右美托咪定联合酮咯酸氨丁三醇麻醉在腹腔镜胆囊切除术中的应用效果分析

目的 分析右美托咪定与酮咯酸氨丁三醇联合应用于腹腔镜胆囊切除术（LC）的麻醉效果。方法 选取2018年1月－2020年1月该院行LC的患者120例,随机分为对照组（60例）和观察组（60例）。手术过程中,对照组给予酮咯酸氨丁三醇超前镇痛,观察组给予右美托咪定联合酮咯酸氨丁三醇超前镇痛。比较两组患者不同时间点心率（HR）、平均动脉压（MAP）、镇痛评分、镇静评分、氧化应激情况及不良反应。结果 切胆时（T₂）,两组患者HR和MAP水平均明显低于术前（T₁）（P < 0.05）,观察组HR和MAP水平明显高于对照组（P < 0.05）;气管拔管时（T₃）,对照组HR和MAP水平明显高于T₁时点（P < 0.05）,观察组HR和MAP水平明显低于对照组（P < 0.05）。术后6 h（T₅）和12 h（T₆）,两组患者Ramsay评分均明显高于术后1 h（T₄）（P < 0.05）;T₄、T₅和T₆时点,观察组Ramsay评分明显高于对照组（P < 0.05）,数字分级评分（NRS）的动态评分明显低于对照组（P < 0.05）。T₅时点,两组患者血清丙二醛（MDA）和超氧化物歧化酶（SOD）水平均明显高于T₁时点（P < 0.05）,总抗氧化能力（T-AOC）水平明显低于T₁时点（P < 0.05）,且观察组SOD和T-AOC水平明显高于对照组（P < 0.05）,MDA水平明显低于对照组（P < 0.05）。两组患者不良反应发生率比较,差异无统计学意义（P = 0.648）。结论 在酮咯酸氨丁三醇基础上辅以右美托咪定超前镇痛,有助于提高镇痛镇静效果,纠正LC患者机体血流动力学紊乱,控制机体氧化应激反应,且安全性较高。     

右美托咪定复合布托啡诺在无痛支气管镜检查中的应用效果

目的 探讨右美托咪定复合布托啡诺在无痛支气管镜检查中的应用效果。方法 选取2021年5月－2022年5月该院呼吸与危重症医学科支气管镜室行电子支气管镜检查的144例肺结节患者作为研究对象。将144例患者分成A组（利多卡因组）、B组（利多卡因+右美托咪定组）、C组（利多卡因+右美托咪定+舒芬太尼组）和D组（利多卡因+右美托咪定+布托啡诺组）,每组36例。该研究为随机对照单盲试验。全部入组患者入室后,予以鼻导管给氧,按分组实施麻醉后,完成支气管镜检查。比较各组入室时（T₀）、麻醉诱导后5 min（T₁）、电子支气管镜通过声门时（T₂）、操作5 min（T₃）、操作结束时（T₄）和出室时（T₅）各时点的心率（HR）、经皮动脉血氧饱和度（SpO₂）和平均动脉压（MAP）,观察并记录各组术中和术后不良反应,待患者清醒后,行患者舒适度和术者操作满意度问卷调查。结果 4组患者全部完成电子支气管镜检查。4组患者T₂和T₃时点与T₀时点HR的差值比较,差异均有统计学意义（H值分别为21.15和19.63,P < 0.05）,Bonferroni检验显示,C组T₂和T₃时点与T₀时点HR的差值与A组和B组比较,差异均有统计学意义（P < 0.05）。4组患者T₂时点与T₀时点SpO₂的差值比较,差异有统计学意义（H = 9.58,P = 0.023）,Bonferroni检验显示,D组T₂时点与T₀时点SpO₂的差值与A组比较,差异有统计学意义（P < 0.05）。4组患者T₂和T₃时点与T₀时点MAP的差值比较,差异均有统计学意义（H值分别为9.65和21.31,P < 0.05）,Bonferroni检验显示,A组T₂时点与T₀时点MAP的差值及D组T₃时点与T₀时点MAP的差值与其他3组比较,差异均有统计学意义（P < 0.05）。D组患者舒适度评分和术者操作满意度评分高于其他3组,差异均有统计学意义（Z值分别为62.77和53.94,P < 0.01）,D组不良反应发生率明显低于其他3组,差异有统计学意义（P < 0.01）。结论 右美托咪定复合布托啡诺麻醉方案用于无痛支气管镜检查,更能达到无痛苦效果,血流动力学更平稳,不易发生呼吸抑制,患者舒适度及术者操作满意度更高,不良反应较少,值得临床推广应用。     

超声造影评价大鼠失血性休克肾皮质血流灌注

目的 应用超声造影（CEUS）技术评价不同程度失血性休克（HS）大鼠肾皮质血流灌注变化。方法 将24只健康雄性SD大鼠随机均分为假手术组（Sham组）、轻度失血性休克组（T₁组）、中度失血性休克组（T₂组）、重度失血性休克组（T₃组）。造模后行CEUS，观察肾皮质血流灌注状况，获取时间-强度曲线（TIC），对比各组峰值浓度（Peak）、达峰时间（TTP）、曲线下面积（AUC）及平均渡越时间（MTT）。造影结束后取静脉血行肾功能生化检查，处死大鼠取肾组织行病理检查。结果 T₁组TTP、AUC、MTT、尿素氮（Urea）较Sham组增加（P均<0.05），病理改变不明显；T₂组TTP、MTT、血肌酐（Crea）较Sham组和T₁组增加（P均<0.05），AUC较Sham组增加（P<0.05），病理改变加重；T₃组TTP、AUC、MTT、Crea较其余3组增加（P均<0.05），Peak较Sham组、T₁组增加、Urea较Sham组增加（P均<0.05），病理改变显著。TTP、AUC、MTT与Crea均呈显著正相关（r=0.789、0.790、0.800，P均<0.001）。结论 CEUS可定量分析大鼠失血性休克所致肾皮质血流灌注改变；TTP、AUC、MTT可作为敏感指标。     

右美托咪定联合综合体温保护对腔镜手术治疗老年恶性肿瘤患者苏醒期质量及免疫功能的影响

目的 探讨右美托咪定联合综合体温保护对腔镜手术治疗老年恶性肿瘤患者苏醒期质量及免疫功能的影响。方法 选择择期行腔镜手术治疗的老年恶性肿瘤患者90例，随机均分为3组：对照组（C组）、体温保护组（T组）和体温保护联合右美托咪定组（T-D组），每组30例。C组常规体温保护，T组和T-D组综合体温保护；T-D组麻醉诱导前10 min泵注右美托咪定0.5 μg/kg。记录3组患者麻醉诱导开始时（T₀）、手术开始30 min（T₁）、60 min（T₂）、90 min（T₃）、120 min（T₄）以及手术结束时（T₅）的鼻咽温度；于T₀、术后2 h（T₆）、24 h（T₇）和48 h（T₈）时抽取静脉血标本，测定T淋巴细胞亚群（CD3⁺、CD4⁺和CD8⁺）和自然杀伤细胞（NK cell）水平；记录患者术中麻醉药物用量及苏醒期质量指标。结果 与T₀比较，C组T₂～T₅时点鼻咽温度均明显降低（P < 0.05）；与C组比较，T组和T-D组T₂～T₅时点鼻咽温度明显升高（P < 0.05）。与T₀时点比较，C组、T组和T-D组T₆、T₇和T₈时点CD3⁺和NK cell活性均明显降低（P < 0.05）；C组在T₆、T₇和T₈时点，T组和T-D组在T₆和T₇时点，CD4⁺活性均明显降低（P < 0.05）。与C组比较，T组和T-D组T₆和T₇时点CD3⁺细胞活性均明显升高（P < 0.05）；T组在T₇时点，T-D组在T₆和T₇时点，CD4⁺细胞活性均明显升高（P < 0.05）；T组在T₇时点，T-D组在T₆、T₇和T₈时点，NK cell活性均明显升高（P < 0.05）。结论 采用体温保护措施联合右美托咪定能够维持老年恶性肿瘤患者的体温稳定，减少围手术期意外低体温（IPH）的发生，并有效提高患者苏醒期质量，减轻免疫抑制程度，加速患者早期恢复。     

控制性低中心静脉压技术对腹腔镜肝切除术患者脑氧饱和度的影响

目的 运用控制性低中心静脉压（CLCVP）技术的腹腔镜肝切除术,会增加患者神经系统并发症的风险,该研究拟评估该类患者术中脑去氧饱和度事件（CDE）的发生率。方法 选择拟行择期腹腔镜肝切除术的患者94例,随机分为CLCVP组（A组）及非CLCVP组（B组）,各47例。两组患者均采用全凭静脉麻醉。分别观察术前（T₀）、麻醉诱导气管插管后5 min（T₁）、患者置于30°头高脚低位后5 min（T₂）、手术切皮后5 min（T₃）、切肝前5 min（T₄）［A组实施CLCVP,中心静脉压（CVP）控制在5 cmH₂O以内;B组维持CVP在正常范围］、切肝结束后5 min（T₅）和术毕（T₆）的血流动力学变化、脑氧饱和度（rSO₂）和升压药使用情况。记录CDE的发生情况、麻醉后监测治疗室（PACU）复苏时间、术后复苏室视觉模拟评分（VAS）≥4分、术后躁动、恶心和呕吐等发生情况。结果 两组患者平均动脉压（MAP）在T₄、T₅和T₆时点较T₀时点更低,且在T₄时点A组MAP下降更明显,两组患者比较,差异有统计学意义（P < 0.05）。两组患者rSO₂在T₄、T₅和T₆时点较T₁时点降低,且A组降低更明显,差异有统计学意义（P < 0.05）。A组CDE发生率较B组高（35.6%和4.3%,P = 0.001）,升压药物使用率较B组高（48.9%和19.6%,P = 0.003）。A组恶心及呕吐发生率较B组高,差异有统计学意义（26.7%和8.7%,P = 0.024）。结论 运用CLCVP技术的腹腔镜肝切除术,较常规腹腔镜肝切除术可明显降低患者术中rSO₂,增加术中CDE发生率。     

纳布啡联合右美托咪定预防性镇痛对鼻内镜手术患者血流动力学和术后疼痛的影响

目的 探讨纳布啡联合右美托咪定预防性镇痛对鼻内镜手术患者血流动力学和术后疼痛的影响。方法 选取择期在鼻内镜下行鼻中隔偏曲矫正术的患者60例，随机分为右美托咪定联合纳布啡组（DN组）和右美托咪定组（D组），每组30例。D组于麻醉诱导前15 min给予右美托咪定0.5 μg/kg泵注；DN组于麻醉诱导前15 min给予右美托咪定0.5 μg/kg泵注，同时静脉注射纳布啡0.20 mg/kg。观察麻醉前（T₁）、插管后即刻（T₂）、手术开始时（T₃）、气管导管拔除即刻（T₄）和拔管后5 min（T₅）的平均动脉压（MAP）和心率（HR），记录术中丙泊酚、舒芬太尼和瑞芬太尼用量，以及苏醒和拔管时间，用数字分级评分（NRS）评估拔管后0.5 h（T₆）、4.0 h（T₇）、8.0 h（T₈）和24.0 h（T₉）的疼痛情况，记录补救镇痛率及不良反应发生率。结果 与T₁时点比较，D组T₂～T₅时点MAP明显升高，HR明显加快（P < 0.05），DN组T₂～T₅时点MAP和HR与T₁时点比较，差异无统计学意义（P > 0.05）。DN组T₂～T₅时点MAP明显低于D组，HR明显慢于D组（P < 0.05），T₆～T₉时点NRS明显较D组低（P < 0.05），瑞芬太尼和丙泊酚用量明显较D组少（P < 0.05），补救镇痛率明显较D组低（P < 0.05）。结论 在鼻内镜手术中使用纳布啡联合右美托咪定预防性镇痛，可稳定患者血流动力学，减少术中麻醉药物用量，减轻术后疼痛，对苏醒及拔管时间无明显影响。     

CEUS参数评估兔骨骼肌缺血再灌注后肌肉活力

目的 探讨CEUS参数评估兔骨骼肌缺血再灌注后肌肉活力的可行性。方法 建立兔骨骼肌缺血再灌注损伤（SMIRI）模型。根据损伤最严重区域肌肉"4C"征，将其分为有肌肉活力组（n=10）和无肌肉活力组（n=8）。对比2组造模前（T₀）及去掉橡胶圈（再灌注）即刻（T₁）、1 h（T₂）、2 h（T₃）、4 h（T₄）时患侧小腿损伤最严重区域CEUS参数。采用ROC曲线分析各参数对骨骼肌缺血再灌注后肌肉活力的诊断效能。结果 有肌肉活力组T₁及T₄时绝对峰值强度（API）均大于无肌肉活力组（P均<0.05），其余指标同一时间点2组间比较差异均无统计学意义（P均>0.05）。ROC曲线结果显示，T₁时API（截断值为6.93 dB）评估骨骼肌缺血再灌注后肌肉活力的敏感度为100%，特异度为60%，AUC为0.85[95%CI（0.67，1.00，P<0.05）]；T₄时API（截断值为4.25 dB）的敏感度为100%，特异度为70%，AUC为0.89[95%CI（0.75，1.00，P<0.05）]。结论 CEUS参数可反映骨骼肌缺血再灌注后肌肉活力，其中API可作为评价缺血再灌注后肌肉活力的指标。     

右美托咪定联合罗哌卡因行竖脊肌平面阻滞用于椎间孔镜手术的临床研究

目的 探讨右美托咪定联合罗哌卡因行竖脊肌平面阻滞（ESPB）在骨科椎间孔镜手术中的临床应用。方法 选择在该院行经皮腰椎间孔镜手术的患者40例，采用随机分组法将患者分为右美托咪定联合罗哌卡因行ESPB组（DR组，n = 20）和单纯罗哌卡因行ESPB组（R组，n = 20）。DR组应用0.5 μg/kg右美托咪定联合0.5%罗哌卡因行超声引导下ESPB，R组单纯用0.5%罗哌卡因行超声引导下ESPB。分别记录切皮时（T₁）、分离肌肉时（T₂）、椎间孔成形时（T₃）、神经根减压时（T₄）和缝皮时（T₅）的平均动脉压（MAP）、心率（HR）、经皮动脉血氧饱和度（SpO₂）和视觉模拟评分法（VAS）评分，记录术中补救使用静脉镇痛药情况，以及术后4、8、24和48 h VAS评分，并记录术后48 h内补救使用静脉镇痛药情况。术后随访患者满意度以及不良反应的发生情况（如恶心呕吐、头晕、嗜睡、穿刺部位血肿和神经损伤等）。结果 与R组比较，DR组T₁～T₃时点VAS和MAP较低，HR较慢；DR组术后4和8 h的VAS评分较R组低；DR组术中和术后48 h内补救静脉镇痛药物使用次数和总量均较R组少；DR组术后随访患者满意度较R组高。两组患者T₄和T₅时点的VAS、MAP和HR比较，差异均无统计学意义（P > 0.05）；两组患者术后24和48 h的VAS、各时点SpO₂和术后不良反应发生情况比较，差异均无统计学意义（P > 0.05）。结论 ESPB作为一种辅助镇痛技术已广泛应用于临床。在骨科椎间孔镜手术时，右美托咪定联合罗哌卡因行ESPB可在术中和术后给患者带来良好的镇痛和镇静作用，减少围手术期静脉镇痛药的使用量，并且可以维持术中血流动力学稳定，提高患者满意度。     

支气管封堵器与双腔支气管导管对开胸前肺萎陷影响的比较

目的 比较支气管封堵器（BB）与双腔支气管导管（DLT）对开胸前肺萎陷效果的影响。方法 选取择期行电视胸腔镜下左肺叶切除术的患者72例,采用随机数表法分为3组（n = 24）：DLT常规萎陷组（DLT组）、DLT开胸前肺萎陷技术组（PTLCT-DLT组）和BB开胸前肺萎陷技术组（PTLCT-BB组）。其中,PTLCT-DLT组和PTLCT-BB组中分别有2例和1例发生低氧血症［经皮动脉血氧饱和度（SpO₂） < 90%］,被剔除,最终DLT组24例、PTLCT-DLT组22例、PTLCT-BB组23例完成该项研究。DLT组右侧卧位前左通道被夹闭并向空气开放,PTLCT-DLT组双肺纯氧通气并在侧卧位前夹闭左通道,PTLCT-BB组在侧卧位前封堵左支气管,排气管被故意堵塞。比较3组患者侧卧位即时（T₁）、单肺通气8 min（T₂）、单肺通气10 min（T₃）和开胸后2 min（T₄）的心率（HR）、收缩压（SBP）、舒张压（DBP）、SpO₂和动脉血氧分压（PaO₂）,记录3组患者在胸腔镜置入即刻的肺萎陷评分（LCS）。结果 与DLT组比较,PTLCT-DLT组和PTLCT-BB组的LCS明显升高（P < 0.05）,PTLCT-DLT组与PTLCT-BB组比较,差异无统计学意义（P > 0.05）。在T₃时点,PTLCT-DLT组和PTLCT-BB组SpO₂较DLT组明显降低（P < 0.05）,PTLCT-DLT组和PTLCT-BB组在T₂和T₃时点PaO₂较DLT组明显降低（P < 0.05）,在T₄时点较DLT组明显升高（P < 0.05）。结论 开胸前肺萎陷技术有助于BB和DLT完成开胸前肺萎陷,两者对开胸前肺萎陷的影响无差异。     

免充喉罩与气管内插管用于全身麻醉下经气管镜超声引导针吸活检的临床研究

目的 探讨免充喉罩与气管插管用于全身麻醉下经气管镜超声引导针吸活检（EBUS-TBNA）对患者围手术期血流动力学、气道峰压、麻醉恢复时间及围手术期不良反应的影响。方法 选择全身麻醉下行EBUS-TBNA的患者64例,随机分为喉罩组（L组,n = 32）和气管插管组（T组,n = 32）。观察两组患者麻醉诱导前（T₀）、诱导后插入喉罩/气管导管前（T₁）、诱导后插入喉罩/气管导管后即刻（T₂）、超声支气管镜置入即刻（T₃）、针吸活检时（T₄）、拔管即刻（T₅）和拔管后10 min（T₆）的血流动力力学变化;记录插入免充喉罩/气管插管后（P₁）、活检镜置入后（P₂）和拔出活检镜后（P₃）的气道峰压;记录两组患者呼吸恢复时间、清醒拔管时间、阿片类药物和顺式阿曲库铵使用量;比较两组患者围手术期不良反应发生率。结果 T组T₂和T₅时点收缩压（SBP）、舒张压（DBP）和心率（HR）均明显高于L组,差异有统计学意义（P < 0.05）;在P₂时点,T组气道峰压明显高于L组,差异有统计学意义（P < 0.05）;L组呼吸恢复时间与清醒拔管时间均短于T组,差异有统计学意义（P < 0.05）;T组瑞芬太尼使用量大于L组,差异有统计学意义（P < 0.05）;T组拔管躁动发生率高于L组,差异有统计学意义（P < 0.05）。结论 与气管插管相比,免充喉罩应用于全身麻醉下EBUS-TBNA,可维持血流动力学平稳,缩短麻醉恢复时间,是围手术期较为安全可行的麻醉管理方式。     

Abstract 18: Plantar fasciitis: a new treatment approach.

Objective: To evaluate the efficacy of a new approach that shortens the duration of plantar fasciitis treatment. Design: Randomized controlled study. Setting: Outpatient clinic. Participants: 64 patients were randomly assigned to intensive conventional physical therapy (PT) (n=34) or needling and infiltration of the myofascial trigger points at the proximal portion of the medial gastrocnemius muscle (n=30). Interventions: Patients in the PT group received ultrasound and electric stimulation at the origin of the plantar fascia followed by stretching exercises of the gastrocnemius muscle. The other group was treated by needling and infiltration (1% lidocaine) of the taut band at the proximal portion of the medial gastrocnemius muscle of the involved limb(s). Injections were performed at weekly intervals. PT was administered for 3 consecutive days after the injections. Patients were instructed to perform stretching of the gastrocnemius muscles and of the plantar fascia at home twice a day. Main Outcome Measures: Visual analog scale and hindfoot functional test (American Orthopaedic Foot and Ankle Society Hindfoot Questionnaire) were performed before and after treatment by an independent evaluator. Duration of treatment was compared between the 2 groups. Results: Statistically significant reduction of pain and improvement in function were observed in both groups, without any differences between them. The time required to achieve the same improvement was significantly less (80%) in the injected group than in the control group (P<.001). The number of PT sessions needed was also significantly reduced (P<.001). Postinjection soreness and local hematoma were found in 30% of the patients. No local infection or other major complications were noticed in any cases. Conclusions: Although treatment in both groups was equally successful, needling and infiltration of the medial gastrocnemius muscle provided faster pain relief and functional recovery in patients with plantar fasciitis.     

A systematic review of manual therapy techniques,dry cupping and dry needling in the reduction of myofascial pain and myofascial trigger points

IntroductionMyofascial pain with myofascial triggers are common musculoskeletal complaints. Popular treatments include manual therapy, dry needling, and dry cupping. The purpose of this systematic review was to compare the efficacy of each treatment in the short-term relief of myofascial pain and myofascial trigger points.MethodsSearch engines included Google Scholar, EBSCO Host, and PubMed. Searches were performed for each modality using the keywords myofascial pain syndrome and myofascial trigger points. The inclusion criteria included English-language, peer-reviewed journals; a diagnosis of myofascial pain syndrome or trigger points; manual therapy, dry needling, or dry cupping treatments; retrospective studies or prospective methodology; and inclusion of outcome measures.ResultsEight studies on manual therapy, twenty-three studies on dry needling, and two studies on dry cupping met the inclusion criteria. The Physiotherapy Evidence Database (PEDro) was utilized to assess the quality of all articles.DiscussionWhile there was a moderate number of randomized controlled trials supporting the use of manual therapy, the evidence for dry needling ranged from very low to moderate compared to control groups, sham interventions, or other treatments and there was a paucity of data on dry cupping. Limitations included unclear methodologies, high risk for bias, inadequate blinding, no control group, and small sample sizes.ConclusionWhile there is moderate evidence for manual therapy in myofascial pain treatment, the evidence for dry needling and cupping is not greater than placebo. Future studies should address the limitations of small sample sizes, unclear methodologies, poor blinding, and lack of control groups.     

Dry needling versus trigger point compression of the upper trapezius: a randomized clinical trial with two-week and three-month follow-up

ABSTRACT

Objectives: The purpose of this randomized controlled trial was to investigate the long-term clinical effect of dry needling with two-week and three-month follow up, on individuals with myofascial trigger points in the upper trapezius muscle.

Methods: A sample of convenience (33 individuals) with a trigger point in the upper trapezius muscle, participated in this study. The individuals were randomly assigned to two groups: trigger point compression (N = 17) or dry needling (N = 16). Pain intensity, neck disability, and disability of the arm, hand, and shoulder (DASH) were assessed before treatment, after treatment sessions, and at two-week and three-month follow ups.

Results: The result of repeated measures ANOVA showed significant group-measurement interaction effect for VAS (p = .02). No significant interaction was found for NPQ and DASH (p > .05). The main effect of measurements for VAS, NPQ, and DASH were statistically significant (p < .0001). The results showed a significant change in pain intensity, neck disability, and DASH after treatment sessions, after two weeks and three months when compared with before treatment scores in both groups. There was no significant difference in the tested variables after two-week or three-month as compared to after treatment sessions between the two groups. However, pain intensity after treatment sessions was significantly different between the two groups (p = .02).

Discussion: Dry needling and trigger point compression in individuals with myofascial trigger point in the upper trapezius muscle can lead to three-month improvement in pain intensity and disability.     

Traditional Chinese Medicine acupuncture and myofascial trigger needling: The same stimulation points?

BackgroundAcupuncture originates in China, and its effectiveness has been well documented in musculoskeletal pain disorders and other conditions. A widely accepted contemporary medical treatment option for myofascial pain is trigger point needling. Although there are many differences between Traditional Chinese Medicine acupuncture theory and the myofascial trigger point needling framework, it is argued that the stimulation sites for these two needling modalities are similar.DiscussionIn this paper we examined the correspondence between Traditional Chinese Medicine acupoints and myofascial trigger points. Based on this correspondence, we considered exploration of Ah-shi points from four aspects: pain recognition, distal Ah-shi points, Anti-Ah-shi points, and management approaches.Summary: The extent of correspondence is influenced by definitions of acupoints. Myofascial trigger points are significantly correlated to Traditional Chinese Medicine acupoints, including primary channel acupoints, extra acupoints, and Ah-shi points. Considering the correlation between MTrPs and acupoints and the rarely-studied research area of Ah-shi points, it may be reasonable to incorporate research findings of myofascial trigger points into further investigations into Ah-shi points. Correspondence between myofascial trigger points and acupoints enhances contemporary understanding of the mechanism of action of acupuncture, and may serve to facilitate increased integration of acupuncture into clinical management.     

Improvement in clinical outcomes after dry needling versus myofascial release on pain pressure thresholds,quality of life,fatigue, pain intensity,quality of sleep,anxiety, and depression in patients with fibromyalgia syndrome

Purpose: To compare the effectiveness of dry needling versus myofascial release on myofascial trigger points pain in cervical muscles, quality of life, impact of symptoms pain, quality of sleep, anxiety, depression, and fatigue in patients with fibromyalgia syndrome.

Method: A single-blind randomized controlled trial was conducted. Sixty-four subjects with fibromyalgia were randomly assigned to a dry needling group or a myofascial release group. Pain pressure thresholds of myofascial trigger points were evaluated in the cervical muscles. In addition, quality of life, impact of fibromyalgia symptoms, quality of sleep, intensity of pain, anxiety and depression symptoms, impact of fatigue at baseline and post treatment after four weeks of intervention were evaluated.

Results: Significant improvement was found in most pain pressure thresholds of the myofascial trigger points in cervical muscles in the dry needling group compared to myofascial release (p?<?0.05). Similarly, these differences between groups were found for the components of quality of life of physical function (F?=?12.74, p?=?0.001), physical role (F?=?11.24, p?=?0.001), body pain (F?=30.26, p?<?0.001), general health (F?=?15.83, p?<?0.001), vitality (F?=?13.51, p?=?0.001), social function (F?=?4.73, p?=?0.034), emotional role (F?=?8.01, p?=?0.006), and mental health (F?=?4.95, p?=?0.030). Similar results were achieved for total impact of FMS symptoms (F?=?42.91, p?<?0.001), quality of sleep (F?=?11.96, p?=?0.001), state anxiety (F?=?7.40, p?=?0.009), and trait anxiety (F?=??14.63, p?<?0.001), hospital anxiety and depression (F?=?20.60, p?<?0.001), general pain intensity (F?=?29.59, p?<?0.001), and fatigue (F?=??25.73, p?<?0.001).

Conclusion: The dry needling therapy showed higher improvements in comparison with myofascial release therapy for pain pressure thresholds, the components of quality of life of physical role, body pain, vitality and social function, as well as the total impact of FMS symptoms, quality of sleep, state and trait anxiety, hospital anxiety-depression, general pain intensity and fatigue.

• Implications for rehabilitation

• Dry needling therapy reduces myofascial trigger point pain in the short term in patients with fibromyalgia syndrome.

• This therapeutic approach improves anxiety, depression, fatigue symptoms, quality of life, and sleep after treatment.

• Dry needling and myofascial release therapies decrease intensity of pain, and the impact of fibromyalgia symptoms in this population.

• These intervention approaches should be considered in an independent manner as complementary therapies within a multidisciplinary setting.

     

Inhibitory effect of dry needling on the spontaneous electrical activity recorded from myofascial trigger spots of rabbit skeletal muscle

OBJECTIVE: Dry needling of myofascial trigger points can relieve myofascial pain if local twitch responses are elicited during needling. Spontaneous electrical activity (SEA) recorded from an active locus in a myofascial trigger point region has been used to assess the myofascial trigger point sensitivity. This study was to investigate the effect of dry needling on SEA. DESIGN: Nine adult New Zealand rabbits were studied. Dry needling with rapid insertion into multiple sites within the myofascial trigger spot region was performed to the biceps femoris muscle to elicit sufficient local twitch responses. Very slow needle insertion with minimal local twitch response elicitation was conducted to the other biceps femoris muscle for the control study. SEA was recorded from 15 different active loci of the myofascial trigger spot before and immediately after treatment for both sides. The raw data of 1-sec SEA were rectified and integrated to calculate the average integrated value of SEA. RESULTS: Seven of nine rabbits demonstrated significantly lower normalized average integrated value of SEA in the treatment side compared with the control side (P < 0.05). The results of two-way analysis of variance show that the mean of the normalized average integrated value of SEA in the treatment group (0.565 +/- 0.113) is significantly (P < 0.05) lower than that of the control (0.983 +/- 0.121). CONCLUSIONS: Dry needling of the myofascial trigger spot is effective in diminishing SEA if local twitch responses are elicited. The local twitch response elicitation, other than trauma effects of needling, seems to be the primary inhibitory factor on SEA during dry needling.     

Effectiveness of dry needling techniques in patients with knee osteoarthritis: A systematic review and meta-analysis

BackgroundDry needling has been found to be effective in various myofascial pain syndromes and musculoskeletal conditions. However, there is a need to evaluate the effects of dry needling techniques in patients with knee osteoarthritis. Hence, the objective of this systematic review was to identify and critically review the evidence on the short-term and long-term effects of dry needling techniques in patients with knee osteoarthritis.MethodsDatabases such as Pubmed, Cochrane library, and Scopus were searched from their inception to July 2019 for randomized controlled trials using dry needling as an active intervention against control/sham/placebo treatment in patients with knee osteoarthritis. The quality of the selected studies was analyzed using Cochrane tool for assessment of risk of bias.ResultsOut of 247 studies, 9 studies were included in the review. The qualitative synthesis for myofascial trigger point dry needling showed contradictory results. The mean difference for periosteal stimulation was significant on pain and function immediately post-treatment (p < 0.00001). The mean difference for intramuscular electrical stimulation on pain was significant (p = 0.03), but marked heterogeneity was found among the studies.ConclusionGood quality studies on myofascial trigger point needling and intramuscular electrical stimulation are required to evaluate their effects in patients with knee osteoarthritis. The review demonstrates a moderate-quality evidence on the short-term effect of periosteal stimulation technique on pain and function in knee osteoarthritis. Future studies comparing the effects of various techniques of dry needling with different dosages and long-term follow up need to be conducted.     

Acupuncture and dry needling in the management of myofascial trigger point pain: A systematic review and meta‐analysis of randomised controlled trials

Pain from myofascial trigger points is often treated by needling, with or without injection, although evidence is inconclusive on whether this is effective. We aimed to review the current evidence on needling without injection, by conducting a systematic literature review.We searched electronic databases to identify relevant randomised controlled trials, and included studies where at least one group were treated by needling directly into the myofascial trigger points, and where the control was either no treatment, or usual care; indirect local dry needling or some form of placebo intervention. We extracted data on pain, using VAS scores as the standard.Seven studies were included. One study concluded that direct dry needling was superior to no intervention. Two studies, comparing direct dry needling to needling elsewhere in the muscle, produced contradictory results. Four studies used a placebo control and were included in a meta-analysis. Combining these studies (n = 134), needling was not found to be significantly superior to placebo (standardised mean difference, 14.9 [95%CI, ?5.81 to 33.99]), however marked statistical heterogeneity was present (I² = 88%).In conclusion, there is limited evidence deriving from one study that deep needling directly into myofascial trigger points has an overall treatment effect when compared with standardised care. Whilst the result of the meta-analysis of needling compared with placebo controls does not attain statistically significant, the overall direction could be compatible with a treatment effect of dry needling on myofascial trigger point pain. However, the limited sample size and poor quality of these studies highlights and supports the need for large scale, good quality placebo controlled trials in this area.     

Minimally invasive non-surgical management of plantar fasciitis: A systematic review

Background

Minimally invasive non-surgical techniques have been widely used worldwide to treat musculoskeletal injuries. Of these techniques, injectable pharmaceutical agents are the most commonly employed treatments, with corticosteroids being the most widely used drugs. The aim of this article is to review current scientific evidence as well as the effectiveness of minimally invasive non-surgical techniques, either alone or combined, for the treatment of plantar fasciitis.

Effects of myofascial trigger point dry cupping on pain and function in patients with plantar heel pain: A randomized controlled trial

ObjectiveTo investigate the effects of dry cupping on calf muscle myofascial trigger points (MTrPs) on pain and function in patients with plantar heel pain.MethodsSeventy-one patients were randomly divided into an intervention group or control group. Both groups performed stretching exercises for the calf muscle and plantar fascia and ankle dorsiflexion exercises. The intervention group also received dry cupping. The primary outcome measures were visual analogue scale (VAS), pressure pain threshold (PPT), and patient-specific functional scale (PSFS). The secondary outcomes were ankle dorsiflexion range of motion (ROM) and ankle plantar flexor strength. These measurements were performed at baseline, immediately after intervention, and after 2 days.ResultsCurrent VAS significantly decreased immediately in the intervention group (p = 0.002), but not in the control group (p ≥ 0.220). Morning VAS decreased significantly in both groups (p < 0.001) after 2 days, but decreased more in the intervention group (p = 0.006). Trigger point PPT significantly improved immediately in the intervention group (p = 0.003), but not in the control group (p = 0.112). Both groups improved significantly in PSFS (p < 0.001) and ankle dorsiflexion ROM (p < 0.001). Plantar flexor strength significantly increased immediately in the intervention group (p < 0.001), but not in the control group (p = 0.556).ConclusionAdding dry cupping on calf MTrPs to self-stretching and ankle dorsiflexion exercises for patients with plantar heel pain was superior to only self-stretching and active ankle dorsiflexion exercises in pain, ankle dorsiflexion ROM, and plantar flexor strength.