胸段硬膜外镇痛对腹腔镜结直肠手术后疼痛的影响及护理观察

目的本研究旨在探讨胸段硬膜外镇痛对腹腔镜结直肠手术后疼痛的影响及护理体会。方法将采用相同围术期处理的腹腔镜结直肠手术患者50例随机分为静脉镇痛(IA)组25例和胸段硬膜外镇痛(TEA)组25例,IA组采用静脉注射曲马朵自控镇痛,TEA组采用胸段硬膜外注射罗哌卡因和芬太尼自控镇痛,测定2组患者的视觉模拟评分(VAS),记录术后排气时间、口服半流饮食时间和术后住院天数,并观察记录不良反应及并发症。结果使用硬膜外镇痛的TEA组在术后第1天、第2天的VAS显著低于IA组(P<0.05);TEA组术后排气时间、口服半流饮食时间及术后住院天数显著短于IA组(P<0.05);2组术后并发症及再住院率则无统计学差异(P>0.05)。结论胸段硬膜外镇痛应用于腹腔镜结直肠手术可为患者提供有效的术后镇痛,并使患者下床活动提前,减少了卧床时间,优化了术后护理。     

An evaluation of postoperative epidural analgesia in acute pain service in an Indian cancer hospital (a preliminary experience of patient satisfaction survey)

Quality improvement approaches have been used to evaluate pain management. The purpose of this study was two-fold: to obtain a baseline data of incidence of severity of pain and patient's level of satisfaction during postoperative period and also to evaluate the changes over time on pain severity, in pain interference with function, patient satisfaction, and time required to deliver the analgesics after implementation of pain protocols. Two hundred patients were administered a questionnaire adapted from American Pain Society's patient outcome questionnaire in a two-phased manner. One hundred patients were included in the survey during January 2004 and a year later a similar cohort of 100 were administered the same questionnaire to evaluate for changes in quality of postoperative management over time. This self-report survey found a significantly high patient satisfaction in the setting of significant postoperative pain. There is a statistically significant reduction in the severity of ‘average pain’ after implementation of pain protocols, however, it did not translate into improvement in the patient satisfaction. The issue of patient satisfaction is complex and needs a systematic program recommended by American Pain society's quality improvement guidelines.     

舒芬太尼硬膜外镇痛用于治疗带状疱疹神经痛的增效作用效果观察

目的观察舒芬太尼硬膜外镇痛治疗带状疱疹神经痛的效果。方法 60例躯干部带状疱疹神经痛患者按随机数字表法分为常规硬膜外镇痛组(A组)和舒芬太尼镇痛组(B组)各30例。两组均给予2%利多卡因3 ml+复方倍他米松1ml+甲钴铵1 mg+0.9%NS 10 ml,在此基础上,B组加用舒芬太尼0.5μg/ml。观察两组治疗前后疼痛的改善情况及不良反应,并随访带状疱疹后遗神经痛的发生率。结果两组患者治疗后各时点与治疗前相比疼痛评分随时间延长而下降(P<0.05);舒芬太尼镇痛组治疗后各时点的视觉模拟评分(Visual analogue scale,VAS)与单纯硬膜外镇痛组比较差异均有统计学意义(P<0.05);两组未出现严重的不良反应,不良反应发生率两组间比较差异均无统计学意义(P>0.05)。治愈后随访3个月,A组1例出现后遗神经痛,B组无后遗神经痛发生。结论舒芬太尼用于硬膜外镇痛可提高带状疱疹神经痛的治疗效果,是一种安全有效的临床治疗方法。     

Why women prefer epidural analgesia during childbirth: the role of beliefs about epidural analgesia and pain catastrophizing.

This study investigated the reasons that might lead women to choose or not choose epidural analgesia as a strategy for the management of pain in childbirth. In our sample 55% of 114 women chose EA. Logistic regression resulted in a statistical model with four unique and independent predictors: Parity status and the fear of the side effects of EA each reduced the odds of choosing EA by half, whereas the desire to have a pain-free childbirth and positive experiences with EA of family and friends each doubled the odds of choosing EA. Pain catastrophizing was not related to EA use. The lack of an interrelationship between pain catastrophizing and EA use is probably due to an ambivalent attitude towards EA in pain catastrophizers. Pain catastrophizing was positively associated with the fear of being overwhelmed by labour pain and tendencies to avoid the pain, but also positively with the fear of pain during the insertion of the EA needle. Pain catastrophizing was also strongly related to recommendations to use EA from others, in particular from the midwife and from the gynecologist. Results are discussed in terms of the social impact of pain catastrophizing.     

Regional analgesia in Italy: A survey of current practice

Two decades of attention have focused on regional anesthesia, both central neuraxial blockades as well as peripheral blocks. Though there are a considerable number of recent publications on the topic, the complex issues around the effect of regional anesthesia on outcome have not been completely resolved, possibly because the data are often not procedure-specific.In this survey, we tried to focus on current Italian practice and therapeutical criteria in the management of postoperative pain. We also evaluated how the clinical practice of the respondents follows the international and national guidelines for postoperative pain.A questionnaire was mailed to 64 anesthesiologists who had been identified from a database kept by the RICALOR Group (Registro Italiano Complicanze Anestesia LOcoRegionale – Italian Registry of Complications during Locoregional Anesthesia). The survey requested information regarding demographic data and general management, postoperative pain management and guidelines, and specific questions on epidural analgesia and on peripheral blocks.Only 35 of the 64 anesthesiologists answered the questionnaire and sended it back for analysis. Basing on these 35 returns, data from 51 surgical units (some respondent referred data of more surgical units) leading to 135 departments (surgical units may be constituted by more departments) were analyzed. A total of 245,382 surgical procedures were analyzed. Regional analgesia was used in 46.71% of the procedures.In university and teaching-hospitals, protocols concerning regional anesthesia were attended and shared with the whole staff more often than in non-teaching hospitals (P = 0.0001).For postoperative pain management 31.48% of responders used <10% of regional analgesia, 20.37% used 10–30%, 25.93% used 30–50%, 14.81% used 50–75% and 7.41% used >75% of regional analgesia.We identified a huge variety of responses regarding therapeutical protocols but the majority of responders used the drugs with the best safety/efficacy profile.In conclusion, we demonstrated an improvement in the management of postoperative pain compared to previous studies, but still efforts should be made to standardize daily practice in order to avoid complications and improve safety.     

心外科术后吗啡与芬太尼患者自控镇痛效果观察

目的观察吗啡和芬太尼患者自控镇痛 (PCIA)用于心外科术后疼痛康复的疗效和安全性。方法将 70例心脏手术患者随机分为吗啡组和芬太尼组 ,术后在ICU病房用PCIA进行疼痛康复 ,观察镇痛起效时间、效果及满意率 ,以及 2 4h、48h和 72h生命体征及恶心、呕吐等副作用。结果两组患者的镇痛效果及满意率无显著性差异 ,生命体征均平稳 ,但芬太尼组的起效时间明显短于吗啡组 (P <0 .0 5 ) ,患者的恶心、呕吐次数明显少于吗啡组 (P <0 .0 5 )。结论吗啡和芬太尼PCIA均能安全地用于心外科术后患者急性疼痛的康复治疗 ,但芬太尼PCIA明显比吗啡PCIA起效快 ,恶心、呕吐副作用少。     

术后单次肌注镇痛药物对手术患者胃肠道功能恢复的影响及其护理

【】 目的 探讨单次使用肌注镇痛药物处理患者术后急性疼痛对其胃肠道功能恢复的影响 方法 选取12例使用过哌替啶、曲马多或强痛定肌注镇痛的腹部手术患者,标记为镇痛组(A组)。选取术后未肌注镇痛药物的患者,经过与Ａ组的严格配对,标记为对照组(B组)。共获得24例12对患者。比较其术后排便、恢复流质饮食情况及出院天数有否显著差异。结果 镇痛组患者术后排便,恢复流质饮食以及出院的天数分别为(5.25±1.71)、(7.08±2.11)、(11.83±5.95)天,对照组分别为(5.67±3.60)(7.75±2.09)(10.67±3.34) 天,两组患者各项的天数差分别为(0.42±3.80)(0.67±2.10)(1.17±5.34)天,两组比较差异无统计学意义(t分别为0.38,1.10,0.76;P均>0.05)。结论 腹部手术患者术后单次肌注镇痛药物对其胃肠道功能恢复无明显影响。术后肌注镇痛仍然是一种简单、有效的术后镇痛方法。     

Predictors and barriers to adequate treatment of postoperative pain after radical prostatectomy

The purpose of this study was to identify preoperative predictors of postoperative pain and barriers to adequate treatment of pain and to describe the pain experience during 3 days after radical prostatectomy. Ninety patients undergoing radical prostatectomy under general anaesthesia with postoperative epidural analgesia were studied. “Worst pain” during the last 24 h was measured with visual analogue scale (VAS) at 24, 48 and 72 h postoperatively. Depending on their pain scores, the patients were referred to three separate groups, i.e. VAS scores 0–30 (no pain), 31–70 (moderate pain) and 71–100 (severe pain). There was a high incidence of pain, with 35 (39%) of the patients having moderate and 27 (30%) having severe pain (VAS > 70) for 1 or more days. In patients with severe pain, preoperative depression was more common (p < 0.01), opioid consumption was increased (p < 0.01) and length of hospital stay (LoS) was prolonged (p < 0.05). Catheter related problem occurred in 57% of the patients, with no intergroup variation. Aside from preoperative depression, the treatment failures could not be predicted but seemed rather to be related to barriers associated with management, technical and pharmacological factors and an inadequate service response in general to patients with moderate or severe pain.     

路径化康复护理对腰椎手术患者术后疼痛与康复效果的影响

目的探讨路径化康复护理对腰椎手术患者术后疼痛及康复效果的影响。方法选取2018年2月至2019年5月我院收治的腰椎手术患者178例为研究对象,按照随机数字表法将其等分为对照组和观察组,对照组给予常规护理,观察组给予路径化康复护理干预。比较两组患者干预前后的疼痛评分、腰椎功能及康复效果。结果实施路径化康复护理干预后,观察组患者术后3,7 d的疼痛评分低于对照组(P <0. 05);术后3个月,观察组腰椎功能评分高于对照组(P <0. 05),康复效果优良率高于对照组(P <0. 05)。结论路径化康复护理的应用,可明显缓解腰椎术后患者的疼痛感,提升腰椎功能的恢复进程和康复效果,值得推广应用。     

Postoperative analgesia and early rehabilitation after total knee replacement: A comparison of continuous low‐dose intravenous ketamine versus nefopam

The effects of nefopam and ketamine on pain control and rehabilitation after total knee replacement were compared in a prospective, double blinded study.Seventy-five patients were randomly assigned to receive a 0.2 mg kg^?1 bolus of nefopam or ketamine, followed by a 120 μg kg^?1 h^?1 continuous infusion until the end of surgery, and 60 μg kg^?1 h^?1 until the second postoperative day, or an equal volume of saline considered as placebo. Pain scores measured on a visual analog scale at rest and on mobilization, and patient-controlled intravenous morphine consumption, were assessed during 48 h. We measured the maximal knee flexion on the third postoperative day, and the delay to obtain a 90° flexion.Ketamine and nefopam reduced morphine consumption (p < 0.0001). Pain scores, were lower at rest and on mobilization in the ketamine group compared to the two other groups at all times of measurement. Pain score were lower in patients receiving nefopam compared to placebo, on arrival in the recovery room and at 2 h. Ketamine improved knee flexion on post operative day 3 (59° [33–63] vs. 50° [47–55] and 50° [44–55] in ketamine, placebo and nefopam groups, respectively, p < 0.0002) and decreased the delay to flex the knee at 90° (9.1 ± 4.2 vs. 12.3 ± 4.0 days, in ketamine and placebo groups, respectively, p = 0.01).Ketamine produces opioid-sparing, decreases pain intensity, and improves mobilization after total knee replacement. Nefopam achieves less significant results in that circumstances.     

快速康复在肩关节术后早期康复中疼痛的管理

目的探讨快速康复在肩关节术后早期康复中对于疼痛的管理影响。方法选取本院骨科肩关节手术患者120例,按照随机数字表的顺序分为观察组65例和对照组55例,观察组患者进行快速康复护理,为患者提供全面的术前准备,精确全面的术后护理,康复训练和详细的出院指导。对照组患者则进行常规康复护理,观察比较2组患者的术后患者疼痛感,并发症的发生情况,患者对治疗满意度的评价等。结果观察组患者的住院时间显著少于对照组患者,显著减轻了患者的经济负担,相同时间内,观察组患者的术后康复效果,疼痛感减轻情况及患者的满意度调查均显著高于对照组患者(P0.05),并发症的发生情况较对照组低,应对结果较对照组好。结论快速康复可以有效减轻肩关节术后患者早期康复中的疼痛感,有效提高临床治疗效率,且并发症的发生情况也较常规康复组稍低,值的临床推广使用。     

多模式镇痛对下肢骨折术后患者 免疫功能、炎性因子及疼痛程度的影响

目的 研究多模式镇痛应用于骨折术后治疗中对患者免疫功能、炎性因子及疼痛程度的影响.方法 回顾性选取2019年1月至2020年1月柳州市工人医院收治的100例下肢骨折患者作为研究对象,根据镇痛方法 不同分为研究组与对照组,各50例.对照组选用芬太尼静脉自控镇痛,研究组选用多模式(硬膜外联合蛛网膜下腔阻滞)镇痛.比较2组患...     

Psychosocial coping profiles after pain rehabilitation: associations with occupational performance and patient characteristics

Purpose The aims of the present study were to assess: (i) changes in coping by use of Multidimensional Pain Inventory profiles from baseline to follow-up, (ii) associations between Adaptive Coper (AC) profiles at follow-up and improvements in occupational performance (by Canadian Occupational Performance Measure COPM) and (iii) ability to predict AC profiles at follow-up by participants’ baseline characteristics. Method Data at baseline, discharge and follow-up from 525 participants in a pain rehabilitation program were analyzed with multivariate statistics. Results AC profiles increased and Dysfunctional (DYS) profiles decreased at follow-up. Clinically relevant improvements on COPM were associated with having an AC profile at follow-up. Being Nordic born, having longer education, an AC profile and higher baseline scores on satisfaction with performance predicted an AC profile at follow-up. Conclusions Pain rehabilitation seems to result in sustainable and favourable coping strategies at follow-up, and improved occupational performance is associated with favourable coping at follow-up. Outcomes need to be measured independently of improved coping strategies and improvements of participant’s individual goals such as difficulties to perform their most meaningful occupations. Patients at risk for unfavourable coping strategies may need modified interventions.

• Implications for Rehabilitation

• More participants reported a beneficial coping, MPI profile, in a long-term perspective after a pain rehabilitation program.

• Improvements on occupational performance prioritized as meaningful by each of the participants are related to adequate coping strategies at follow-up.

• The associations between improved occupational performance and beneficial coping profiles need to be better understood.

• Patients with worse initial occupational performance may need modified pain rehabilitation interventions to improve their coping strategies.

     

Acupuncture anesthesia and analgesia for clinical acute pain in Japan

Acupuncture anesthesia has been practiced in China since about 1960. In Japan, Hyodo reported 30 cases of acupuncture anesthesia in 1972. However, from around 1980, the direction of acupuncture investigations turned from anesthesia to analgesia. Acupuncture analgesia is presently considered a way to activate the body's endogenous analgesic system. Recently, with the rise of acupuncture as one of the most well known CAM therapies, acupuncture or moxibustion treatment has been reported for both acute and chronic pain. Even so, few clinical reports and original articles have been reported in Japan. This review illustrates how acupuncture is being used in Japan for acute pain such as surgical operations, post- operative pain (POP), neuropathic pain, pain associated with teeth extractions and after the extraction of impacted wisdom teeth.     

静脉全麻复合硬膜外麻醉及自控硬膜外镇痛对食管癌患者术后T细胞亚群和循环与呼吸的影响

目的观察食管癌患者静脉全麻复合硬膜外麻醉(CGEA)及自控硬膜外镇痛(PCEA)对术后T细胞亚群、循环及呼吸的影响。方法食管癌手术患者100例,根据选择的麻醉方式不同分为观察组和对照组,每组50例,观察组采用CGEA及PCEA,对照组采用CGEA及术后经静脉自控镇痛(PCIA),观察两组麻醉前30 min、术后2 h、24 h、3 d、5 d外周血T淋巴细胞亚群百分率、循环和呼吸的变化。结果①两组患者术后2 h、24 h时CD3+、CD4+、CD8+、CD8+/CD4+与麻醉前比较,差异有统计学意义(P0.05),观察组术后2 h、24 h T淋巴细胞亚群百分率下降少,第3 d恢复正常平均水平,对照组第5天恢复正常平均水平;②观察组术后2 h、24 h、3 d MAP增高,心率增快,与对照组比较,差异有统计学意义(P0.05)。③观察组术后2 h RR增快、Vt、Vc、SpO2降低,与观察组比较差异有统计学意义(P0.05)。结论 CGEA及PCEA对食管癌患者术后T细胞亚群、循环与呼吸功能影响小,恢复快。     

Effectiveness of continuous femoral nerve block for pain relief after total knee arthroplasty: comparison with epidural patient-controlled analgesia and periarticular injection

ObjectiveTo compare the clinical outcomes among three analgesic techniques, continuous femoral nerve block (CFNB), epidural patient-controlled analgesia (EPCA) and periarticular injection (PAI), in patients undergoing total knee arthroplasty (TKA).MethodsThis retrospective case–control study enrolled patients that underwent TKA. Visual analogue scale (VAS) pain scores, sleep disturbance, additional opioid consumption and incidence of opioid-related side-effects were assessed.ResultsA total of 120 patients were categorized into three groups: EPCA (group A, n = 40), PAI (group B, n = 40) and CFNB (group C, n = 40). Group C had significantly lower VAS pain scores than groups A and B at 8, 12 and 24 h after TKA. There were no significant differences in VAS pain scores among the three groups from 48 h after TKA. Sleep quality on the first day after surgery was significantly better in group C than in groups A and B. Additional opioid consumption was significantly lower in the group C than in the groups A and B. Group C showed a lower rate of opioid-related side-effects than groups A and B.ConclusionCFNB was a more effective additional analgesic technique than EPCA or PAI for acute postoperative pain control within 24 h of TKA.     

Quality of life and maintenance of improvements after early multimodal rehabilitation: a 5-year follow-up

Purpose. There is a paucity of long-term evaluations on rehabilitation of musculoskeletal disorders, e.g., neck, shoulder or back pain. The aim of this study was to assess quality of life and the effect of early multimodal rehabilitation on 91 patients with musculoskeletal pain and disability at a 5-year follow-up.

Method. The follow-up assessment, which included questions on pain, function, quality of life, perceived health, sick leave and psychosomatic symptoms, was performed 5 years after the assessment of baseline status.

Results. Improvements in pain, perceived health and psychosomatic symptoms were maintained at the 5-year follow-up. In addition, improvements in function, quality of life, and level of acceptable pain were significant in comparison to baseline. At the time of the baseline assessment all patients were on sick leave (13% were on partial sick leave). At the 5-year follow-up, 58% of the patients were at work part or full time. The results show that those working differed significantly from those not working at the 5-year follow-up on almost all variables, indicating that those working enjoy better health. The most salient prognostic factors for return to work were perceived health and educational level at the time of the baseline evaluation.

Conclusions. These results show that treatment improved quality of life and the effects were basically maintained at 5 years. Work capacity as reflected in return to work increased greatly (81%) at a 1-year follow-up and was substantial (58%) at the 5-year follow-up. Moreover, perceived health and educational levels were important prognostic factors. Finally, the fact that patients working reported better health underscores the probable importance of return to work. Our results imply that it may be feasible to obtain long-term benefits from such a primary care-based intervention.     

Quality of life and maintenance of improvements after early multimodal rehabilitation: A 5-year follow-up

Purpose.?There is a paucity of long-term evaluations on rehabilitation of musculoskeletal disorders, e.g., neck, shoulder or back pain. The aim of this study was to assess quality of life and the effect of early multimodal rehabilitation on 91 patients with musculoskeletal pain and disability at a 5-year follow-up.

Method.?The follow-up assessment, which included questions on pain, function, quality of life, perceived health, sick leave and psychosomatic symptoms, was performed 5 years after the assessment of baseline status.

Results.?Improvements in pain, perceived health and psychosomatic symptoms were maintained at the 5-year follow-up. In addition, improvements in function, quality of life, and level of acceptable pain were significant in comparison to baseline. At the time of the baseline assessment all patients were on sick leave (13% were on partial sick leave). At the 5-year follow-up, 58% of the patients were at work part or full time. The results show that those working differed significantly from those not working at the 5-year follow-up on almost all variables, indicating that those working enjoy better health. The most salient prognostic factors for return to work were perceived health and educational level at the time of the baseline evaluation.

Conclusions.?These results show that treatment improved quality of life and the effects were basically maintained at 5 years. Work capacity as reflected in return to work increased greatly (81%) at a 1-year follow-up and was substantial (58%) at the 5-year follow-up. Moreover, perceived health and educational levels were important prognostic factors. Finally, the fact that patients working reported better health underscores the probable importance of return to work. Our results imply that it may be feasible to obtain long-term benefits from such a primary care-based intervention.     

纳布啡联合酮咯酸氨丁三醇预防性镇痛对鼻内镜手术患者术后疼痛及恢复质量的影响

目的 观察纳布啡联合酮咯酸氨丁三醇预防性镇痛对鼻内镜手术患者术后疼痛及恢复质量的影响.方法 选取2019年6月-2020年4月该院择期行鼻内镜下鼻中隔偏曲矫形术治疗的患者46例,随机分为纳布啡联合酮咯酸氨丁三醇组(NK组)和酮咯酸氨丁三醇对照组(C组),每组23例.两组患者均于麻醉诱导前10 min行预防性镇痛,NK组...