自控止痛泵在疼痛治疗中的应用

介绍了自控止痛泵在临床各种类型疼痛病人治疗中的应用，研究了最佳给药途径、注药模式及常见的不良反应，为临床正确用药提供了帮助。     

硬膜外和穴位置管自控止痛泵给药治疗癌性疼痛

目的：比较硬膜外与穴位置管PCA（自控止痛泵）给药治疗晚期癌性疼痛的镇痛效果。方法：选择60例晚期癌性疼痛患者,随机分成硬外给药组和穴位给药组,负荷量后外接日本全自动多用途便携式微量PCA泵,以0．5ml/h或0．8ml/h的速度给药,必要时可PCA追加。结果：两组病人镇痛效果差异无显著意义（P＞0．05）,以尿潴留为主的不良反应的发生率硬外给药组明显高于穴位给药组。结论：穴位埋管PCA给药法安全、便利、有效,可用于治疗晚期癌性疼痛。     

病人自控止痛泵术后镇痛的护理新进展

介绍了自控止痛泵（PCA泵）用于术后镇痛的护理方法，告诫病人要根据自己的镇痛需要控制好给药的时机和剂量。用PCA前，应征得病人和家属的同意，详细介绍PCA仪器的性能、使用方法、治疗目的、药物的作用、剂量和反应等，应用PCA过程中，护士应给予严密观察，尤其注意对PCA泵及止痛效果的观察。     

静脉自控镇痛泵在晚期癌症患者疼痛护理中的应用

目的总结静脉自控镇痛泵用于晚期癌症患者镇痛的效果。方法2004年6月至2007年6月晚期癌症患者120例,分为观察组和对照组各60例。观察组采用静脉自控止痛泵持续镇痛,对照组采用间断肌内注射盐酸哌替啶镇痛。结果观察组镇痛效果优于对照组,应用止痛药后不良反应率明显低于对照组。结论静脉自控止痛泵持续镇痛用于晚期癌症患者。镇痛效果较好,不良反应少。     

胆道手术后使用自控止痛泵镇痛疗效观察

疼痛是机体自我保护的一种反射机制，也是临床上最常见的一种症状。许多年来，人们对疼痛的认识存在误区，认为疼痛是疾病的一种自然过程，所以未能对合理控制疼痛给予足够的重视。仍有50％～70％的患者术后疼痛得不到有效的缓解。随着临床白控止痛泵（PCA）新技术的应用及镇痛效果明显优于传统肌注给药的方法，使术后疼痛治疗达到了一个新的境界。     

对自控止痛泵止痛效果的护理观察及介入镇痛护理措施

我科自 1999年 1月～ 2000年 12月对 21例肾上腺嗜铬细胞瘤手术患者术后镇痛采用自控止痛泵（ PCA）结合康复护理的方法，并与同期采用术后间断肌肉注射法（ IMD)比较。效果满意。现将护理观察报告如下。 1资料与方法 本组患者 41例，男 12例，女 29例，年龄 25～ 68岁，平均 43岁。其中左肾上腺上及肿瘤切除 17例，右肾上腺及肿瘤切除 24例；病人均为气管插管、静脉与吸入复合麻醉，无镇痛药过敏史或成瘾史。将其随机分 2组，观察组 21例，采用康复护理加 PCA镇痛。对照组 20例，采用度冷丁间断肌注（ IMD）加常规护理。 方法：术后观…     

自控镇痛泵的应用在人文关怀中的体现

目的 探讨心外科病人术后PCA的应用，满足患者更高层次的需求，提升人文关怀的氛围。方法 选取2006年1月～7月手术病人62例，术前进行PCA宣教，术后将使用PCA和未使用PCA病人分组试验，针对两组病人术后恢复情况及护理满意度问卷调查进行分析比较；结果使用PCA病人明显减轻手术带来的疼痛，情绪稳定，并发症少，对护理质量满意；结论 PCA的应用，满足病人缓解术后疼痛的需求，体现科技性与人文性完美结合与统一。     

病人自控止痛泵术后镇痛的护理新进展

介绍了自控止痛泵 (PCA泵 )用于术后镇痛的护理方法 ,告诫病人要根据自己的镇痛需要控制好给药的时机和剂量。用PCA前 ,应征得病人和家属的同意 ,详细介绍PCA仪器的性能、使用方法、治疗目的、药物的作用、剂量和反应等 ,应用PCA过程中 ,护士应给予严密观察 ,尤其注意对PCA泵及止痛效果的观察     

自控静脉镇痛泵在疼痛介入科的应用及护理体会

目的:探讨自控静脉镇痛泵(PCIA)的镇痛效果及护理体会。方法:回顾性分析我科2011年10月～2012年2月慢性疼痛患者80例,所有病例平均分成两组,观察组采用自控静脉镇痛泵泵入镇痛,对照组采用口服或肌内注射盐酸曲马多镇痛,观察两组患者的镇痛效果及不良反应。结果:与对照组比较,观察组患者镇痛效果好、不良反应少(P<0.05)。结论:自控静脉镇痛泵镇痛方法简便、效果满意。     

Bridging the analgesic gap

In this paper, the concept of the analgesic gap in the postoperative period is defined. An audit was performed to examine the current situation of the adequacy of analgesia following the discontinuation of epidural infusions or intravenous morphine.

Out of 89 patients assessed, it was found that 14 (16%), 18 (20%) and eight (9%) patients demonstrated an analgesic gap on Day 0, Day 1 and Day 2 respectively. Of these patients, 9 (64%), 12 (67%) and five (63%) on the respective days had at least one group of analgesics prescribed regularly. Most of these patients prescribed regular analgesia had non-steroidal anti-inflammatory drugs (NSAIDs), paracetamol and moderate analgesics. Oral opioids were not used.

It was shown that of the 22 patients with high pain scores on the day of discontinuation of the analgesic pumps, 17 (77%) had their pump withdrawn too early (within 48 hours).

In view of our findings, recommendations have been made to improve the provision of postoperative analgesia during this transitional period. Acute Pain 2000; 3 (4): x-x.     

静脉镇痛泵用于心脏术后疼痛的疗效观察及护理

[目的]探讨静脉镇痛泵应用于心脏术后疼痛的镇痛效果及不良反应的发生情况。[方法]将860例心脏手术病人随机分为两组,观察组700例术后给予静脉镇痛泵镇痛,对照组160例术后不予静脉镇痛泵镇痛,其余治疗两组相同,对术后镇痛效果及不良反应发生情况进行比较。[结果]在减轻心脏术后疼痛方面,观察组效果明显优于对照组。[结论]静脉镇痛泵用于心脏术后疼痛的镇痛效果良好,操作简单,使用方便。     

Endogenous opioid function mediates the association between laboratory-evoked pain sensitivity and morphine analgesic responses

Predictors of responsiveness to opioid analgesic medications are not well understood. This study tested whether individual differences in endogenous opioid (EO) function are associated with analgesic responsiveness to morphine. In randomized, counterbalanced order over 3 sessions, 45 chronic low back pain participants and 31 healthy controls received an opioid antagonist (8 mg naloxone), morphine (0.08 mg/kg), or placebo. Participants then engaged in 2 laboratory-evoked pain tasks (ischemic and thermal). Outcomes included pain threshold, pain tolerance, and pain ratings. Indexes of EO function and morphine analgesic responsiveness were derived for each measure as the difference in pain responses between the placebo condition and naloxone or morphine condition, respectively. For all 7 pain measures across the 2 laboratory pain tasks, greater EO function was associated with significantly lower morphine analgesic responsiveness (P < 0.001–P = 0.02). Morphine reduced pain responses of low EO individuals to levels similar to those of high EO individuals receiving placebo. Higher placebo condition–evoked pain sensitivity was associated with significantly greater morphine analgesic responsiveness for 5 of 7 pain measures (P < 0.001–P = 0.02). These latter associations were significantly mediated by EO function for 4 of these 5 pain outcomes (all P values < 0.05). In the laboratory-evoked pain context, opioid analgesic medications may supplement inadequate EO analgesia, with little incremental benefit in those with preexisting high EO function. Implications for personalized medicine are discussed.     

Baclofen as an adjuvant analgesic

Baclofen is a γ-aminobutyric acid (GABA) agonist approved for the treatment of spasticity and commonly used in the management of many types of neuropathic pain. Controlled studies have demonstrated the efficacy of this drug in trigeminal neuralgia. Although its precise mechanism of analgesic action is unknown, it is likely that a drug-induced increase in inhibitory activity is sufficient to interrupt the cascade of neural events that culminates in aberrant activity of wide dynamic range neurons, or more rostral neurons in nociceptive pathways, that is the substrate for some types of neuropathic pain. The optimal use of baclofen as an adjuvant analgesic requires an understanding of its pharmacology, side effect spectrum, and dosing guidelines that have proven useful in clinical practice. Failure of baclofen therapy following a prolonged trial requires dose tapering prior to discontinuation due to the potential for a withdrawal syndrome.     

静脉自控镇痛泵在剖宫产术后的应用及护理

[目的] 观察静脉自控镇痛泵镇痛与肌肉注射镇痛药的镇痛效果、不良反应和剖宫产术后48 h内母乳喂养时间、睡眠时间及第1次排气时间,总结护理对策.[方法] 将180例剖宫产术后产妇随机分为两组,实验组90例,产妇术后用自控镇痛泵镇痛,对照组90例,产妇术后实行肌肉注射镇痛药的方法镇痛,采用相应护理措施.[结果]实验组疼痛明显减轻,与对照组比较差异有统计学意义(P＜0.01);实验组恶心、呕吐、头痛、头晕、尿潴留等不良反应明显少于对照组(P＜0.05);实验组48 h内母乳喂养时间和睡眠时间明显多于对照组(P＜0.01),实验组术后第1次排气时间明显短于对照组(P＜0.01).[结论] 静脉自控镇痛泵镇痛明显优于肌肉注射镇痛法.     

Improving the quality of pain treatment by a tailored pain education programme for cancer patients in chronic pain.

Educational interventions, aiming to increase patients' knowledge and attitude regarding pain, can affect pain treatment. The purpose of this study was to evaluate the effects of a Pain Education Programme (PEP), on adequacy of pain treatment, and to describe characteristics predicting change in adequacy. The PEP consists of a multi-method approach in which patients are educated about the basic principles regarding pain, instructed how to report pain in a pain diary, how to communicate about pain, and how to contact healthcare providers. The effects of the PEP were evaluated taking into consideration the lack of well-established outcome measures to evaluate adequacy of pain treatment, the lack of long-term follow-up, and the influence of missing data.A prospective, randomized study was utilized in which 313 chronic cancer patients were followed-up until 8 weeks postdischarge. Adequacy of pain treatment was evaluated by means of the Amsterdam Pain Management Index (APMI), consisting of an integrated score of patients' Present Pain Intensity, Average Pain Intensity, and Worst Pain Intensity, corrected for patients' Tolerable Present Pain, with the analgesics used by the patient. At pretest, 60% of the patients in the hospital were treated inadequately for their pain. Postdischarge, the control group patients were significantly more inadequately treated at 2 weeks after discharge (56% vs 41%), at 4 weeks after discharge (62% vs 42%) and at 8 weeks after discharge (57% vs 51%) than the intervention group patients. While the level of inadequacy in the control groups remained relatively stable at all assessment points, a slight increase in the percentage of patients being treated inadequately was found in the intervention group patients over time. A beneficial effect of the PEP was found for patients both with and without district nursing. Variables predicting an improvement in adequacy of pain treatment consisted of the PEP, the APMI score at baseline, patients' level of physical functioning, patients' level of social functioning, the extent of adherence to pain medication, patients' pain knowledge, and the amount of analgesics used.These findings suggest that quality of pain treatment in cancer patients with chronic pain can be enhanced by educating patients about pain and improving active participation in their own pain treatment. The benefit from the PEP, however, decreases slightly over time, pointing at a need for ongoing education.     

Systematic review of the analgesic efficacy and tolerability of COX-2 inhibitors in post-operative pain control

OBJECTIVE: To evaluate the relative analgesic efficacy and tolerability of single-dose COX-2 inhibitors in post-operative pain management. METHOD: Systematic review of randomized controlled trials (RCTs). OUTCOME MEASURES: The area under the pain relief vs. time curve was used to evaluate the proportion of patient achieving at least 50% pain relief using validated equations. The proportions of patients experiencing any adverse event or specific adverse events were also examined. RESULTS: In all, 18 RCTs were included which contained 2783 patients. The results of the effects of single-dose analgesics on the basis of 50% of patients achieving pain relief over 6 h from dental pain models suggested that oral rofecoxib 50 mg was more effective than codeine/paracetamol 60/600 mg, and the rate ratio (RR) was 2.11 (95% CI 1.6-2.75). Valdecoxib 40 mg was also more effective than oxycodone/paracetamol 10/1000 mg (RR 1.34; 95% CI 1.11-1.62). There was no significant differences between other oral COX-2 inhibitors and non-selective non-steroidal anti-inflammatory drugs (NSAIDs), except that celecoxib 200 mg was less effective than ibuprofen 400 mg (RR 0.66; 95% CI 0.48-0.90) and rofecoxib 50 mg (RR 0.65; 95% CI 0.49-0.87). The results from orthopaedic pain model showed no significant difference between rofecoxib 50 mg and naproxen sodium 550 mg (RR 1.04; 95% CI 0.73-1.49). The adverse effects of single-dose COX-2 inhibitor used in short-term post-operative pain management were generally mild and less than non-selective NSAIDs, although there was no significant difference. CONCLUSIONS: The analgesic efficacy and tolerability of single-dose COX-2 inhibitors were more effective than opioid-containing analgesics and similar to non-selective NSAIDs in post-operative pain management. Further studies are needed to examine the efficacy and tolerability of COX-2 inhibitors compared against active comparators over a longer duration to assess whether these short-term effects are mirrored by longer-term outcomes and to determine their ultimate risk-benefit profile.     

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.     

The WHO analgesic ladder for cancer pain control, twenty years of use. How much pain relief does one get from using it?

Introduction Pain is a major problem in the treatment of patients with cancer. This article reviews studies concerning evaluation of patients with cancer pain treated according to The World Health Organization (WHO) analgesic ladder.Materials and methods Systematic search of PUBMED, MEDLINE, EMBASE, LILACS, BDENF, and OVID and a hand search of reference lists and textbooks from 1982 to 2004 were performed.Result Analgesia was considered adequate in 45 to 100% of patients analyzed in the studies.Conclusion However, the evidence that they provide is insufficient to grant the effectiveness of the WHO guidelines because a controlled clinical trial of this intervention has never been published.