The influence of injection speed on pain during injection of local anaesthetic

Study objective: To determine the influence of injection speed on pain during injection of local anaesthetics. Methods: In a blinded randomised study with 36 healthy volunteers, each volunteer received three injections of 4.5 ml lidocaine subcutaneously on the abdomen. The injections were given during 15 seconds (0.3 ml/s), 30 seconds (0.15 ml/s), and 45 seconds (0.1 ml/s). The needle tip remained beneath the skin for 45 seconds during all three injections. Participants rated the pain experienced on a 100 mm visual analogue scale (VAS) immediately after each injection. After the last injection, they were asked which injections were the least and most painful. Results: The mean VAS pain score for the 15 seconds injections was 26 (SD = 19), for the 30 seconds injections 24 (SD = 19), and for the 45 seconds injections also 24 (SD = 18) (ns). Eight subjects preferred the 15 seconds injection, 15 preferred the 30 seconds injection, and 10 preferred the 45 seconds injection (ns). Conclusion: It is concluded that varying the injection speed between 0.3 ml/s and 0.1 ml/s has no influence on the pain experienced during subcutaneous injection of 4.5 ml lidocaine.     

The effect of warming local anaesthetic on the pain of injection during sub-Tenon's anaesthesia for cataract surgery

In a double blind, randomised controlled trial, we examined the effect of warming local anaesthetic solutions on the pain experienced by patients undergoing a sub-Tenon's block for cataract surgery. In all, 140 patients were randomly allocated to receive either local anaesthetic stored at room temperature (control group) or local anaesthetic warmed to 37 °C (study group). Pain scores were assessed using a verbal analogue scale from 0 to 10. There was no significant difference in pain scores between the two groups. We conclude that the practice of warming local anaesthetic prior to performing a sub-Tenon's block does not significantly reduce the amount of pain experienced by patients.     

分散患者注意力对手部伤口换药疼痛的影响

目的观察虚拟现实技术分散患者注意力缓解手部伤口换药疼痛的效果,以寻找更有效的减痛措施。方法将98例手部伤口换药的患者随机分为观察组和对照组各49例,对照组采用常规方式换药,观察组在此基础上使用虚拟现实技术分散注意力。使用视觉模拟量表评估两组患者换药前、换药中的疼痛感,使用投入感问卷测量观察组患者对虚拟环境投入情况。结果观察组换药中疼痛评分显著低于对照组(P0.01),观察组换药时的投入感与疼痛感呈负相关(P0.05)。结论虚拟现实技术因能增加患者的投入感而获得较好的减痛效果。     

急性阑尾炎患者早期止痛的临床探讨

目的 探讨早期使用止痛剂(盐酸哌替啶)对急性阑尾炎患者腹痛症状缓解、体格检查、诊断准确性和治疗效果的影响.方法 对120例急性阑尾炎进行疼痛VAS评分和早期止痛意愿调查,94例实施手术,73例VAS 5级以上者分为实验组与对照组进行统计学分析.结果 94例急性阑尾炎VAS 4级腹痛为21例(22.34%)均无止痛意愿;5～7级中度疼痛者为47例(50.00%),其中有16例(34.04%)要求紧急止痛处理;8级剧烈疼痛患者26例(27.66%)中有23例(88.46%)要求紧急止痛;73例腹痛VAS 5级以上紧急止痛意愿率为53.42%,39例有紧急止痛意愿患者予盐酸哌替啶1.5 mg/kg肌肉注射,30～45 min后再次评估,疼痛评分下降2～5级,平均3.10级,止痛效果良好.实验组和对照组二次腹痛评估差异有统计学意义(P＜0.05);而二次体格检查的腹部压痛部位均无改变,部分病例腹部压痛程度有所改变但未影响诊断,平均住院时间、术后并发症、误诊率的比较差异均无统计学意义(P＞0.05).结论 早期止痛可有效缓解急性阑尾炎患者的腹痛症状,对体格检查、诊断准确性和治疗效果无影响.     

The influence of active warming on signal quality of pulse oximetry in prehospital trauma care

Victims of trauma such as contusions and simple fractures are usually transported by paramedics. Because many victims are intoxicated with alcohol or other drugs, they are vulnerable to some risk of inadequate respiration. Thus, their oxygenation is monitored by noninvasive pulse oximetry. We tested the hypothesis that active warming of the whole body during transport to the hospital can improve the reliability of arterial oxygen saturation (SpO(2)) monitoring. Twenty-four trauma patients transported to hospital were included in the study and randomly assigned to two groups: one group (n = 12) was covered with normal wool blankets, and the other group (n = 12) was treated with resistive heating blankets during transport. We recorded core temperature, shivering, skin temperature at the forearm and finger, SpO(2), and hemodynamic variables. Before randomization, both groups were comparable. On arrival at the hospital, the actively warmed patients had significantly warmer core (36.1 +/- 0.3 degrees C versus 35.5 +/- 0.3 degrees C; P < 0.001) and skin (34.1 +/- 1.5 degrees C versus 24.9 +/- 1.4 degrees C; P < 0.001) temperatures. In the actively warmed group, the pulse oximeter had significantly fewer alerts (31 versus 58) and a significantly less time of malfunction (146 +/- 42 s versus 420 +/- 256 s) and provided more constant measurements in the actively warmed group (P < 0.001). In this study we showed that active warming improves pulse oximeter monitoring quality in trauma patients during transport to the hospital. IMPLICATIONS: Clinical trials show that pulse oximeter signal quality is limited by hypothermia. In this study we show that active whole-body warming of trauma victims improves monitoring quality during transport to the hospital.     

The impact of ultrasound-guided transmuscular quadratus lumborum block combined with local infiltration analgesia for arthroplasty on postoperative pain relief

Study objectiveThis study aimed to evaluate the efficacy of ultrasound-guided transmuscular quadratus lumborum block (QLB) combined with local infiltration analgesia (LIA) for pain management and recovery in patients who have undergone total hip arthroplasty (THA) via a posterolateral approach.DesignThis was a prospective, randomized controlled trial.SettingWe collected data in the preoperative area, operating room, and bed ward.PatientsA total of 80 patients with American Society of Anesthesiology functional status scores of II-III were included and assigned to two groups, and all 80 patients were included in the final analysis.InterventionsAll included patients were randomly assigned to the nerve block (group N) or the control group (group C). Patients in the group N received transmuscular QLB combined with LIA, while patients in the group C received only LIA.MeasurementsThe primary outcome was postoperative pain during the first active motion: it was measured at six hours after surgery and assessed using a visual analog scale (VAS). Secondary outcomes were the resting VAS scores in the post-anesthesia care unit (PACU) and at 2, 6, 12, 24, 48, and 72 h after surgery; VAS scores during motion at 12, 24, 48, and 72 h after surgery; intraoperative consumption of opioids; postoperative consumption of morphine hydrochloride; frequency of sleep interruption due to pain on the night of surgery; time until the first “walk out of the bed” after surgery; muscle strength of the quadriceps femoris; and postoperative adverse effects.Main resultsCompared to the group C, patients in the group N had significantly lower VAS scores during motion at 6, 12, and 24 h after surgery, as well as lower resting VAS scores in the PACU and at 2, 6, 12, and 24 h after surgery. Patients in the group N also consumed significantly smaller amounts of intraoperative opioids and morphine after surgery. Patients in the group N reported significantly fewer interruptions in sleep due to pain on the night of surgery and were able to “walk out of the bed” significantly earlier than those in the group C. There was no significant difference between the two groups in muscle strength of the quadriceps femoris or incidence of postoperative adverse effects.ConclusionsCompared to treatment with LIA alone, ultrasound-guided transmuscular QLB combined with LIA can provide better postoperative pain relief and enhance the recovery of THA patients, since it does not cause quadriceps femoris muscle weakness and is associated with significantly lower need for intraoperative opioids.     

The relationship between the visual analog pain intensity and pain relief scale changes during analgesic drug studies in chronic pain patients.

BACKGROUND: Most analgesic drug studies in humans quantify drug action based on verbal reports of pain intensity and pain relief. Although measures of pain intensity and pain relief show a good overall correlation, it is not known if they relate to each other consistently over time Such consistency is necessary if both measures are used to depict analgesic drug action versus time. This study examined in chronic pain patients if the relationship between visual analog pain intensity and pain relief scores was consistent during two analgesic drug studies. METHODS: Data from two independently performed analgesic drug studies were analyzed using linear regression. Data were split into pain intensity and pain relief scores recorded before and after patients' experience of maximum analgesia (>90% of maximum pain relief). The slopes of the linear regression line depicting pain intensity versus pain relief scores before and after maximum analgesia were statistically compared. RESULTS: The slope of the linear regression line before and after maximum analgesia was significantly different in both drug studies (nonoverlapping 95% confidence intervals), -2.16+/-0.57 versus -1.05+/-0.10 and -1.47+/-0.26 versus -1.09+/-0.07, respectively. These results are compatible with the observation that patients indicating the same pain intensity before and after maximum analgesia reported a different magnitude of pain relief. CONCLUSIONS: The relationship between visual analog pain intensity and pain relief scores changed systematically during both analgesic drug studies. The authors hypothesize that patients' interpretation of the pain relief scale had changed during the studies and therefore suggest using the pain intensity scale to quantify analgesic drug action over time.     

The influence of Lidocaine temperature on pain during subcutaneous injection

Background: Injection of local anaesthetics is an uncomfortable procedure. The purpose of this study was to determine the influence of lidocaine temperature on pain during subcutaneous injection.

Methods: A randomised, double blind trial with 36 healthy volunteers was performed. Each subject received three injections of 4.5?ml 1% lidocaine subcutaneously on the abdomen; refrigerated (8?°C), at room temperature (21?°C), and warmed to body temperature (37?°C). By giving every subject injections of all three temperatures they served as their own controls. The participants were asked to evaluate the pain felt during the injection by placing a pencil mark on a 100?mm Visual Analogue Scale without intermediate markings immediately after every injection. They were told that the scale ranged from no pain to worst imaginable pain (0?=?best; 100?=?worst). Retrospectively the participants did a verbal assessment of the most and least painful injection.

Results: The median VAS score for the heated lidocaine was 16 (range =11–28), lidocaine at room temperature 25 (13–40) and for the cold 24 (11–35). The VAS scores for the heated lidocaine was significantly lower than for lidocaine at room temperature (p?=?0.004). Also, the verbal assessment of heated lidocaine being less painful than the injection at room temperature was statistically significant (p?=?0.015).

Conclusions: Injection with lidocaine heated to around body temperature was less painful than injection with lidocaine at room temperature. There was no statistically significant difference in verbal assessment or VAS scores between the cold lidocaine and that at room temperature.     

硬膜外低浓度布比卡因缓解分娩疼痛

目的　观察低浓度布比卡因硬膜外阻滞缓解分娩疼痛的效果。方法　根据随机分组 原则,200例足月产妇接受0.125%布比卡因(A组),185例足月产妇接受含芬太尼2μg/ml的 0.125%布比卡因的硬膜外阻滞组(B组),156例足月产妇不作镇痛作为对照组(C组)。在宫口至2 ～3cm时两观察组经L3～4硬膜外穿刺向头端置管成功,经5ml1.5%的利多卡因试验后,均一次性 注射10ml相应局麻药,30min后接各自局麻药以5ml/h持续输入。采用视觉模拟评分(VAS)和改 良Bromage法记录疼痛分数和下肢运动阻滞分级。记录产妇生命体征、产程时间、催产素使用量、器 械助产、产后出血量及胎心宫缩图和新生儿出生1、5min的Apgar评分。结果　两观察组镇痛效果 差异有极显著性(P<0.01),三组在活跃期VAS评分分别为:A组(3.85±0.64)分,B组(3.67± 0.62)分,C组(8.98±1.41)分。运动阻滞两观察组均以1级为主,全部能自主或在护士搀扶下行 走。两观察组第一产程活跃期明显短于C组(P<0.05)。三组借助器械分娩,分别为9%、9.7%和 8.3%。催产素用量两观察组明显多于C组(P<0.05),且以B组最多。产后失血量两观察组稍多 于C组(P>0.05)。新生儿Apgar评分三组相似。结论　0.125%布比卡因持续硬膜外阻滞能提供 满意的分娩镇痛,并促进活跃期,无明显副作用。此浓度局麻     

Intravenous flurbiprofen for post-thymectomy pain relief in patients with myasthenia gravis

Background

The use of CoSeal?, a polyethylene glycol sealant, in cardiac and vascular surgery for prevention of anastomotic bleeding has been subject to prior investigations. We analysed our perioperative data to determine the clinical benefit of using polyethylene glycol sealant to inhibit suture line bleeding in aortic surgery.

Methods

From January 2004 to June 2006, 124 patients underwent aortic surgical procedures such as full root replacements, reconstruction and/or replacement of ascending aorta and aortic arch procedures. A Bentall procedure was employed in 102 of these patients. In 48 of these, a polyethylene glycol sealant was added to the anastomotic closure of the aortic procedure (sealant group) and the other 54 patients did not have this additive treatment to the suture line (control group).

Results

There were no significant between-group differences in the demographic characteristics of the patients undergoing Bentall procedures. Mean EuroSCORES (European System for Cardiac Operative Risk Evaluation) were 13.7?±?7.7 (sealant group) and 14.4?±?6.2 (control group), p?=?NS. The polyethylene glycol sealant group had reduced intraoperative and postoperative transfusion requirements (red blood cells: 761?±?863 versus 1248?±?1206?ml, p?=?0.02; fresh frozen plasma: 413?±?532 versus 779?±?834?ml, p?=?0.009); and less postoperative drainage loss (985?±?972 versus 1709?±?1302?ml, p?=?0.002). A trend towards a lower rate of rethoracotomy was observed in the sealant group (1/48 versus 6/54, p?=?0.07) and there was significantly less time spent in the intensive care unit or hospital (both p?=?0.03). Based on hypothesis-generating calculations, the resulting economic benefit conferred by shorter intensive care unit and hospital stays, reduced transfusion requirements and a potentially lower rethoracotomy rate is estimated at ?1,943 per patient in this data analysis.

Conclusions

The use of this polymeric surgical sealant demonstrated improved intraoperative and postoperative management of anastomotic bleeding in Bentall procedures, leading to reduced postoperative drainage loss, less transfusion requirements, and a trend towards a lower rate of rethoracotomy. Hypothesis-generating calculations indicate that the use of this sealant translates to cost savings. Further studies are warranted to investigate the clinical and economic benefits of CoSeal in a prospective manner.     

Effect of scalp block on postoperative pain relief in craniotomy patients

The efficacy of scalp nerve block using 0.5% bupivacaine with adrenaline for postoperative pain relief in craniotomy patients was evaluated in 40 ASA I or II adult patients undergoing supratentorial craniotomy. A standard general anaesthesia technique was followed. Patients were randomly divided into two groups. Group B received 0.5% bupivacaine with 1:400,000 adrenaline and group S received normal saline with 1:400,000 adrenaline, both after skin closure. Postoperative pain was assessed at 30 seconds and 1, 2, 4, 6, 8 and 12 hours using a numerical rating scale. Diclofenac IM was administered as rescue analgesia if patients reported a numerical rating scale of 40 or more. Tramadol IV was administered as second rescue analgesia. Sixty per cent of patients in group S experienced moderate to severe pain (numerical rating scale of 40 or more) at some time during the first 12 postoperative hours in comparison to 25% patients in group B. Median pain scores were significantly lower in group B for up to 6 hours. Significantly more patients were pain free up to four hours in group B. Median duration for the requirement of first dose of diclofenac was longer in group B compared to group S (360 min vs 30 min, P < 0.01). The number of doses of diclofenac (5 vs 19) was significantly lower in group B compared to group S (P < 0.01). Tramadol was required by six patients in group S only. Scalp nerve block using 0.5% bupivacaine with 1:400,000 adrenaline decreases the incidence and severity of postoperative pain in patients undergoing supratentorial craniotomy.