1.9, P value 0.6). 相似文献
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Rosseland LA Helgesen KG Breivik H Stubhaug A 《Anesthesia and analgesia》2004,98(6):1546-51, table of contents
We have previously studied intraarticular (IA) analgesics compared with saline 10 mL in 2 randomized clinical trials. The patients who were given IA saline experienced rapid pain relief. Hypothetically, saline may produce a local analgesic effect by cooling or by diluting IA algogenic substances. This randomized double-blind study compared the analgesic effect of IA saline 10 mL with saline 1 mL, which should be a pure placebo. A soft catheter was left IA in 79 patients. We included 60 patients who developed moderate-to-severe pain within 1 h after knee arthroscopy under general anesthesia. A randomized, double-blind controlled comparison of IA saline 10 mL with saline 1 mL followed. Outcome measures were pain intensity, pain relief, and analgesic consumption. Within 1 h pain intensity decreased in both groups from approximately 50 to approximately 27 on a 0-100 mm visual analog scale. Pain intensity remained low and other pain outcome measures were similar during the 36-h observation period. The patients experienced equally good pain relief after IA injection of saline 10 mL and 1 mL. Our finding of a major placebo effect may have implications for the interpretation of previously published placebo-controlled IA analgesia studies. IMPLICATIONS: In a randomized controlled trial we showed that pain after knee arthroscopy is modest and short-lived and can successfully be treated with intraarticular saline as placebo. 相似文献
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The effects of preoperative inflammation on the analgesic efficacy of intraarticular piroxicam for outpatient knee arthroscopy 总被引:3,自引:0,他引:3
Izdes S Orhun S Turanli S Erkilic E Kanbak O 《Anesthesia and analgesia》2003,97(4):1016-9, table of contents
We conducted a double-blinded study in 90 patients undergoing elective arthroscopic knee surgery to determine whether there is a role of inflammation in the analgesic efficacy of intraarticular piroxicam. Standardized general anesthetic techniques were used for all patients. At the end of the operation, after harvesting synovial biopsies, patients were randomized into three intraarticular groups equally. Group 1 received 25 mL saline, Group 2 received 25 mL 0.25% bupivacaine, and Group 3 received 25 mL 0.25% bupivacaine and piroxicam 20 mg. After microscopic examination of the synovial materials, the patients were divided into two subgroups, inflammation positive (I+) and inflammation negative (I-). Preoperatively and postoperatively at 1, 2, 4, and 6 h, pain levels, analgesic duration, and postoperative analgesic consumption were recorded. Analgesic duration was significantly longer in the I+ subgroup than the I- subgroup of Group 3 (P < 0.05). Pain scores at 1, 2, and 4 h postoperatively were significantly lower in the I+ subgroup than the I- subgroup of Group 3 (P < 0.05), whereas there were no significant differences among the subgroups of Group 1 and 2. We concluded that preoperative inflammation is one of the most important determinants of analgesic efficacy of intraarticular piroxicam. IMPLICATIONS: Intraarticular administration of piroxicam along with bupivacaine improves postoperative analgesia in synovial inflammation before surgery. 相似文献