Effect of meloxicam on postoperative pain relief after inguinal hernia repair with local anaesthesia

AIM: To investigate the effect of the administration of a single dose of meloxicam pre-emptively on postoperative pain management in patients who underwent inguinal hernia repair under local anaesthesia. SUBJECTS AND METHOD: Fifty patients who underwent inguinal hernia repair under local anaesthesia during the period November 2005 to May 2006 were recruited into the study prospectively. The patients were randomized to two groups regarding administration and non-administration of pre-emptive meloxicam. The postoperative visual analogue pain scale (VAS) values at 4, 8, 12 and 24 hours and analgesic needs of the patients were recorded RESULTS: No difference was found between the groups in terms of age, gender, hernia localization and type. The VAS values of the patients regarding their pain severity were evaluated at 4, 8, 12 and 24 hours and were significantly lower in the group which received meloxicam pre-emptively (p = 0.001, 0.0001, 0.003 and 0.0001 respectively). The need for non-steroidal anti-inflammatory drug was also found to be significantly lower (p = 0.0001). CONCLUSION: Postoperative pain severity and hence analgesic requirement were significantly decreased in the patients who received meloxicam pre-emptively. Single dose pre-emptive meloxicam seems to be an effective analgesic therapy for patients undergoing inguinal hernia repair under local anaesthesia. It thereby improves patients comfort and should be considered for use in outpatient surgery.     

结核菌素纯蛋白衍生物（TB-PPD）临床安全性的研究

目的评价结核菌素纯蛋白衍生物（TB-PPD）的临床安全性。方法随机选取50例健康志愿者,对其皮内注射0.1mL TB-PPD试剂,注射结束后分别于30min、24h、48h、72h和7d观察其不良反应发生率,评价其安全性。结果不良反应主要表现为发热、接种部位疼痛、硬结等,未发现严重不良反应。结论 TB-PPD具有较好的临床安全性。     

Combined incisional ropivacaine infiltration and pulmonary recruitment manoeuvre for postoperative pain relief after diagnostic hysteroscopy and laparoscopy

Background Preoperative incisional local anaesthesia with ropivacaine is a common method of providing postlaparoscopy pain relief.The pulmonary recruitment manoeuvre also provides pain relief,but the combined effect of these two methods on pain following laparoscopic procedures has not been reported.We investigated the efficacy of combining local anaesthetic infiltration of ropivacaine with pulmonary recruitment manoeuvre on postoperative pain following diagnostic hysteroscopy and laparoscopy.Methods This prospective,randomized,controlled study involved 60 patients divided into two groups （n=30,each）.Group 1 received 20 ml of 0.5％ ropivacaine injected peri-incisionally preoperatively,with intra-abdominal carbon dioxide removed by passive deflation.Group 2 received 20 ml of 0.5％ ropivacaine injected peri-incisionally with five manual inflations of the lungs with a positive-pressure ventilation of 40 cmH2O at the end of surgery.The last inflation was held for 5 seconds.The intensity of postoperative incisional and shoulder pain was evaluated using a numerical rating scale at 0,2,4,8,12,24 and 48 hours postoperatively by an independent blinded anaesthesiologist.Tramadol was given postoperatively for analgesia.Results Compared with group 1,incisional ropivacaine infiltration combined with pulmonary recruitment manoeuvre significantly reduced dynamic pain at 0 hour,4 hours,and 24 hours postoperatively （4.1 ± 2.2 vs.2.1 ± 1.9,P=0.002;2.7 ± 2.7 vs.1.2 ± 1.3,P=0.035; and 3.5 ± 2.1 vs.2.1 ± 1.8,P=0.03,respectively）.Static incisional pain was significantly relieved at 0 hour,2 hours,and 24 hours postoperatively （3.1 ± 1.7 vs.1.6 ± 1.3,P=0.001; 1.4 ± 1.3 vs.0.5 ± 0.8,P=0.012;and 2.3 ± 1.9 vs.1.0 ± 1.5,P=0.038,respectively）.Group 2 had more patients without shoulder pain （P＜0.05） and fewer requiring tramadol （P＜0.05）.Conclusion Ropivacaine with pulmonary recruitment manoeuvre provided simple and effective pain relief after diagnostic hysteroscopy and laparoscopy.     

Latrodectism: a prospective cohort study of bites by formally identified redback spiders

OBJECTIVE: To determine the spectrum of severity and early diagnostic predictors of redback spider bites (Latrodectus hasselti), and to examine the effect of intramuscular redback antivenom. DESIGN AND SETTING: Prospective cohort study of calls to New South Wales, Queensland and Western Australian poisons information centres and presentations to Royal Prince Alfred Hospital and Royal Darwin Hospital emergency departments. PATIENTS: 68 people with definite redback spider bites in which the spider was immediately collected and expertly identified (1 February 1999 to 30 April 2002). INTERVENTIONS: Intramuscular redback spider antivenom in a smaller cohort of hospitalised patients. MAIN OUTCOME MEASURES: Pain severity and duration, local effects and systemic envenomation (effects, prevalence, and persistence > 24 hours). RESULTS: The median duration of effects was 48 hours (interquartile range, 24-96 hours). Pain occurred after all bites and was severe in 42 (62%). Forty-five patients (66%) had pain lasting longer than 24 hours, and 22 (32%) were unable to sleep because of pain. Systemic effects occurred in 24 (35%). Increasing pain over one hour occurred in 37 cases (54%), and local/regional diaphoresis in 23 (34%); both these features were highly predictive of L. hasselti bites compared with bites of other spiders. One of six patients treated with intramuscular antivenom (17%) had no pain at 24 hours, compared with two of 17 untreated patients (12%) (difference, 5%; 95% CI, -36% to +64%; P = 0.95). There was no difference in duration of systemic effects with antivenom administration. CONCLUSIONS: Most redback spider bites cause severe and persistent effects. Intramuscular antivenom appears to be less effective than previously thought and its use by this route needs review.     

消纤痛颗粒镇痛与抗炎作用的实验研究

目的：研究消纤痛颗粒的镇痛和抗炎作用。方法：观察对小鼠热板法、扭体法致疼痛模型的影响,大鼠角叉菜胶致炎症模型的影响。结果：消纤痛能明显延缓小鼠因热板法和注射冰醋酸引起的疼痛,减轻大鼠因注射角叉菜胶引起的足肿胀程度,抑制PGE2的释放。结论：消纤痛颗粒有良好的镇痛、抗炎作用。其镇痛的机制主要在于改善机体对疼痛刺激的耐受性,降低痛觉感受器的敏感性从而提高痛阈。抗炎的作用的机制可能与其能减少PGE2等多种炎症递质的合成和释放,降低毛细血管通透性有关。     

穴位处皮肤内胆碱酯酶阳性神经与痛阈的关系

本文通过实验表明大白鼠穴位内乙酰胆碱酯酶(AChE)或丁酰胆碱酯酸(ChE)阳性神经末梢越多其痛阈越低。用电针刺激穴位后可明显提高全身痛阈,但针刺含阳性神经末梢较多的穴位其全身痛阈升高的水平要比含末梢少的低,提示欲提高全身痛阈无需选择含AChE阳性神经多的穴位。穴位内注射6-羟多巴胺(6-OHDA)毁损交感神经可使局部痛阈明显降低,提示外周交感神经对痛觉信息的传入可能有一定的影响。     

Effect of warming adult diphtheria-tetanus vaccine on discomfort after injection: a randomised controlled trial

OBJECTIVE: To determine whether warming or rubbing adult diphtheria tetanus (ADT) vaccine immediately before administration affects its temperature and reduces the incidence of pain. DESIGN: Double-blind, randomised controlled trial and in-vitro temperature study. SETTING: Emergency department (ED) of a regional hospital between April and December 2001. PATIENTS: Convenience sample of 150 patients aged 16 years or over who presented to the ED requiring ADT booster vaccination. INTERVENTION: Patients were randomised to receive vaccine that was "cold" (no deliberate warming), "rubbed" between the palms for 1 minute, or "warmed" in a 37 degrees C incubator; vaccine was administered as recommended in Australian guidelines. MAIN OUTCOME MEASURES: Incidence of pain and pain score on McGill Present Pain Intensity Questionnaire at 5 minutes, 24 hours and 48 hours after injection; and temperature of vaccine after preparation for simulated administration. RESULTS: The "cold" vaccine had significantly lower temperature (mean, 19.1 degrees C; 95% CI, 17.5-20.7 degrees C) than the "warmed" vaccine (mean, 28.9 degrees C; 95% CI, 28.4-29.4 degrees C) and "rubbed" vaccine (mean, 26.9 degrees C; 95% CI, 24.5-29.3 degrees C). There was no significant difference in incidence of pain between the groups who received vaccine prepared in different ways at any follow-up (5 min: P = 0.62; 24 h: P = 0.58; 48 h: P = 0.61) or overall (P = 0.99). Among those who completed follow-up, incidence of pain at any time was 77/138 (56%); there was no difference in their time-averaged pain scores (P = 0.63) or peak pain scores (P = 0.60). CONCLUSIONS: Warming or rubbing ADT vaccine does not reduce the incidence of pain after administration. Regardless of how ADT vaccine is prepared, its temperature approaches ambient by the time it is injected.     

针灸治疗肛肠病术后疼痛临床应用概述

肛肠疾病术后疼痛极其常见,被视为"天下第一痛",直接影响到手术质量和术后恢复期患者的生活质量。局部疼痛的及时解决,对术后换药、术后创口处理、术后紧张等都有积极作用。通过对引起肛肠病术后疼痛的病因病机阐述,对目前中医针灸疗法在肛肠病术后疼痛的临床应用进行列举和比较。     

分次局部浸润麻醉应用于会阴侧切缝合术的效果

目的:探讨分次会阴局部浸润麻醉在会阴侧切缝合术中的镇痛效果。方法:选阴道分娩初产妇100例,随机分成观察组与对照组,各50例。观察组采用分次会阴局部浸润麻醉,对照组采用阴部神经阻滞麻醉。观察指标为切口缝合时的疼痛程度、产后24 h会阴切口局部水肿情况及出院前会阴切口愈合情况。结果:观察组缝合切口时的疼痛分级低于对照组(P<0.05);两组产后24 h会阴切口局部水肿情况和出院前会阴切口愈合情况比较差异无统计学意义(P>0.05)。结论:分次会阴局部浸润麻醉在会阴侧切缝合时的镇痛效果优于阴部神经阻滞麻醉,且不增加对产妇的危害,不影响会阴切口的愈合。     

全盆腔器官联合切除治疗晚期局部宫颈癌4例临床分析

目的探讨全盆腔器官联合切除治疗晚期局部宫颈癌的临床价值.方法对1997年4月至2001年4月我院实施全盆腔器官联合切除的4例晚期局部宫颈癌患者病例资料进行分析.结果 4例患者手术进展顺利,手术时间为6～9h,平均7.5h;手术中出血量为300～2000ml,平均775ml;术后生存时间为4～41个月,平均16.3个月.4例患者分别死于肠梗阻、小肠阴道残端瘘、绝食、盆腔痛疼绝食和肺转移.结论对同时侵及膀胱和直肠的晚期宫颈癌施行全盆腔器官联合切除可延长患者生存期,提高生存质量.但需严格掌握手术指征,规范手术步骤.     

CAUDAL ANALGESIA FOR POSTOPERATIVE PAIN RELIEF IN CHILDREN

Postoperative pain relief in 40 children undergoing elective infraumbilical surgery was assessed after caudal epidural adminstration of either lignocaine or bupivacaine in the doses of 0.5 mL/kg body weight of a 1 per cent solution and 0.5 mL/kg body weight of a 0.25 per cent solution respectively. Pain free period was assessed by subjective pain scales. The pain free period was significantly prolonged in children who were given bupivacaine (14.75 ± 2.75 hours) as compared to lignocaine (7.25 ± 3.25 hours).KEY WORDS: Analgesia epidural, Anaesthesia, Bupivacaine, Lignocaine, Pain postoperative     

音乐疗法对减轻小儿静脉输注1,6-二磷酸果糖所致局部疼痛的效果观察

目的:观察音乐疗法减轻小儿静脉输注1,6二磷酸果糖(FDP)所致局部疼痛的效果。方法:189例小儿静脉输注FDP,随机分为对照组(93例)和实验组(96例),后者在静脉滴注过程中播放儿歌30分钟。采用自我描述问卷和FLACC评分法评估小儿疼痛的程度。结果:(1)自我描述问卷::实验组中"非常疼痛和疼痛"二项低于对照组,"轻微疼痛和无痛"二项高于对照组。(2)FLACC评分法:实验组得分低于对照组(P<0.01)。结论:被动音乐疗法可有效地减轻小儿静注FDP所致的局部疼痛。     

Efficacy of interspace between the popliteal artery and the capsule of the posterior knee (iPACK) block versus periarticular local infiltration analgesia after unilateral total knee arthroplasty: Prospective randomized control trial

Objectives:To compare the efficacy of interspace between the popliteal artery and the capsule of the posterior knee (iPACK) block with periarticular local infiltration analgesia (LIA) to assess postoperative pain control and enhanced recovery after total knee arthroplasty (TKA).Methods:This research was carried out at King Saud University Medical City, Riyadh, Saudi Arabia, from September 2020 to March 2021. Eighty Patients scheduled for elective unilateral TKA were randomized to receive either iPACK or periarticular LIA along with adductor canal block under spinal anesthesia. The primary outcome was postoperative pain score, and secondary outcomes included physical rehabilitation, duration of surgery, length of post-anesthesia care unit stay, hemodynamics, and length of hospital stay.Results:The pain score during activity in iPACK group was significantly lower compared to LIA group at 4 hours postoperatively, but no significant difference was observed at 24 or 48 hours. The timed up and go test took significantly longer for patients in LIA group at 4, 24, and 48 hours compared to those in iPACK group. No significant differences in knee range of motion were observed between the 2 groups at any point.Conclusion:Based on our findings, iPACK block is an effective technique in reducing pain in the immediate postoperative period without affecting motor function, resulting in enhanced recovery following primary TKA.     

方剑乔针灸治疗颞颌关节紊乱经验

方剑乔认为颞颌关节紊乱多由经脉受阻、气血不畅、脉道瘀滞所致,针灸治疗要以通畅气血、舒筋活络为原则,在遵循经选穴基础上多选取局部腧穴,常选用下关、颊车为主穴,使用温针灸,以艾灸温热效力降低患者病处周围神经兴奋,从而缓解肌肉痉挛、改善微循环、消炎镇痛;强调根据患者颞颌关节紊乱发病的时间长短来判断病邪深浅,对于初期发病者,痹证较轻,采用轻刺之"扬刺",将痹邪浮而散之,而对于长久不愈者,其痹邪久居于内,采用深刺之"齐刺"以驱邪外出;临床上,方老师尤其善用电针,根据患者疼痛的急缓期选用不同的电针频率,对于急性疼痛期使用100 Hz电针可快速缓解疼痛,而对于疼痛不明显者则选用2 Hz电针,将以上诸法合用,临床疗效显著。     

算盘子提取物抗炎镇痛作用的实验研究

目的探讨算盘子提取物的抗炎镇痛作用及其可能机制。方法建立角叉菜胶所致大鼠足跖肿胀模型,观察算盘子提取物对角叉菜所致炎性足肿胀程度和炎症局部组织中组胺含量的影响。采用热板法进行疼痛实验,测定各组小鼠对热刺激疼痛的痛阈值。结果算盘子提取物高、中两个剂量组能明显抑制角叉菜胶引起的大鼠足跖致炎后2、4、6 h时的肿胀,低剂量组能明显抑制角叉菜胶引起的大鼠足跖致炎后4、6 h时的肿胀,且与模型组相比,组胺含量均具有显著性差异;算盘子提取物高、中两个剂量组能明显提高热刺激小鼠给药后30、60、90 min的痛阈值,低剂量组能明显提高热刺激小鼠给药后60、90 min的痛阈值。结论算盘子提取物具有明显的抗炎、镇痛作用。其作用可能与降低炎症部位组胺含量有关。     

程序化疼痛护理管理在髋关节置换术后的运用及效果评价

目的 评价程序化疼痛护理管理在髋关节置换术后运用的效果。 方法 于2016年10月—2019年5月从滁州市第一人民医院住院患者中,选取80名需进行髋关节置换术的患者,按照随机数字表分为对照组和观察组,每组患者例数各40例,对照组采取常规护理措施及止痛治疗,而观察组通过建立程序化疼痛管理小组,给予患者疼痛知识教育和多模式镇痛措施,分别评价术前、术后24、48 h患者日常生活活动能力评分(ADL)、髋关节功能评分量表及疼痛度评分情况。 结果 程序化疼痛护理管理对患者术后24 h的日常生活能力得分无影响,但是提高了患者术后48 h日常生活活动能力得分[(49.78±6.51)分]和髋关节功能评分[(65.85±4.29)分];降低患者术后24 h [(3.82±1.13)分]和48 h[(4.95±1.58)分]的疼痛度。 结论 通过本次对照实验,研究者发现程序化疼痛护理管理显著提高了髋关节置换术后患者的日常生活活动能力(术后48 h)和髋关节功能(术后48 h),降低患者术后疼痛反应(术后24 h和48 h),提高患者术后治疗的依从性和心理阈值,促进患者肢体功能和日常生活自理能力的恢复,缩短了住院时间,降低治疗费用,促进患者疾病的康复。      

针刺麻醉中有衣大致密核心小泡非突触部位的胞吐

目的：进一步证实在针刺镇痛中有衣的大致密核心小泡（CLDV）通过非突触部位胞吐递质参与疼痛的调节,为疼痛生理研究提供形态学基础。方法：取大鼠的“人中”、“四白”穴进行针刺镇痛,并将针刺显效时间分别延长至0．5、1、2、3、4小时,各组动物时间一致,立即杀死取材,制作电镜样品,电镜下观察、记录各针刺时间段内动物延髓三叉神经脊束交状质亚核中间部分神经元的CLDV于非突触部位的胞吐影像。结果：在三叉神经脊束交状质亚核内发现了各阶段CLDV的胞吐影像,实验和对照组之间有显著性的差别（P＜0．01）。结论：在针刺镇痛中CLDV借助其非突触部位胞吐内含的递质参与了针刺中痛的调节过程。     

电视胸腔镜术后年龄与疼痛的关系

目的:分析电视辅助胸腔镜手术(VATS)后疼痛与年龄的关系。方法:采用目前常用的疼痛视觉模拟评分(VAS)方法,记录接受胸腔镜手术的31例病人术后24h、48h和72h疼痛情况,将疼痛与年龄数据进行统计学处理。结果:VATS术后24h平静时疼痛评分为3.98±0.88,属轻到中度;咳嗽时疼痛评分为6.69±1.08,属中到重度。通过直线相关与回归分析,术后24h平静和咳嗽时年龄与疼痛程度呈负相关,P<0.05,疼痛随年龄增加而减轻;术后48h、72h疼痛与年龄无相关关系,P>0.05。结论:VATS术后24h年龄与疼痛程度呈负相关,疼痛随年龄增加而减轻。     

规范化疼痛评估在肝脏外科临床护理实践中的应用效果

目的：探讨规范化疼痛评估在肝脏外科临床护理实践中的应用效果。方法将某三甲医院肝脏外科182例行开腹肝切除手术患者按入院时间分为两组,2013年6月~11月入院的85例患者为对照组（传统疼痛评估组）,2013年12月~2014年5月入院的97例患者为观察组（规范化疼痛评估组）。观察组按照统一的疼痛评估频次、时机,定时、规律地对患者实施规范化疼痛评估;对照组在患者出现疼痛难忍时护士即刻评估患者疼痛。分析两组患者对疼痛管理满意度,手术当日睡眠时长,48 h 内疼痛评分,术后主动翻身活动时间等。结果182例患者中94.85%的患者主动报告个人疼痛;疼痛管理满意度观察组为93.82%,对照组为50.59%,手术当日睡眠时长观察组平均为（5.48±0.74）h,对照组为（4.16±1.07）h,手术后主动开始活动时间观察组平均是（9.7±6.4）h,对照组为（21.1±5.6）h,术后24小时疼痛评分观察组平均为（2.39±1.14）分,对照组为（3.30±1.33）分,上述观察组数据均优于对照组,两组比较差异均有统计学意义（P ﹤0.05）。结论规范化疼痛评估,能提高肝脏外科患者疼痛控制满意度和舒适度,促进患者参与,减轻患者痛苦,促进患者快速康复。     

耳颞神经阻滞(ANB)在ROSA机器人辅助下颅内电极植入术后镇痛中的应用

目的 评估选择性耳颞神经阻滞（auriculotemporal nerve block，ANB）应用于ROSA机器人辅助下颅内电极植入术术后镇痛的效果。方法 60例接受ROSA机器人辅助下颅内电极植入术的患者，年龄13~65岁，16n=30）和静脉患者自控镇痛组（PCIA组，n=30）。ANB组在手术结束后用0.5%罗派卡因2~3 mL在超声引导下阻滞双侧耳颞神经，术后留置导管，每8 h通过留置导管推注0.5%罗哌卡因2 mL以维持神经阻滞效果；PCIA组术后配制镇痛泵，2 μg/kg舒芬太尼+2 μg/kg右美托咪啶+昂丹司琼8 mg+0.9%氯化钠注射液，稀释至100 mL。术后4、12、24和48 h记录患者的简化McGill疼痛评分和不良反应，包括恶心呕吐、皮肤瘙痒、呼吸抑制、低血压、心动过缓、局麻药中毒等。结果 与PCIA组比较，ANB组术后4、12、24和48 h的McGill疼痛评分差异无统计学意义，ANB组的不良反应与12 h内张口咬合疼痛发生率明显低于PCIA组。结论 超声引导下选择性ANB是ROSA机器人辅助下颅内电极植入术术后镇痛的有效方法，较PCIA镇痛更具优势。