Efficacy of various epidural analgesia regimens after lung surgery

A prospective study included 90 adult patients undergoing thoracic surgery. After placing an epidural catheter at the Th4-Th5 level, all the patients were randomized in 3 groups. Twenty-nine patients received controlled epidural analgesia (PCEA) with fentanyl, 2 microg/ml, in 0.2% bupivacaine solution (Group 1). In other groups, these analgesics were given either as bolus infections (Group 2; n = 30) or as a continuous epidural infusion of fentanyl, 2 microg/ml, in 0.2% bupivacane solution (Group 3; n = 27). Pain scores and the incidence of adverse effects were assessed within the first 24 hours after surgery. The data were compared using the Student's t-test and x2 test with Bonferroni correction; p < 0.017 was regarded as statistically significant. The VAS scores in coating were significantly lower in Group 1 than in Groups 2 and 3. The need for epidural opioids for adequate analgesia within the first 24 hours after surgery was significantly less in Group 1 than in Groups 2 and 3. There were no excessive sedation episodes in all the groups. In Group 2, the incidence of nausea was 20%. These adverse reactions were not found during PCEA and continuous infusion (p < 0.017). Opioid-induced pruritis was mostly (23%) observed in Group 2. Thoracic PCEA with fentanyl-bupivacaine solution provided adequate postoperative analgesia after thoracotomy and reduced the need for opioids. In addition, PCEA reduced the incidence of adverse reactions of opioids.     

舒芬太尼复合罗哌卡因用于开胸术后硬膜外镇痛的疗效

【目的】观察舒芬太尼或芬太尼复合罗哌卡因用于开胸手术后硬膜外自控镇痛（PCEA）的临床镇痛效果和安全性。【方法】ASAⅠ～Ⅱ级,全麻复合连续硬膜外阻滞麻醉行开胸手术病人70例,随机分为两组（n=35）,使用0．75μg／ml舒芬太尼（S组）或3μg／ml芬太尼（F组）复合0．125％罗哌卡因,术后行PCEA。镇痛泵设定持续背景剂量2mL／h、PCA每次0．5mL,锁定时间15min。观察病人术后镇痛效果,记录术后4h、8h、12h、24h、48h各时间点的疼痛评分（VAS）、镇静评分、PCA使用次数、不良反应和病人满意度。【结果】S组术后8h、24h和48hVAS评分明显低于F组（P〈0．05）;S组各时间点镇静评分均明显大于F组（P〈0．05）;S组PCA按压次数显著低于F组（P〈0．05）;S组病人对PCA的满意度明显高于F组（P〈0．05）。两组恶心、呕吐发生率低,呼吸抑制相比无明显差异。【结论】舒芬太尼复合罗哌卡因用于开胸手术后PCEA,镇痛安全有效,镇痛镇静效果优于芬太尼,不良反应程度较轻。     

舒芬太尼用于髋关节置换术后患者自控硬膜外镇痛的观察

目的比较舒芬太尼与等效剂量芬太尼在髋关节置换术后患者硬膜外镇痛的临床效果。方法 2006年11月-2008年9月收治的50例硬膜外麻醉下髋关节置换术患者,随机分为两组（n=25）。芬太尼组（A组）：芬太尼0.75mg加0.894%甲磺酸哌卡因20mL加生理盐水至100mL;舒芬太尼组（B组）,舒芬太尼75μg加0.894%甲磺酸哌卡因20mL加生理盐水至100mL硬膜外镇痛。其中,A组患者于手术结束时,静脉滴注格拉司琼3mg。持续剂量2mL/h,单次给药量（PCA）0.5mL/次,锁定时间15min。观察两组的镇痛效果,恶心、呕吐次数,记录脉搏血氧饱和度、心率、呼吸的变化。结果镇痛泵开机后,B组各时段镇静评分,2分以上者明显多于A组,镇痛评分明显低于A组,有统计学意义（P〈0.05）,两组术后恶心、呕吐发生率都较低,组间差异无统计学意义（P〉0.05）。两组4、12、24h的呼吸频率和脉搏血氧饱和度差异有统计学意义（P〈0.05）,但48h的呼吸频率和脉搏血氧饱和度无统计学意义（P〉0.05）。结论在等效剂量下,髋关节置换术后患者硬膜外镇痛,舒芬太尼明显优于芬太尼。     

小儿尿道下裂修补术后硬膜外自控镇痛与静脉自控镇痛的效果观察

目的比较盐酸曲马多＋岁哌卡因硬膜外白控镇痛与盐酸曲马多＋芬太尼静脉白控镇痛用于小儿尿道下裂修补术后的效果及不良反应。方法60例ASAI～II级、年龄3～8岁的尿道下裂患儿,随机分为两组,每组30例。A组（n=30）：盐酸曲马多＋罗哌卡因硬膜外自控镇痛（PCEA）,术毕前30min硬膜外给予盐酸曲马多0．5mg／kg＋0．125％罗哌卡因3m1,术毕盐酸曲马多1rag／kg＋氟哌利多0．05mg／kg＋0．125％布比卡因,加生理盐水至100ml,持续泵入1ml／h,PCA 1ml／次,锁定时间为10min;B组（n=30）：盐酸曲马多＋芬太尼静脉白控镇痛（PCIA）,盐酸曲马多1mg／kg＋芬太尼0．001mg／kg＋氟哌利多0．05mg／kg,加生理盐水至100ml,术毕静脉泵入1ml／h,PCA 1ml／次,锁定时间10min。观察术后采用视觉模拟评分（VAS）分别记录两组术后1h、3h、6h、12h、24h、48h的镇痛效果,同时记录心率、血氧饱和度及不良反应的发生率。结果A、B组的VAS评分、心率无明显差异（P〉0．05）;B组在术后1h、3h血氧饱和度明显低于A组（P〈0．05）,在其他时间与A组无明显差异（P〉0．05）;B组有5例嗜睡,6例出现轻度恶心呕吐（P〈0．01）。结论小儿尿道下裂术后PCEA与PCIA的效果相当,但PCIA的副作用稍大,PCEA更合适。     

Comparative evaluation of preventive analgesia with xefocam, ropivacaine, and transdermal drug delivery system of durogesic in patients after craniotomy

The goal of this study was to comparatively evaluate the efficacy of pre-emptive analgesia in patients after supra- and infratentorial craniotomy. Three hundred and sixty-two postcraniotomy patients aged 16 to 72 years were recruited in the study. The patients were divided into 5 groups. The first two groups received traditional analgesia on demand with metamizole sodium and ketoprofen (Group 1) or xefocam (Group 2). Groups 3-5 had different preemptive analgesia modes. Scheduled dosing of xefocam (8 mg i.v. 30 min prior to surgery and then 8 mg every 8 hours within 48 hours) was used in Group 3. Group 4 underwent scalp nerve block and skin infiltration with ropivacaine. Group 5 had a scheduled dosing of fentanyl (12-18 hours before surgery, Durogesic was applied to the patient's skin in a dose 25 microg per hour for 3 days). Postoperative pain was assessed using the visual analogue scale (VAS) at 6, 18, 30, 42, and 54 hours after surgery. The patients who received pre-emptive analgesia showed significantly lower VAS scores than those who had traditional analgesia (p < 0.05).     

罗哌卡因两种给药方案在分娩镇痛中的应用比较

目的　比较罗哌卡因 2种连续输注方案在产科硬膜外分娩镇痛中的应用。方法　 60例产妇随即均分为A组和B组 ,两组于宫口开 2cm时行硬膜外镇痛 ,负荷量均为 0 . 2 %罗哌卡因 7～ 10ml。A组为 0 .1%罗哌卡因 (10ml/h) ,B组为0 2 %罗哌卡因 (5ml/h) ,同时分别加入 2mg/L芬太尼 ,待宫口近开全 (8～ 9cm)停药。检测两组产妇的生命体征 ,疼痛程度 ,下肢运动能力 ,宫缩感觉变化 ,产程及分娩结果等。结果　 2组均获得满意镇痛 ,两组满意度分别为 93 %、96%。运动能力 :两组产妇Bromega分级均未超过I级 ,但行走至产床时A组 5例 ,B组 7例感觉腿软无力 (P >0 . 0 1)。感觉能力 :两组对宫缩的感觉无明显下降 ,第二产程时均可良好的屏气用力 ,产钳助产率分别为 7%和 10 %。产程时间及分娩结果 :两组产程时间均在正常范围 ,组间无明显差异。结论　罗哌卡因两种给药方案均可安全有效应用于无痛分娩。     

罗哌卡因联合镇痛药蛛网膜下隙阻滞用于剖宫产术

目的：比较不同剂量罗哌卡因以及与芬太尼或吗啡联合用于蛛网膜下隙阻滞，剖剖宫产患者阻滞效果、血压、心率和不良反应的影响。方法：选择急诊剖宫产患者60例，随机分成四组，每组15例。经侧卧位L2－3间隙穿刺行阻滞麻醉。A组：罗哌卡因10mg，B组：罗吡卡因7．5mg 芬太尼25μg，C组：罗吡卡因7．5mg 吗啡0．2mg,D组：罗吡卡因5mg 芬太尼25μg。用针刺法测感觉阻滞平面，用改良Bromage法测运动阻滞，术后随访并记录开始出现切口疼痛的时间，以及头痛，恶心、呕吐等并发症。结果：A组的感觉阻滞平面上界为T2－6，高于其他组（P＜0．05），下肢运动完全阻滞百分率明显大于其他组，差异有显著性（P＜0．05），但A组感觉阻滞时间与B组相比没有差异（P＞0．05）。四组中。C组感觉阻滞持续时间最长，与其他组比较差异有显著性（P＜0．05），运动阻滞时间与B组比较没有差异（P＞0．05），明显比A组短（P＜0．05）。在D组中，有66．7％的患者因感觉阻滞平面不完善，需在硬膜外导管内注入局麻药。血流动力学的影响以A组最为明显，在注药后的5min，血压，心率显著降低，与基础值比较，差异有意义（P＜0．05），术后恶心、呕吐发生率C组最高，与其他组比较，差异有显著性（P＜0．05）；四组患者术后均无头痛症状。结论：罗吡卡因加入芬太尼25μg，能减少局麻药的用量，达到良好的麻醉效果，对机体血流动力学影响小，能延长术后镇痛时间，并且不增加术后呕吐的发生率。     

氯普鲁卡因与罗哌卡因用于硬膜外自控分娩镇痛的比较

【目的】比较10g／L氯普鲁卡因与1．25g／L罗哌卡因用于硬膜外自控分娩镇痛的效果。【方法】选择本院拟行硬膜外自控分娩镇痛的初产妇患者68例,随机分为氯普鲁卡因（A组）和罗哌卡因（B组）两组（n=34）,在宫口开至2～3cm时A组给予镇痛液配方为10g／L氯普鲁卡因＋0．003g／L芬太尼;B组给予1．25g／L罗哌卡因＋0．003g／L芬太尼的硬膜外自控分娩镇痛,至第二产程开始时停止。观察并记录镇痛前、给予硬膜外负荷量后5min、30min,宫口开全时的疼痛评分（VAS）和运动神经阻滞评分（MBS）以及各产程时间,新生儿出生后Apgar评分。【结果】A组的疼痛评分较B组在给负荷量后5min低（P〈0．05）,其余各时间点的疼痛评分均无差异（P〉0．05）。两组的运动神经阻滞评分、产程时间、新生儿出生后1min和5min的Apgar评分在各时间点均无缡计学意义（P〉0．05）。【结果】10g／L氯普鲁卡因分娩镇痛较1．25g／L罗哌卡因起效快,两者用于硬膜外分娩镇痛效果相当。     

Epidural Labor Analgesia: Continuous Infusion Versus Patient-Controlled Epidural Analgesia With Background Infusion Versus Without a Background Infusion

The purpose of this study was to compare the total epidural dose of 3 commonly used labor epidural modalities. After local institutional review board approval, 195 laboring parturients received an epidural catheter for labor analgesia. All patients received an initial bolus of 0.1% ropivacaine (10 mL) and fentanyl (100 microg). Maintenance of labor analgesia consisted of ropivacaine 0.1% with fentanyl 2 microg/mL. Patients were then randomly assigned into 3 groups: Group 1 (continuous epidural infusion [CEI]), continuous infusion at 10 mL/h; group 2 (CEI + patient-controlled epidural analgesia [PCEA]), CEI at 5 mL/h with a demand dose of 5 mL allowed every 20 minutes with a 20 mL/h maximum dose; group 3 (PCEA), demand doses only of 5 mL every 15 minutes with a 20 mL/h maximum dose. Measured variables included total epidural dose, total bolus requests and boluses delivered, number of staff interventions, pain Visual Analog Scale (VAS; 0-100), modified Bromage scores, stage I and II labor duration, delivery outcome, and maternal satisfaction after delivery. No differences were noted with respect to pain VAS, modified Bromage scores, stage I and II labor duration, number of staff interventions, delivery outcome, and maternal satisfaction score. Total infusion dose was lower in demand dose only PCEA compared with CEI and CEI + PCEA groups (P = < .01). Demand dose-only PCEA results in less total epidural dose compared with CEI and CEI + PCEA without affecting labor duration, motor block, pain VAS, maternal and neonatal outcomes, and maternal satisfaction. PERSPECTIVE: This article compares 3 commonly used labor epidural delivery modalities (traditional continuous epidural infusion, patient-controlled epidural analgesia with a background infusion, and demand dose-only patient-controlled epidural analgesia). Benefits in epidural dose reduction with demand dose only PCEA does not translate into improved maternal and neonatal outcome.     

芬太尼、吗啡分别联合罗哌卡因用于术后硬膜外镇痛的比较

目的：比较芬太尼、吗啡分别联合罗哌卡因用于术后硬膜外镇痛的效果及不良反应的发生率。方法：择期肿瘤手术患者150例随机分为Ⅰ组、Ⅱ组、Ⅲ组各50例。Ⅰ组给予吗啡60—80μg／mL复合0．125％罗哌卡因100mL硬外镇痛;Ⅱ组给予芬太尼5-6μg／mL复合0．125％罗哌卡因100mL硬外镇痛;Ⅲ组单纯给予芬太尼20μg／kg静脉镇痛。比较三组术后不同时点VAS评分、Ramsay评分以及不良反应的发生率。结果：VAS评分三组间比较差异无统计学意义（P〉0．05）;Ⅲ组在术后12h、24h、48h的Ramsay评分显著高于其他组（P〈0．05）;恶心、呕吐、皮肤瘙痒的发生率Ⅱ组、Ⅲ组均显著小于Ⅰ组（P〈0．05）;头晕、嗜睡的发生率Ⅰ、Ⅱ组显著低于Ⅲ组（P〈0．05）。结论：芬太尼联合低浓度罗哌卡因用于术后硬膜外镇痛效果确切、不良反应发生率少。     

不同剂量布托啡诺应用于剖宫产术后硬膜外镇痛的临床研究

【目的】将不同剂量布托啡诺应用于剖宫产术后硬膜外镇痛,观察其镇痛效果,探讨布托啡诺用于剖宫产术后硬膜外镇痛的最佳剂量和配伍。【方法】180例（ASAⅠ～Ⅱ）剖宫产患者随机分为六组,每组30例,对照组（C组）,实验组（E2、E3、E4、E5、E6组）。镇痛液为：C组,0．125％罗哌卡因＋0．005％吗啡;E2组,0．125％罗哌卡因＋0．004％布托啡诺;E3组,0．125％罗哌卡因＋0．005％布托啡诺;E4组,0．125％罗哌卡因＋0．006％布托啡诺;E5组,0．125％罗哌卡因＋0．007％布托啡诺;E6组,0．125％罗哌卡因＋0．008％布托啡诺。采用负荷剂量＋持续剂量给药模式,持续剂量背景流速2mL／h。【结果】①E2组VAs评分分别在4h、8h、12h点高于C组,E3、E4、E5、E6组与C组无明显差异;E2组BCS评分在4h、8h、12h点低于C组,E3、E4、E5、E6组与C组无明显差异。②并发症：C组恶心呕吐、皮肤瘙痒发生率高于E2、E3、E4、E5、E6组,且差异显著。【结论】布托啡诺应用于剖宫产术后硬膜外镇痛效果确切、副作用发生率低,可以0．005％布托啡诺＋0．125％罗哌卡因作为初始剂量,再根据病人的镇痛效果情况酌情增加布托菲诺的剂量。     

全膝关节置换后的多模式镇痛

背景：围全膝关节置换期疼痛处理一直是临床所关注的重点问题,寻找安全有效的镇痛方式,成为关节外科医生的重要任务之一。目的：比较硬膜外镇痛和股神经阻滞镇痛在患者全膝关节置换后镇痛、康复的效果,探索相关的多模式联合镇痛方案。方法：随机选取行单侧膝关节置换的患者40例,按照镇痛方案的不同分为硬膜外镇痛组和股神经阻滞镇痛组,每组20例。患者在连续硬膜外麻醉下进行单侧膝关节置换并进行术前宣教和塞来昔布给药。置换后硬膜外镇痛组通过留置导管连接0．2％罗哌卡因、2mg／L芬太尼止痛泵镇痛;股神经阻滞镇痛组通过股神经阻滞导管间断注射0．2％罗哌卡因镇痛。观察全膝关节置换后患者6,12,24h和2—7d每天的疼痛程度,以及2-7d每天的膝关节活动度。结果与结论：全膝关节置换后2-7d,2组患者每天的静息痛和活动痛的目测类比评分均呈下降的趋势,股神经阻滞镇痛组患者的疼痛程度小于硬膜外镇痛组患者。置换后2-7d,股神经阻滞镇痛组和硬膜外镇痛组患者膝关节活动度都逐渐升高,股神经阻滞镇痛组患者膝关节活动度大于硬膜外镇痛组。结果说明虽然硬膜外镇痛和股神经阻滞镇痛都能缓解全膝关节置换术后疼痛,但股神经阻滞镇痛在全膝关节置换后近期的运动镇痛效果优于硬膜外镇痛,能加快患者关节功能的康复,且多模式联合镇痛方案能有效控制疼痛。     

蛛网膜下腔使用舒芬太尼联合硬膜外腔运用罗哌卡因进行分娩镇痛的研究

目的:探讨蛛网膜下腔使用舒芬太尼,联合硬膜外腔运用罗哌卡因进行分娩镇痛的有效性和安全性。方法:选择ASAI-II级的健康产妇80名,随机分为两组,S组(蛛网膜下腔-硬膜外联合镇痛组)和E组(硬膜外镇痛组)。S组在蛛网膜下腔注射舒芬太尼5μg(2 ml),硬膜外腔给予0.15%罗哌卡因5 ml。E组单纯在硬膜外腔给予0.15%罗哌卡因和5μg舒芬太尼混合液5 ml。30分钟后,用0.125%罗哌卡因行病人自控硬膜外镇痛(patient-controlled epidural analgesia,PECA),维持量为6ml/h。分别于镇痛前、给药后5分钟、10分钟、20分钟、30分钟、60分钟行疼痛视觉模拟评分(visualanalogue scale,VAS)和运动神经阻滞分级(采用改良Bromage分级法测定),记录产妇的镇痛起效时间、罗哌卡因用量、镇痛不良反应、镇痛满意程度以及血压、心率、产程、分娩方式、催产素使用量、新生儿Apgar评分。同时行宫缩和胎心监测。结果:镇痛期间两组的VAS评分降低(P<0.01),镇痛效果满意。S组的镇痛起效时间明显短于E组(P<0.01)。所有产妇的Bromage评分均为0分。产程、催产素使用量、新生儿Apgar评分也没有明显差异(P>0.05)。S组产妇的5分钟和10分钟时血压有一定的下降(P<0.05),出现的皮肤瘙痒明显多于E组(P<0.01),但均为轻度,无须特殊处理。两组各一名产妇改行剖腹产,其原因均为胎儿宫内窘迫,与分娩镇痛无直接关联。结论:蛛网膜下腔使用舒芬太尼,联合硬膜外腔运用罗哌卡因可以快速、有效地进行分娩镇痛。     

Immunity and cytokine status after surgeries on the large intestine

The aim of our study was to examine the effect of individual schemes of multimodal analgesia on indicators of immunity and inflammation markers after operations on the colon. Patients of group 1 (n=15) received paracetamol, lornoxicam and epidural ropivacaine, 2nd group of patients (n=15)-paracetamol, epidural ropivacaine and tramadol. Comparison group (n=10) patients underwent patient controlled analgesia by promedol. Before surgery, 1st and 3rd days after surgery we examined the contents of cytokines in plasma: interleukin 12p70, interleukin 10, interleukin 6, and TNF. Before surgery and at 5-7 days after surgery indicators of cellular, fagocytal and humoral immunity were monitored. Before surgery patients with colorectal cancer revealed changes in the indices of different components of immunity, as well as an increase in pro-and anti-inflammatory cytokines compared with healthy donors. Multimodal analgesia in patients after operations on the colon is not accompanied by changes in plasma concentrations of cytokines and parameters of immune status in comparison with monoanalgesia by promedol.     

Transient neurological symptoms in puerperas after epidural analgesia during labor

The investigation was undertaken to elucidate the impact of epidural analgesia (EA) during labor on the incidence of transient neurological symptoms (TNS). By the agreement of a local ethics committee, an informed consent was obtained from 90 healthy puerperas enrolled in the investigation. The patients were randomized into 3 groups, with 30 patients in each. At the beginning of labor, an epidural catheter was inserted in all the puerperas. For EA, 1% lidocaine solution and 0.2% ropivacaine solution were used in Groups 1 and 2, respectively; Group 3 was control in which EA was not performed. Two days after labor, an independent observer asked the females about possible neurological symptoms, by using the standard questionnaire. TNS included symmetric pain and/or dysesthesia in the buttocks, lower lumbar region, and/or legs. The patients who presented problems were proposed to indicate the degree of discomfort by a 10-score verbal scale. The findings were statistically processed using the U-test and X-test (p < 0. 05). A total of TNS occurred in 22 (25%) patients, including 7 (27%), 8 (27%), and 7 (23%) in Groups 1, 2, and 3, respectively. This difference was not statistically significant. The duration of TNS was generally short; in all the patients, the symptoms were completely resolved after 24-72 hours. Labor EA is not a cause of TNS. The type of a local anesthetic (lidocaine, ropivacaine) does not affect the incidence of TNS in puerperas after labor EA.     

Addition of ketamine to propofol–fentanyl anaesthesia can reduce post-operative pain and epidural analgesic consumption in upper abdominal surgery

The aim of this study was to confirm whether intravenous anaesthesia supplemented with the N-methyl- -aspartate (NMDA) antagonist ketamine could reduce post-operative pain after elective open cholecystectomy. Fifty patients were randomised double-blind to one of the following two groups: PF Group received propofol and fentanyl supplemented with saline infusion; PFK Group received propofol and fentanyl supplemented with ketamine (total dose 2 mg/kg). During the first 48 post-operative hours, epidural analgesia was provided for all patients with patient-controlled epidural analgesia (PCEA) using 0.125% bupivacaine and morphine (0.05 mg/ml). Pain assessments at rest and movement, and cumulative PCEA volume consumed, were recorded at 5, 24 and 48 h post-operatively. The visual analogue scale (VAS) scores at rest were significantly less in the PFK Group than in the PF Group at 5, 24 and 48 h (P<0.001, P<0.001 and P=0.02, respectively). The VAS score at movement were also significantly (P<0.001) less throughout this study than in the PF Group. The difference in PCEA analgesic consumption at 0–5 and 5–24 h reached statistical significance (P<0.001 and P=0.008, respectively). Our results show that an intra-operative ketamine dose provides advantages for post-operative analgesia beyond its duration of action after an open cholecystectomy.     

Epidural methadone for acute post-thoracotomy pain: An alternative to a ropivacaine plus fentanyl-based patient-controlled epidural regimen

Accurate management of acute post-thoracotomy pain can be obtained with epidural local anaesthetics with or without opioids. The routine in our centre for many years has been boluses of epidural methadone with satisfactory results and a lack of serious complication.

Objectives To compare the analgesic effectiveness of two epidural regimens for acute post-thoracotomy pain management.

Methods We enrolled 49 patients undergoing lung resection by thoracotomy in a prospective, non-blinded open study. Study groups: 25 patients received a patient controlled epidural (PCEA) regimen of 0.16% ropivacaine plus 3.5 μg ml⁻¹ fentanyl, and the other 24 patients receiving 4–6 mg of epidural boluses of 0.1% methadone every 8 h.

Results Both regimens provided similar pain relief during the first two postoperative days, however, patients receiving methadone needed less rescue analgesia and presented fewer numbers of hypotensive events compared to PCEA patients.

Conclusions Epidural boluses of methadone are as a safe and adequate analgesic regiment as a PCEA with ropivacaine plus fentanyl for post-thoracotomy pain management. Additionally, the cost of our current technique is much lower than the ropivacaine infusion.     

Efficacy of Intravenous Ibuprofen and Intravenous Paracetamol in Multimodal Pain Management of Postoperative Pain After Percutaneous Nephrolithotomy

PurposeMany different techniques, including multimodal analgesia, have been used for the management of postoperative pain after Percutaneous nephrolithotomy (PCNL). Ketorolac, intravenous (IV) paracetamol, rofecoxib, and IV ibuprofen have been used as a part of a multimodal analgesic approach in different surgical procedures. However, the efficacy of IV ibuprofen has not been well elucidated in adult patients undergoing elective PCNL. The aim of the study was to examine the efficacy of IV ibuprofen compared to IV paracetamol after elective PCNL.DesignThis was a prospective randomized clinic study.MethodsThe study was conducted with 50 patients scheduled for PNCL between the ages of 18 and 65. IV ibuprofen 800 mg infusion was used for Group I, and 1 g IV paracetamol infusion Group P. IV tramadol infusion was administered with a Patient Controlled Analgesia device for postoperative analgesia. The primary outcome was 24-hour tramadol consumption. Secondary outcomes were pain intensity and side effects of the drugs. All outcomes were recorded in the 30th minute in the PACU and in 2, 4, 6, 12, 24 hours postoperatively.FindingsTotal postoperative tramadol consumption was significantly lower in Group I compared with Group P (P = .031). There was also a significant decrease in the cumulative tramadol consumption between the two groups in the 2nd and 24th hours (P < .012). In all measurement periods, pain intensity, sedation score, nausea and vomiting, itching, additional analgesia, and satisfaction with pain management were similar between the two groups.ConclusionIV ibuprofen, used as a part of multimodal tramadol-based analgesia reduced tramadol consumption compared with IV paracetamol in the first 24 hours postoperatively after elective PCNL. The IV ibuprofen-tramadol combination seems appeared superior to a paracetamol-tramadol combination.     

Epidural analgesia in surgical treatment of scoliosis

The article provides data on the use of a two-level epidural analgesia as a component of general anesthesia and postoperative analgesia in surgical treatment of scoliosis on the front and back structures of the spine. The study included 150 patients aged from 12 to 25 years. All the patients were divided into 4 groups. The patients of the 2-nd and 3-rd groups before the main stage was carried out an epidural analgesia with 0.75% ropivacaine and sevorane-propofol general anaesthesia . In the 1-st and 4-th group carried out an propofol-fentanyl TIVA or inhalational sevorane-fentanyl one. The best result were obtained in the 3-rd group, where they carried out the infusion 0.2% ropivacaine with fentanyl (1 microg/ml) and epinephrine (2 microg/ml) via 2 epidural catheters. It was noted decreased blood loss by more than 50% in groups with epidural analgesia.     

Ropivacaine/Fentanyl vs. Bupivacaine/Fentanyl for Pain Control in Children after Thoracic Surgery: A Randomized Study

BackgroundAlthough bupivacaine remains a standard local anesthetic for postoperative epidural infusions in pediatric patients, it is increasingly being replaced with ropivacaine by many anesthesiologists. Ropivacaine is associated with less risk for cardiac and central nervous system toxicity.AimsThe purpose of this study was to compare analgesic efficacy and adverse events of postoperative epidural analgesia with ropivacaine/fentanyl versus bupivacaine/fentanyl in children after the Ravitch procedure and thoracotomy.DesignThis was a prospective randomized controlled study.SettingsThis study was conducted at the Department of Thoracic Surgery of the Institute of Tuberculosis and Lung Diseases in Rabka Zdroj, Poland.Participants/Subjects94 patients undergoing elective thoracic surgery.MethodsPatients aged 7-17 years were randomly allocated into a ropivacaine 0.2% (RF, n = 45) or bupivacaine 0.125% (BF, n = 45) group; 1 mL of each analgesic solution contained 5 μg fentanyl. All patients received acetaminophen and nonsteroidal anti-inflammatory drugs. Nurses assessed pain intensity and incidence of adverse events over 72 hours after surgery and modified analgesia if patient pain intensity was greater than 2 out of 10.ResultsThere was no statistically significant difference in median pain scores and incidence of adverse events between the RF group and the BF group. The analgesia was excellent (median pain intensity scores at rest, during deep breathing, and when coughing was less than 1 out of 10 in all patients). Adverse events included incidents of desaturation (64/90), nausea (18/90), vomiting (31/90), pruritus (12/90), urinary retention (2/90), paresthesia (11/90), anisocoria (2/90), and Horner syndrome (2/90).ConclusionsThoracic epidural analgesia using an RF and BF solution resulted in similar pain relief and adverse event profiles.