Role of magnesium sulfate in postoperative pain management for patients undergoing thoracotomy

OBJECTIVE: The purpose of this study was to investigate the effect of magnesium sulfate on pain management for post-thoracotomy patients. DESIGN: A prospective, randomized, controlled clinical study. SETTING: University hospital. PARTICIPANTS: Twenty-four patients undergoing thoracotomy. INTERVENTIONS: After thoracotomy operations, patients were assigned to 2 groups. The control group received intravenous morphine (0.5 mg/h infusion, 0.3 mg patient-controlled anesthesia dose, 15-minute lockout time) via patient-controlled analgesia, and the magnesium group received magnesium sulfate (30-mg/kg bolus, 10 mg/kg/h infusion for 48 hours) plus the same patient-controlled analgesia protocol. MEASUREMENTS AND MAIN RESULTS: Visual analog scale for pain score, sedation score, mean arterial pressure, heart rate, and valid and invalid analgesic demand were recorded. Serum magnesium levels were determined at postanesthesia care unit admission, at 24 hours, and at 48 hours. Side effects were also recorded. There were no significant differences between groups with respect to demographics, sedation score, and pain score. Cumulative mean morphine consumption was found to be higher in the control group compared with the magnesium group at 4, 8, and 48 hours (5.6 +/- 1 mg v 3.2 +/- 0.6 mg [p < 0.0001], 10.2 +/- 1.8 mg v 7.2 +/- 1.6 mg [p = 0.0003), and 40.2 +/- 4.5 mg v 34.8 +/- 6.3 mg [p = 0.02], respectively). CONCLUSION: Postoperative use of magnesium sulfate reduced opioid consumption for pain after thoracotomy operations.     

Fentanyl HCl iontophoretic transdermal system (ITS): clinical application of iontophoretic technology in the management of acute postoperative pain

The fentanyl HCl iontophoretic transdermal system (fentanylITS) is a novel patient-controlled analgesia (PCA) system thathas been approved in the USA and Europe for the management ofacute, moderate-to-severe postoperative pain. This system extendsthe applicability of transdermal drug delivery to acute painmanagement, allowing patients to self-administer pre-programmeddoses of fentanyl non-invasively through the use of iontophoretictechnology. Iontophoresis is the process by which an electriccurrent is used to drive ionized drug molecules across the skinand into the systemic circulation. Results of a recent US clinicaltrial found the fentanyl ITS to provide pain control equivalentto a standard regimen of morphine i.v. PCA, with a similar incidenceof opioid-related adverse events. The fentanyl ITS may offera number of clinical advantages over existing PCA modalities.Its method of drug delivery avoids the risk of complicationsfrom needle-related injuries and infection, and its pre-programmedelectronics eliminate the potential for manual programming errorsand excessive dosing. In addition, the compact size of the systemcould enable greater patient mobility following surgery. Thefentanyl ITS has the potential to become a valuable option inthe management of acute postoperative pain.     

Iontophoretic transdermal system using fentanyl compared with patient-controlled intravenous analgesia using morphine for postoperative pain management

Background: The fentanyl iontophoretic transdermal system (fentanyl ITS)enables needle-free, patient-controlled analgesia for postoperativepain management. This study compared the efficacy, safety, andease of care of fentanyl ITS with patient-controlled, i.v. analgesia(PCIA) with morphine for postoperative pain management. Methods: A prospective, randomized, multicentre trial enrolled patientsin Europe after abdominal or orthopaedic surgery. Patients receivedfentanyl ITS (n = 325; 40.0 µg fentanyl over 10 min) ormorphine PCIA [n = 335; bolus doses (standard at each hospital)]for 72 h. Supplemental i.v. morphine was available during thefirst 3 h. The primary efficacy measure was the patient globalassessment (PGA) of the pain control method during the first24 h. Results: PGA ratings of ‘good’ or ‘excellent’were reported by 86.2 and 87.5% of patients using fentanyl ITSor morphine PCIA, respectively (95% CI, –6.5 to 3.9%).Mean (SD) last pain intensity scores (numerical rating scale,0–10) were 1.8 (1.77) and 1.9 (1.86) in the fentanyl ITSand morphine PCIA groups, respectively (95% CI, –0.38to 0.18). More patients reported a system-related problem forfentanyl ITS than morphine PCIA (51.1 vs 17.9%, respectively).However, fewer of these problems interrupted pain control (4.4vs 41.3%, respectively). Patients, nurses, and physiotherapistsreported more favourable overall ease-of-care ratings for fentanylITS than morphine PCIA. Study termination rates and opioid-relatedside-effects were similar between groups. Conclusion: Fentanyl ITS and morphine PCIA were comparably effective andsafe.     

Pharmacokinetics and pharmacodynamics of sublingual sufentanil for postoperative pain management

Achieving successful treatment of postoperative pain remains a challenge. Recently, a sufentanil sublingual tablet system has been developed for treatment of moderate‐to‐severe postoperative pain. The phenylpiperidine sufentanil is a potent analgesic that rapidly crosses the blood–brain barrier and selectively activates central μ‐opioid receptors. The system makes use of a hand‐held dispenser system, which contains forty 15‐μg sufentanil sublingual micro‐tablets. The patient can release one tablet at 20‐min intervals using a unique radiofrequency adhesive tag, which is wrapped around the patient's thumb. In this review, the authors discuss the pharmacology of sublingual sufentanil with reference to its suitability in the treatment of postoperative pain, the current evidence for the sublingual sufentanil system in postoperative pain treatment, and advantages and limitations of the sublingual system. We conclude that sufentanil is suited for the transmucosal route due to its pharmacokinetic profile, including rapid onset, absence of active metabolites and low tissue accumulation. The efficacy and safety of the sufentanil sublingual tablet system has been shown in over 600 patients in a limited set of studies; further independent studies are required to determine the position of the system among other forms of postoperative pain treatment. We conclude that the sublingual sufentanil tablet system allows effective pain relief, and allows patients to control their own pain relief and early postoperative mobility.     

Intravenous ketoprofen for pain relief after total hip or knee replacement

Background: There are few studies in which ketoprofen, a propionic acid derivate NSAID, has been tested as an intravenous postoperative analgesic. The aim of this double-blind, randomized, placebo-controlled work was to study the tolerability and efficacy of intravenous ketoprofen in seventy-six patients undergoing hip or knee total endoprothesis surgery using three different doses.
Methods: The patients received either ketoprofen 50 mg, 100 mg or 150 mg, or placebo as an initial intravenous loading, followed by an infusion containing 50 mg, 100 mg or 150 mg or placebo, respectively, over the following eleven and a half hours. The consumption of fentanyl was recorded and the patients assessed their pain intensity on a 10-cm visual analogue scale (VAS) at 0, 2, 4 and 12 hours. Possible side-effects were recorded at the same intervals.
Results: Patients receiving ketoprofen showed significantly lower total fentanyl consumption and significantly better pain relief at 12 hours was achieved by a 300 mg dose of ketoprofen than by placebo. Side-effects were minimal, with no differences between the groups.
Conclusion : A bolus of ketoprofen following continuous infusion of ketoprofen, coupled with a PCA-system, was an effective and safe approach for the relief of postoperative pain.     

Role of beta-blockade in anaesthesia and postoperative pain management after hysterectomy

Background. Perioperative use of ß-blockers has beenadvocated as a strategy to prevent cardiac sequelae. This studyevaluated the influence of perioperative esmolol administrationupon anaesthesia and postoperative pain management amongst patientsundergoing hysterectomy. Methods. Ninety-seven ASA I–II patients, undergoing abdominaltotal hysterectomy, were randomly divided into one of two groups.Patients in the Esmolol group received an i.v. loading doseof esmolol 0.5 mg kg^–1 followed by infusion of 0.05 mgkg^–1 min^–1 before anaesthesia induction. The infusionwas documented at the completion of surgery. The Control groupreceived a volume of normal saline. After surgery, all patientswere treated with patient-controlled i.v. analgesia (PCA), whichwas programmed to deliver 1 mg of morphine on demand for 3 consecutivedays. Pain intensity on movement and at rest, sedation score,and side effects were recorded. Results. The two groups were comparable with respect to theircharacteristics. Patients in the esmolol group received significantlylower end-tidal isoflurane concentrations (1.0 (0.3) vs 1.4(0.5)%, respectively; P<0.001) and fentanyl (0.9 (0.2) vs1.2 (0.5) µg kg^–1, respectively; P=0.006) duringanaesthesia. They also showed a reduced heart rate and arterialpressure response to tracheal intubation, skin incision, andtracheal extubation. The Esmolol group consumed less PCA morphinein 3 days (37.3 (8.4) vs 54.7 (11.2) mg, respectively; P=0.005).Pain intensity and medication side effects were similar in thetwo groups. Conclusion. The results suggest that perioperative esmolol administrationduring anaesthesia reduces the intraoperative use of inhalationanaesthetic and fentanyl, decreases haemodynamic responses,and reduced morphine consumption for the first 3 postoperativedays.     

Retrospective evaluation of continuous epidural infusion for postoperative pain in children

BACKGROUND: The safety and efficacy of postoperative epidural analgesia (EDA) in children are not well documented in larger series of patients given routine postoperative care. The aims of this study were to evaluate the efficacy of pain relief, determine the incidence and type of complications during the entire period of epidural pain treatment in children, and assess the factors affecting efficacy METHODS: Children treated postoperatively with an EDA infusion during the period 18 September 1994 to 1 January 1999 were studied. Data regarding the age, gender, efficacy of analgesia, duration of epidural infusion, types of side-effects and complications, reasons for discontinuation, and types and duration of surgery were collected daily by the Acute Pain Treatment Service. The sensory dermatomal level of the surgical incision site was included retrospectively. RESULTS: Five hundred and eighteen epidural infusions were given to 476 children. Pain relief was rated as 'good' at 76% of visits. There were no major complications or sequelae. Thirty-seven per cent of the epidural infusions were prematurely discontinued, and 21% were discontinued because of unsatisfactory analgesia. Factors related to a higher percentage of unsatisfactory function were surgical incision site located above the umbilicus, gastroenterologic surgery, protracted surgery and age. Age and duration of surgery were significantly related to unsatisfactory function. CONCLUSION: This study shows that continuous epidural infusion for postoperative pain was satisfactory in most cases, and that no major side-effects or complications occurred in children nursed on regular wards. The early recognition of unsatisfactory function of an EDA is important for a child's well being.     

Acute perioperative pain in neonates: An evidence-based review of neurophysiology and management

Current literature lacks systematic data on acute perioperative pain management in neonates and mainly focuses only on procedural pain management. In the current review, the neurophysiological basis of neonatal pain perception and the role of different analgesic drugs and techniques in perioperative pain management in neonates are systematically reviewed. Intravenous opioids such as morphine or fentanyl as either intermittent bolus or continuous infusion remain the most common modality for the treatment of perioperative pain. Paracetamol has a promising role in decreasing opioid requirement. However, routine use of ketorolac or other nonsteroidal anti-inflammatory drugs is not usually recommended. Epidural analgesia is safe in experienced hands and provides several benefits over systemic opioids such as early extubation and early return of bowel function.     

The effect of short-term continuous epidural morphine on postoperative pain after laparoscopic cholecystectomy

This study was undertaken to determine whether short-term continuous epidural analgesia using morphine would relieve pain after laparoscopic cholecystectomy. The authors retrospectively reviewed the clinical data of 182 cases who had undergone a laparoscopic cholecystectomy. These cases were divided into four groups according to their anesthetic modes as follows: a control group with general anesthesia only (n=37); group I, general anesthesia combined with one shot of epidural morphine (n=78); and group II, general anesthesia combined with continuous epidural analgesia using morphine (IIa for 12 h (n=33); IIb for 8 h (n=34)). The pain score on a four-category verbal scale and the frequency of analgesic use were investigated. There were no differences in the background characteristics of the patients among the groups, except for the duration of surgery (Ivs IIa;P=0.006). The pain scores were significantly different between the control group and the other groups. The frequency of analgesic use in the control group was also significantly higher than in the other groups. A tendency toward a higher frequency of analgesic use in group I, compared with that in groups IIa and IIb, was observed. These findings thus suggest that short-term continuous epidural analgesia using morphine can effectively relieve postoperative pain after a laparoscopic cholecystectomy.     

Respiratory and haemodynamic effects of acute postoperative pain management: evidence from published data

Background. This study examines the evidence from publisheddata concerning the adverse respiratory and haemodynamic effectsof three analgesic techniques after major surgery; i.m. analgesia,patient-controlled analgesia (PCA), and epidural analgesia. Methods. A MEDLINE search of the literature was conducted forpublications concerned with the management of postoperativepain. Information relating to variables indicative of respiratorydepression and of hypotension was extracted from these studies.Over 800 original papers and reviews were identified. Of thesepapers, 212 fulfilled the inclusion criteria but only 165 providedusable data on adverse effects. Pooled data obtained from thesestudies, which represent the experience of a total of nearly20 000 patients, form the basis of this study. Results. There was considerable variability between studiesin the criteria used for defining respiratory depression andhypotension. The overall mean (95% CI) incidence of respiratorydepression of the three analgesic techniques was: 0.3 (0.1–1.3)%using requirement for naloxone as an indicator; 1.1 (0.7–1.7)%using hypoventilation as an indicator; 3.3 (1.4–7.6)%using hypercarbia as an indicator; and 17.0 (10.2–26.9)%using oxygen desaturation as an indicator. For i.m. analgesia,the mean (95% CI) reported incidence of respiratory depressionvaried between 0.8 (0.2–2.5) and 37.0 (22.6–45.9)%using hypoventilation and oxygen desaturation, respectively,as indicators. For PCA, the mean (95% CI) reported incidenceof respiratory depression varied between 1.2 (0.7–1.9)and 11.5 (5.6–22.0)%, using hypoventilation and oxygendesaturation, respectively, as indicators. For epidural analgesia,the mean (95% CI) reported incidence of respiratory depressionvaried between 1.1 (0.6–1.9) and 15.1 (5.6–34.8)%,using hypoventilation and oxygen desaturation, respectively,as indicators. The mean (95% CI) reported incidence of hypotensionfor i.m. analgesia was 3.8 (1.9–7.5)%, for PCA 0.4 (0.1–1.9)%,and for epidural analgesia 5.6 (3.0–10.2)%. Whereas theincidence of respiratory depression decreased over the period1980–99, the incidence of hypotension did not. Conclusions. Assuming a mixture of analgesic techniques, AcutePain Services should expect an incidence of respiratory depression,as defined by a low ventilatory frequency, of less than 1%,and an incidence of hypotension related to analgesic techniqueof less than 5%.     

Intraoperative low-dose S-ketamine has no preventive effects on postoperative pain and morphine consumption after major urological surgery in children

BACKGROUND: Clinical studies suggest low-dose ketamine may have preemptive effects on postoperative pain in adults. The objective of this study was to determine whether intraoperative low-dose S-ketamine reduces postoperative pain and morphine consumption in children undergoing major urological surgery. MATERIALS: Thirty children scheduled for major urological surgery were included in this prospective study. Anesthesia was performed as total intravenous anesthesia (TIVA) with alfentanil and propofol. Fifteen patients additionally received an intravenous bolus of S-ketamine (0.2 mg.kg-1) followed by a continuous infusion of 5 microg.kg-1.min-1, which was stopped immediately after skin closure (Ketamine Group). Another 15 patients received an infusion of saline (Control group). After transfer to the PACU, pain intensity was evaluated using a numeric rating scale (NRS). First patient controlled analgesia (PCA) request, cumulative morphine consumption and pain intensities within the first 72 h were compared. RESULTS: Morphine consumption was not significantly different during the first 72 h (Control: 0.4 mg.kg-1, 0.24-0.51 mg.kg-1, Ketamine: 0.32 mg.kg-1, 0.19-0.61 mg.kg-1; median, 25-75% percentile; n.s.). However, differences were found in pain intensity during the first postoperative hour (Control: 4.0, 3.2-4.6, Ketamine: 2.5, 1.3-3.5; median, 25-75% percentile; P<0.05) and in the time to first PCA use (Control: 37, 28-46 min, Ketamine: 62, 38-68 min; median, 25-75% percentile; P<0.05). CONCLUSIONS: Intraoperative low-dose S-ketamine had no effect on morphine consumption during the first 72 h after surgery. The differences in pain intensity and time to first PCA use probably reflect additional sedation and antinociceptive effects of S-ketamine rather than a true 'prevention' of pain.     

Comparison of the analgesic efficacy of ketobemidone and morphine for management of postoperative pain in children: a randomized, controlled study

BACKGROUND: Ketobemidone has been used as an analgesic for postoperative pain in children, but to our knowledge the effect and occurrence of adverse effects of ketobemidone compared to morphine is not known. The aim was to determine if the analgesic potency and the occurrence of adverse effects of ketobemidone differ from morphine when administered to children, as measured by patient-controlled analgesia consumption (PCA) for postoperative pain. METHODS: Sixty healthy children, aged 6 to 16 years, scheduled for elective surgery were randomized to receive either ketobemidone (Ke) 1 mg ml(-1) or morphine (Mo) 1 mg ml(-1) for postoperative pain through PCA. Drug consumption (microg kg(-1) h(-1)), the number of PCA doses, pain intensity, and adverse effects were recorded at regular intervals. RESULTS: Data on total drug consumption were based on 26 children in the Ke group and 28 in the Mo group. A non-statistically significant difference for total mean consumption of ketobemidone (18.6 microg kg(-1)h(-1)) and morphine (23.2 microg kg(-1)h(-1)) was obtained. The mean dose ratio (Mo/Ke) was 0.80 and the median was 0.94. Children's characteristics, loading dose, PCA doses, VAS scores, and adverse effects showed no significant differences between the groups. CONCLUSION: The analgesic potency and adverse effects of ketobemidone are similar to morphine when used for postoperative pain management in children.     

Posterior quadratus lumborum block versus epidural analgesia for postoperative pain management after open radical cystectomy: A randomized clinical trial

Background

In open abdominal surgery, continuous epidural analgesia is commonly used method for postoperative analgesia. However, ultrasound (US)-guided fascial plane blocks may be a reasonable alternative.

Methods

In this randomized controlled trial, we compared posterior quadratus lumborum block (QLB) with epidural analgesia for postoperative pain after open radical cystectomy (ORC). Adult patients aged 18–85 with bladder cancer (BC) scheduled for open RC were randomized in two groups. Exclusion criteria were complicated diabetes mellitus type I, lack of cooperation, and persistent pain for reasons other than BC. In one group, a bilateral US-guided single injection posterior QLB was performed with 3.75 mg/ml ropivacaine 20 ml/side. In the other group, continuous epidural analgesia with ropivacaine was used. Basic analgesia was oral paracetamol 1000 mg three times daily, and long-acting opioid twice daily in both groups. All patients had patient-controlled rescue analgesia with oxycodone. Postoperative cumulative rescue opioid consumption was recorded for the day of surgery, and the following 2 postoperative days (POD 0–2). Secondary outcomes were postoperative pain and nausea and vomiting.

Results

In total, 20 patients (QLB), and 19 patients (epidural analgesia) groups, were included in the analyses. Cumulative rescue opioid consumption on POD 0, being of duration 9–12 h, was 14 mg (7.6–33.3) in the QLB group versus 6.1 mg (2.0–16.1) in the epidural analgesia group, p = 0.089, and as doses, 8 doses (3.6–15.7) versus 4 doses (1.3–8.5), p = .057. On POD 1 consumption was 25.3 mg (11.0–52.9) versus 18.0 mg (14.4–43.7), p = .749, and as doses 12 (5.5–23.0) versus 10 (8–20), p > .9, respectively. On POD 2 consumption was 19.1 mg (7.9–31.0) versus 18.0 mg (5.4–27.6) p = .749, and as doses 8.5 (5.2–14.7) versus 11 (3.0–18.0) p > .9, respectively.

Conclusion

Opioid consumption did not differ significantly between posterior QLB and an epidural infusion with ropivacaine for the first 2 postoperative days following RC. Trial registration: ClinicalTrials.gov identifier NCT03328988.     

氢吗啡酮在骨科术后镇痛中应用的有效性和安全性

目的评估氢吗啡酮用于骨科术后镇痛的有效性和安全性,并与传统强阿片药舒芬太尼的镇痛效能和副作用进行比较。方法全麻下行骨科手术、术后接受24小时自控静脉镇痛患者114例。将114例患者随机分为氢吗啡酮组和舒芬太尼组,镇痛药液包含0.16 mg/ml盐酸氢吗啡酮或1μg/ml枸橼酸舒芬太尼。记录患者性别、年龄、身高、体重、手术部位、后静脉镇痛期间、记录用药剂量、静止和运动疼痛评分、镇静评分、心率、血压、脉搏氧饱和度以及不良反应。结果氢吗啡酮组患者术后各个时点患者心率(80±15)次/分,收缩压(113±15)mmHg,舒张压(65±10)mmHg,脉搏氧饱和度(98±1)%,两组比较差异无统计学意义。术后6小时氢吗啡酮组VAS评分低于舒芬太尼组,而术后18小时、24小时氢吗啡酮组VAS评分高于VAS组。术后6小时、18小时和24小时氢吗啡酮组PCA按压次数和药物用量均高于舒芬太尼组。两组患者以上指标比较差异无统计学意义。两组患者Ramsay镇静评分均为2(2,2),也未出现术后镇痛相关的呼吸抑制。氢吗啡酮组患者术后恶心呕吐和眩晕的发生率分别为7.1%和1.9%,与舒芬太尼组比较差异无统计学意义。两组患者对术后镇痛的满意度均为5(4,5)。结论氢吗啡酮可以安全有效地用于成人骨科术后静脉自控镇痛,0.16mg/ml盐酸氢吗啡酮与1μg/ml枸橼酸舒芬太尼的镇痛效能和不良反应相似。     

Epidural morphine for postoperative pain relief in children

Epidural morphine for postoperative pain relief is in general use, and has proved to be very efficient in adults. The epidural technique and the use of epidural morphine are much less frequent in children. For 2 years we have prospectively followed 76 children who had epidural morphine for postoperative pain relief after major abdominal surgery. The age distribution was from newborn to 13 years, with a median age of 12 months. It was estimated that 94% of the patients had good analgesia for the first 24 postoperative hours and no other opioids were given. The side effects were few, but one case of respiratory depression was seen and 20% of the children had pruritus. There were four dural punctures and three catheters slipped out accidentally, but otherwise the treatment was continued as long as it was considered necessary (1–11 days). The use of postoperative ventilatory support decreased during the investigation. We observed a change in the sleeping pattern with an increased number of sleep–induced myoclonia during the administration of epidural morphine. In conclusion, the use of epidural morphine in children for postoperative pain relief is very efficient. The minimal effective dose has not been established as yet, but 50 Hg/kg every 8 h, supplemented with small doses of bupivacaine, provides excellent analgesia in the immediate postoperative period after major abdominal surgery. The side effects are few, but the risk of respiratory depression is always present and observation in the intensive care unit or recovery for the first 24 h is strongly recommended.     

Randomized, double-blind comparison of patient-controlled epidural infusion vs nurse-administered epidural infusion for postoperative analgesia in patients undergoing colonic resection

BACKGROUND: There is little published evidence of the analgesic efficacyof patient-controlled epidural analgesia (PCEA) for postoperativepain relief. The aim of this study was to compare the analgesicefficacy of epidural infusion of bupivacaine 0.125% and fentanyl4 µg ml^–1 administered by either PCEAwith a background infusion or nurse-administered continuousepidural infusion (CEI) after major intra-abdominal surgery. METHODS: In a double-blind, randomized clinical trial, 205 adult patientsundergoing colonic resection by laparotomy received either PCEAor CEI. Pain scores were recorded via a four-point verbal ratingscale at 1, 2, 3, 4, 8, 12, 24, 48, and 72 h after surgery.The administration of epidural top-ups and systemic analgesiaover the same period was also recorded, and patient satisfactionquestionnaires completed. RESULTS: The median area under the curve of pain against time was significantlylower in the PCEA group (2 vs 24, P<0.001) as were mediansummary pain scores on movement (0.67 vs 1.33, P<0.001).Significantly fewer patients in the PCEA group received oneor more epidural top-ups (13 vs 36%, P = 0.0002) or any systemicanalgesics (41 vs 63%, P = 0.0021). Patients in the PCEA groupwere significantly more likely to be very satisfied than inthe CEI group (76 vs 43%, P<0.0001). CONCLUSIONS: PCEA provides greater analgesic efficacy than CEI for postoperativeanalgesia after major intra-abdominal surgery, and a decreasedrequirement for physician or nurse intervention.     

急性疼痛服务组织的构建与实践

目的规范术后疼痛管理,提高术后镇痛效果。方法成立在麻醉医生督导下以疼痛专科护士为主体的急性疼痛服务组织,制定各级人员职责,完善运作流程,对860例术后患者实施规范化手术后镇痛,包括术前访视,疼痛查房,上报和处理不良事件,建立疼痛档案等。结果术后患者发生的并发症包括恶心呕吐(51例,5.93%)、皮肤瘙痒(9例,1.05%)和腹胀(27例,3.14%),无一例发生呼吸抑制。术后3d患者静息痛和运动痛评分均保持在3分以下。患者对急性疼痛管理的满意度达到95.0%,较上年同期提高20.0%。结论成立APS实施规范的术后镇痛,可以提高镇痛质量和患者满意度。     

Patient-controlled epidural analgesia versus continuous epidural analgesia after total knee arthroplasty

BACKGROUND: Patient-controlled epidural analgesia (PCEA) has been found to be an effective method for pain relief during labour and after surgery. The goal of this study was to compare the efficacy of bupivacaine-fentanyl PCEA and continuous epidural infusion with the same mixture for treatment of pain after total knee arthroplasty. METHODS: Fifty-four patients under spinal anaesthesia were allocated to two groups in this randomized, double-blind study: the PCEA group could demand a bolus of 0.05 ml/kg of the bupivacaine 1.1 mg/ml and fentanyl 5 microg/ml solution, with a lockout interval of 10 min and total dose limit of three bolus doses per hour. The EPI group received a continuous infusion of 0.1 ml kg(-1) h(-1) of the same bupivacaine-fentanyl solution, and only a minimal extra bolus dose of 0.2 ml with the same lockout interval. All the patients received also paracetamol 1 g, orally, three times a day. In addition to pain scores at rest and during leg lifting, the 20-h analgesic consumption and the incidence of side effects were recorded. RESULTS: Forty-nine patients completed the study. The bupivacaine and fentanyl consumption during 20 h was smaller in the PCEA group (P<0.001). Analgesia and the need for rescue-opioid medication were similar in both groups. There were no differences between the PCEA and EPI groups regarding the incidence of side effects. Five patients were confused about how to operate the PCEA apparatus. CONCLUSION: The amount of bupivacaine-fentanyl solution consumed was significantly less with PCEA than with continuous infusion of bupivacaine-fentanyl solution without affecting the quality of postoperative analgesia after total knee arthroplasty. Several of the elderly patients had difficulties in operating the PCEA apparatus.     

The influence of patient characteristics on the requirements for postoperative analgesia

The requirements for analgesia after upper abdominal surgery were evaluated in 100 patients who received morphine by way of a patient-controlled analgesia system. Hourly and cumulative 24-hour requirements were analysed for possible correlations with patient characteristics and for the patterns of consumption throughout the 24-hour study period. The level of pain relief was assessed by linear analogue pain scores at 4-6 hours and 24 hours. Male patients (n = 46) required significantly more morphine than female patients (n = 54) to achieve similar levels of pain relief (p less than 0.05). There was an inverse correlation between age and morphine consumption in both males and females (r = -0.684, p less than 0.00005 and r = -0.502, p less than 0.00005 respectively). No correlation was found between morphine consumption and patient weight. The pattern of hourly morphine consumption appeared to follow a diurnal rhythm, with peak times of demand at 0900 and 2000 hours. The variations in requirements for analgesia among patients and with time of day should be taken into account when a regimen for postoperative analgesia is prescribed.