超声引导下腹横肌平面阻滞用于剖宫产患者超前镇痛的效果

目的 评价超声引导下腹横肌平面(transversus abdominis plane,TAP)阻滞用于剖宫产患者超前镇痛的效果.方法 采用前瞻性、随机对照研究设计.择期行剖宫产患者90例,年龄20～39岁,体重50～80 kg,ASA分级Ⅰ、Ⅱ级,采用随机数字表法分为3组(每组30例):对照组(Ⅰ组)、术前TAP阻滞组(Ⅱ组)、术后TAP阻滞组(Ⅲ组).Ⅰ组不实施TAP阻滞,Ⅱ组和Ⅲ组分别于麻醉诱导前即刻和手术结束时即刻在超声引导下行双侧TAP阻滞.记录术后2、4、12、24 h和48 h时点3组产妇静息状态下的VAS评分,术后24 h内舒芬太尼累积消耗量、镇痛补救率、镇痛泵按压次数,术后24 h内副作用发生情况.结果 Ⅱ组患者术后2、4h和12 h VAS评分[(2.3±0.4)、(2.4±0.4)、(2.2±0.4)分]与Ⅲ组[(3.2±0.8)、(34±0.3)、(3.1±0.5)分]比较,明显降低(P＜0.05);Ⅱ组患者术后24 h内舒芬太尼累积消耗量、镇痛补救率及镇痛泵按压次数[(40±5)μg、10％、(5.8±1.4)次]与Ⅲ组[(53±7)μg、20％、(10.3±2.6)次]比较,明显降低(P＜0.05);Ⅱ组患者术后24h内恶心呕吐发生率与Ⅲ组比较,明显降低(P＜0.05). 结论 术前超声引导下TAP阻滞对剖宫产患者具有良好的超前镇痛效应,且安全性较高.     

Epidural anesthesia during hysterectomy diminishes postoperative pain and urinary cortisol release

Purpose To examine the hypothesis that epidural anesthesia throughout lower abdominal surgery would depress both postoperative pain and cortisol release. Methods Forty adult patients undergoing abdominal total hysterectomy were studied. The patients were randomly assigned to two groups. Group G received general anesthesia alone (sevoflurane 1.5%–2.5%); group E received a combination of epidural anesthesia (1.5% mepivacaine) with a light plane of general anesthesia (sevoflurane<0.5%). Postoperative analgesia was obtained epidurally by patient-controlled analgesia. Postoperative pain at rest and during movement was assessed by a visual analogue scale (VAS) at 2, 24, and 48 h following surgery. The plasma concentration and urinary excretion of cortisol were measured during the perioperative period. Results VAS values were lower in group E than in group G during movement at 24h (4.6±0.5vs 6.1±0.4 cm). Urinary cortisol excretion on the first postoperative day was less in group E than in group G (192±34vs 480±120μg). Conclusions Epidural blockade prior to surgical stimuli and throughout lower abdominal surgery reduces the postoperative dynamic pain and stress response.     

术前焦虑对腹腔镜胆囊切除患者术后疼痛及麻醉后复苏的影响

目的 观察腹腔镜胆囊切除患者术前焦虑对术后疼痛及麻醉后复苏的影响. 方法 选择82例择期行腹腔镜胆囊切除术患者,术前依照贝克焦虑量表(Beck's anxiety inventory,BAI)评测结果将患者分为两组:正常组(50例)和焦虑组(32例).焦虑组患者伴有焦虑症状,正常组患者无焦虑症状.观察记录手术时间、麻醉时间、改良Aldrete评分(modified Aldrete score,MAS)达9分的时间和副作用.术后疼痛控制采用芬太尼患者自控静脉镇痛的方法,记录患者术后VAS评分、芬太尼用量和补充镇痛药物使用情况. 结果 患者术前焦虑症发生率为39％.焦虑组患者改良Aldrete评分达9分的时间为(6.3± 1.5)s,明显长于正常组(5.0±1.4)s(P＜0.05),术后副作用发生率也高于正常组(P＜0.05).术后4、8、12h焦虑组患者VAS评分高于正常组[4 h:(3.5±0.7)分比(2.6±1.0)分;8 h:(3.3±0.9)分比(2.2±0.8)分;12 h:(3.1±0.5)分比(2.4±0.6)分](P＜0.05).患者术前BAI评分与术后8、12 h VAS评分呈正相关(8 h:r=0.422;12 h:r=0.526)(P＜0.05).焦虑组患者术后芬太尼用量和追加氯诺昔康补充镇痛的需求均高于正常组(P＜0.05). 结论 术前焦虑对麻醉后复苏以及术后镇痛有着负面影响,对于焦虑患者需增加术后镇痛力度才能达到良好的止痛效果.     

Balanced anestesia versus total intravenous anestesia for kidney transplantation

AIM: An ideal anesthetic regimen for kidney transplantation should be able to assure haemodynamic stability to obtain an optimal graft reperfusion. The aim of this study was to compare 2 regimens of anesthesia for patients submitted to kidney transplantation. METHODS: We studied 40 patients: 20 subjects (Group A) received balanced anesthesia with thiopental, fentanyl and isoflurane, to the others 20 (Group B), a total intravenous anesthesia (TIVA) with propofol and remifentanyl was given. In both groups muscle relaxation was obtained with a bolus of cisatracurium followed by a continuous infusion. We performed standard clinical, invasive blood pressure and central venous pressure monitoring. Hemodyna-mic data have been collected at standard times. During the postoperative period we evaluated the recovery (Aldrete Score) in the recovery room and the analgesia (VAS) at 1, 6, 24 h after the end of surgery. RESULTS: The trend of hemodynamic parameters did not show statistically significant differences between the 2 groups. We observed statistically significant differences concerning the quality of the recovery and the postoperative analgesia. The recovery in group B was faster than in group A, but in group A the pain control was better than in group B at least during the first postoperative hour. CONCLUSIONS: For their pharmacokinetic properties, propofol, remifentanyl and cisatracurium allow to obtain a good control of the hemodynamic parameters and a fast and safe recovery of consciousness. Total intravenous anesthesia regimen seems to be an alternative to the balanced anesthesia for patients undergoing kidney transplantation.     

Preoperative administration of intravenous flurbiprofen axetil reduces postoperative pain for spinal fusion surgery

Purpose The aim of the study was to investigate postoperative analgesia and the opioid-sparing effect of the preoperative administration of intravenous flurbiprofen axetil in patients undergoing spinal fusion surgery. Methods Thirty-six patients were randomly allocated into one of three groups. Group A received preoperative flurbiprofen axetil, 1 mg·kg⁻¹. Group B received postoperative flurbiprofen axetil, 1 mg·kg⁻¹. Group C received a placebo. All groups were given a standardized anesthesia and intravenous morphine via a patient-controlled analgesia device for postoperative analgesia. The pain score was evaluated by a visual analog scale (VAS) at 0 (T₀), 1 (T₁), 2 (T₂), 6 (T₃), 12 (T₄), and 24 (T₅) h after surgery, and the morphine requirement was recorded during the study period. Results VAS in group A was significantly lower than that in group B at T₀ and T₁. VAS in group A was significantly lower than that in group C throughout the time course after surgery. Postoperative morphine consumption in group A was significantly lower than that in groups B and C at T₀ to T₃. Conclusion As compared with postoperative administration, preoperative administration of intravenous flurbiprofen axetil provides better postoperative analgesia and an opioid-sparing effect in patients undergoing spinal fusion surgery under general anesthesia.     

Efficacy of different concentrations of sevoflurane administered through a face mask for magnetic resonance imaging in children

Background: The main aim of this study was to use a non‐invasive method such as a face mask to maintain anesthesia in children during magnetic resonance imaging (MRI). The secondary aim was to ascertain hemodynamic‐respiration parameters, recovery time and complications of anesthesia with the administration of different concentrations of sevoflurane. Methods: This prospective and randomized study included 96 ASA I–II children, aged 1–10, scheduled to undergo MRI with anesthesia with sevoflurane through a face mask. All patients were administered midazolam 0.5 mg·kg^?1 orally 30 min before anesthesia induction. Sevoflurane 8% was given to induce anesthesia under assisted‐controlled ventilation for 2 min, and an intravenous route was opened on the hand. Three different concentrations of sevoflurane were administered through a face mask under spontaneous respiration to maintain anesthesia. A mixture of sevoflurane, oxygen, and air of 5 l·min^?1 was given through a face mask for anesthesia. Group 1 (n = 32) received 1.5% sevoflurane, Group 2 (n = 32) 1.25% sevoflurane, and Group 3 (n = 32) 1.0% sevoflurane. Recovery time, removal from the MRI room, postanesthesia care unit discharge data, and complications were also recorded. Heart rate, mean arterial pressure (MAP), peripheral oxygen saturation (SpO₂), respiration rate, and anesthesia adequacy were recorded every 5 min from the time of induction until completion of the MRI. Results: All three groups were similar in demographic and hemodynamic respiratory features. MRI was successfully performed in 96.6% of all patients without additional intervention. Sevoflurane concentrations were increased for a short time in one patient in Group 1 and in two patients in Group 3. Oxygen flow was increased in one patient in Group 1 and in one patient in Group 2 as SpO₂ was lower than 95%. The mean time to eye opening (from discontinuation of sevoflurane to eye opening) was 155.8 ± 50.0 s in Group 1, 89.5 ± 16.0 s in Group 2, and 53.5 ± 10.0 s in Group 3; differences between the groups were statistically significant (P = 0.001). Airways were not used on any of the patients, and none vomited or required endotracheal intubation or laryngeal mask anesthesia. Conclusions: We believe that the administration of sevoflurane at a concentration of 1% via a face mask under spontaneous respiration may provide light anesthesia without complications to induce an unarousable sleep for children during MRI.     

连续股神经阻滞镇痛与静脉镇痛用于全膝关节置换术后快速康复的比较

目的比较连续股神经阻滞（continuous femoral nerveblock,CFNB）镇痛与静脉镇痛用于全膝关节置换术（total knee arthroplasty,TKA）后的快速康复效果。方法择期行单侧TKA患者60例,年龄45。78岁,ASA分级I、Ⅱ级,采用随机数字表法分为两组（每组30例）：患者自控神经阻滞镇痛（patient controlled nerve block analgesia,PCNA）组与患者自控静脉镇痛（patient controlled intravenous analgesia,PCIA）组。两组均采用蛛网膜下腔顿膜外腔联合麻醉。观察患者术后静息和运动时VAS评分、患者自控镇痛（patient-contmlled analgesia,PCA）泵按压次数及补救性镇痛药应用次数,观察术后患肢膝关节主动屈曲角度、术后血糖变化、术后平均住院日、并发症、副作用及满意度。结果术后6、12、24、48h静息状态下,两组VAS评分差异无统计学意义（P〉O．05）;与PCIA组比较,PCNA组术后24、48h被动运动时VAS评分降低[（3．6±0．5）分比（4．7±0．6）分、（3．4±0．5）分比（4．5±0．4）分]（P〈O．05）,PCA泵按压次数及肌内注射哌替啶次数减少（P〈0．05）。与PCIA组比较,PCNA组术后24、48h患肢膝关节主动屈曲角度增大（P〈0．05）,术后各时点血糖水平降低（P〈O．05）,深静脉血栓形成并发症及嗜睡、呼吸抑制等副作用减少（P〈O．05）;PCNA组术后满意度评分高于PCIA组[（9．6±1．4）分比（7．9±1．2）分]（P〈O．05o结论与静脉镇痛比较,CFNB用于TKA术后镇痛效果确切、并发症及副作用少、住院时间缩短、术后恢复快、总体满意度高,符合快速康复外科理念。     

Pressure support ventilation vs spontaneous ventilation via ProSeal™ laryngeal mask airway in pediatric patients undergoing ambulatory surgery: a randomized controlled trial

Aim: To investigate the advantages of using pressure support ventilation (PSV) vs spontaneous ventilation via ProSeal? laryngeal mask airway in children undergoing ambulatory surgery. Background: In our ambulatory surgical unit, the use of unassisted spontaneous breathing via laryngeal mask airway is a common anesthetic technique during general anesthesia. However, this may be associated with inadequate ventilation. PSV is a ventilatory mode that is synchronized with the patient’s respiratory effort and may improve gaseous exchange under general anesthesia. Materials and methods: After the approval from the ethics committee, a randomized controlled trial involving 24 pediatric patients was conducted in our ambulatory surgical unit. They were randomized into two groups, namely Group PSV (receiving PSV) and Group SV (unassisted spontaneous ventilation). Outcome measures included intraoperative respiratory and hemodynamic parameters as well as recovery room data. Results: There were no significant differences in baseline characteristics between the two groups. Patients in Group PSV had lower ETCO₂ (42.8 ± 5.8 vs 50.4 ± 4.0, P = 0.001) and higher expiratory tidal volume per kg bodyweight (8.3 ± 1.8 ml kg^?1 vs 5.8 ± 0.8 ml kg^?1, P = 0.001) compared with patients in Group SV. There were no significant differences in other respiratory and hemodynamic parameters or recovery room data between the two groups. Conclusion: Pressure support ventilation via ProSeal? laryngeal mask airway during general anesthesia improves ventilation in pediatric patients undergoing ambulatory surgery. However, this did not translate to a difference in clinical outcome among our study patients.     

右美托咪定联合舒芬太尼用于老年患者全髋关节置换术后自控静脉镇痛

目的 探讨右美托咪定(dexmedetomidine,Dex)联合舒芬太尼用于老年患者全髋关节置换术后患者自控静脉镇痛(patients controlled infusion analgesia,PCIA)的临床安全性和有效性. 方法 采用随机数字表法将90例择期行全髋关节置换手术的患者(年龄65～89岁,ASA分级Ⅰ～Ⅲ级)分为3组(每组30例).各组PCIA药物:舒芬太尼组(S组),舒芬太尼0.04μg· kg-1 ·h-1+托烷司琼5 mg;Dex 1组(D1组),舒芬太尼0.04 μg· kg-1·h-1+托烷司琼5 mg+Dex 0.02 μg·kg-1·h-1;Dex 2组(D2组),舒芬太尼0.04 μg·kg-1·h-1+托烷司琼5 mg+Dex 0.05μg·kg-1·h-1;各组药物均用生理盐水稀释至150 ml.所有患者麻醉方式均采用蛛网膜下腔阻滞,穿刺间隙L3～L4.手术结束前10 min,均静脉注射5μg舒芬太尼,术后连接镇痛泵.记录手术和麻醉时间,术中出血量,副作用的发生率,镇痛总体舒适度评分(Bruggrmann comfort scale,BCS),术后4、8、12、24、48 h VAS评分和Ramsay镇静评分,镇痛48 h后各组单位体重下舒芬太尼的消耗量. 结果 术后8、12、24、48 h,S组Ramsay评分[(1.7±0.5)、(1.6±0.6)、(1.6±0.5)、(1.8±0.5)分]低于D1组[(2.2±0.6)、(2.0±0.5)、(2.2±0.5)、(2.2±0.5)分]和D2组[(2.3±0.5)、(2.3±0.4)、(2.4±0.5)、(2.3±0.5)分](P＜0.05);D1组和D2组比较,差异无统计学意义(P＞0.05).术后12、24 h,D1组VAS评分[(0.7±0.8)、(0.7±0.8)分]低于S组[(1.3±1.1)、(1.4±1.0)分](P＜0.05);术后8、12、24、48 h,D2组VAS评分[(0.8±0.6)、(0.8±0.6)、(0.6±0.7)、(0.7±0.7)分]明显低于S组(P＜0.01).镇痛48 h后,D1组BCS评分[(3.2±0.7)分]明显高于S组[(2.1±0.5)分](P＜0.01),D2组BCS评分[(3.6±0.6)分]高于S组与D1组(P＜0.05);S组[(2.02±0.10) μg/kg]舒芬太尼消耗量大于D1组[(1.96±0.61)μg/kg]和D2组[(1.94±0.39) μg/kg](P＜0.05),D1组和D2组比较,差异无统计学意义(P＞0.05). 结论 Dex0.05μg·kg-1·h-1联合舒芬太尼0.04 μg·kg-1·h-1 PCIA用于老年患者髋关节置换术后有较好的术后镇痛效果,且降低了舒芬太尼的消耗量,临床应用安全、可行、有效.     

Optimal target concentration of remifentanil during cataract surgery with monitored anesthesia care

Study objectiveTo determine the effect-site target concentration (C_et) of remifentanil that provides optimal conditions for patients and operators during cataract surgery during monitored anesthesia care using a target controlled infusion (TCI) of propofol and remifentanil.DesignProspective, randomized, double-blinded study.SettingOperating room and postoperative recovery area of a university-affiliated hospital.Patients66 adult, ASA physical status I, II, and III patients undergoing cataract surgeryInterventionsGroup I received C_et of remifentanil 0.5 ng/mL; Group 2 received C_et of remifentanil one ng/mL; and Group 3 received C_et of remifentanil 1.5 ng/mL. After giving TCI propofol (C_et; one μg/mL) - remifentanil, an ophthalmologist administered topical anesthesia.Measurements and main resultsIntraoperative hemodynamics, pain scores, sedation scores, patient satisfaction scores, and operators’ satisfaction scores regarding surgical conditions were recorded. No statistical differences in heart rate or mean blood pressure were detected among the three groups during surgery. Pain scores (Group 1: 31.9 ± 17.9 vs. Group 2: 11.8 ± 7.7 and Group 3: 11.8 ± 7.7; P < 0.05) were higher and patient satisfaction scores (Group 1: 4.7 ± 0.8 vs. Group 2: 5.4 ± 0.4 and Group 3: 5.5 ± 0.4; P < 0.05) were lower in Group 1 than Groups 2 and 3. On the other hand, surgeon satisfaction was lowest in Group 3 (Group 3: 2.9 ± 1.3 vs. Group 1: 4.7 ± 0.4 and Group 2: 4.6 ± 0.7; P < 0.05) due to ocular movement.ConclusionC_et values of remifentanil and propofol of one ng/mL and one μg/mL, respectively, appear to provide optimal conditions for patients and operators during cataract surgery using monitored anesthesia care with TCI.     

The effect of preoperative anxiety on postoperative analgesia and anesthesia recovery in patients undergoing laparascopic cholecystectomy

Purpose

In patients who are hospitalized for surgery, anxiety disorders are frequently observed. Anxiety affects the patient’s perception of postoperative pain and has a negative impact on recovery from anesthesia. This study attempted to compare the effect of preoperative anxiety on postoperative pain control and recovery from anesthesia in patients undergoing laparoscopic cholecystectomy.

Methods

A total of 80 patients were enrolled who were undergoing laparoscopic cholecystectomy. Demographic characteristics of the patients were recorded. Beck’s anxiety ?nventory (BAI) was administered to the patients: patients with anxiety were included in the high-anxious patient group (group H) and patients without anxiety were enrolled in the low-anxious group (group L). Duration of surgery, duration of anesthesia, extubation time, and adverse effects were recorded. During the postoperative period, patient-controlled analgesia with tramadol was used for pain control. Visual analog scale (VAS) scores and tramadol consumption of all patients were recorded.

Results

Among all patients, 31 (38.75 %) patients had preoperative anxiety, and significant correlation was found between the days of hospitalization and preoperative score of BAI. In group L, extubation time, the time for the modified Aldrete score to reach 9, was seen as significantly shorter and fewer postoperative side effects were determined. Also in group L, postoperative VAS score and tramadol consumption were significantly lower, and less tenoxicam was needed.

Conclusion

A high preoperative anxiety level negatively affects recovery from anesthesia and control of postoperative pain. In this patient group, the increased need for postoperative analgesia must be adequately met.     

氟比洛芬酯超前镇痛用于乳腺癌根治术患者的临床观察

目的:探讨氟比洛芬酯超前镇痛对乳腺癌根治术患者术后疼痛以及全麻苏醒期躁动的影响。方法:选择全身麻醉下乳腺癌根治术患者(ASA I～II级)120例,随机分为A组(麻醉诱导完成后立即给予50 mg氟比洛芬酯,切口缝合完成时再给予50 mg),B组(麻醉诱导完成后立即给予100 mg氟比洛芬酯),C组(切口缝合完成时给予100 mg氟比洛芬酯)D组(对照组,切口缝合完成时换等量的生理盐水),每组30例。比较各组患者术后1,3,6,12,24 h的VAS评分,手术结束时与拔管时的心血管反应,以及全麻苏醒躁动情况。结果:3个观察组术后12 h内各时间点VAS评分均明显低于对照组(均P<0.05),其中A组各时间点均明显低于C组(均P<0.05),在1,3 h明显低于B组,而B组在1,3 h明显低于C组(均P<0.05),术后24 h的VAS评分4组间差异无统计学意义(均P>0.05);手术结束时4组间平均动脉压(MAP)和心率(HR)变化差异无统计学意义(P>0.05),但3个观察组患者拔管时的MAP,HR的变化均小于对照组(均P<0.05),其中A组变化最小,其次为B组和C组(均P<0.05),B组明显低于C组(均P<0.05);各组全麻苏醒期躁动发生率分别为:A组13.3%,B组23.3%,C组33.3%,D组43.3%,各组间的差异均有统计学意义(均P<0.05)。结论:氟比洛芬酯超前镇痛能有效减轻乳腺癌根治术患者术后早期疼痛程度、心血管反应,以及降低全麻苏醒期躁动的发生率。     

不同麻醉镇痛方式对胃癌根治术患者快速康复的影响

目的 比较不同麻醉镇痛方式对开放胃癌根治术患者快速康复的影响.方法 全身麻醉下行开放胃癌根治术患者67例,采用随机数字表法分为3组:全身麻醉联合硬膜外镇痛组(EA组,20例)、全身麻醉联合患者自控静脉镇痛(patient-controlled intravenous analgesia,PCIA)组(PCIA组,24例)、全身麻醉联合肋缘下腹横肌平面(subcostal transverseabdominis plane,STAP)阻滞组(STAP组,23例).3组全身麻醉诱导、维持用药相同,EA组行硬膜外阻滞和硬膜外镇痛,PCIA组行静脉镇痛,STAP组行双侧STAP阻滞和静脉镇痛.记录七氟醚、舒芬太尼及血管活性药物用量,记录术后1 h(T1)、6 h(T2)、12 h(T3)、24 h(T4)、48 h(T5)、72 h(T6)VAS评分及哌替啶用量,记录肠道功能恢复时间、首次进食时间、首次下床时间、住院时间,观察不良事件的发生情况.结果 与PCIA组VAS评分[(3.8±2.0)、(4.7±1.8)、(6.5±1.7)分]比较,EA组和STAP组在T1[(2.3±1.2)、(3.1±2.3)分]、T2[(2.3±1.1)、(3.4±2.0)分]、L[(2.8±1.1)、(3.6±2.0)分]时点VAS评分显著降低(P＜0.05),发生恶心呕吐、疲倦嗜睡和头晕的例数显著减少(P＜0.05).与EA组比较,PCIA组、STAP组舒芬太尼和哌替啶用量显著增多,麻黄碱用量和低血压例数显著减少(P＜0.05).STAP组、EA组、PCIA组两两比较,肠道功能恢复时间[(37±12)、(50±16)、(74±13) h]、首次进食时间[(47±10)、(61±15)、(89±11) h]、首次下床时间[(41±15)、(54±18)、(56±22)h]依次延长(P＜0.05).3组住院时间差异无统计学意义(P＞0.05).结论 全身麻醉联合硬膜外阻滞或多点STAP阻滞对开放胃癌根治术患者术后快速康复有利,而全身麻醉联合PCIA效果较差、副作用较多、恢复时间较长.     

盐酸羟考酮复合罗哌卡因用于剖宫产术后硬膜外自控镇痛的研究

目的 探讨剖宫产术后患者使用盐酸羟考酮复合罗哌卡囚行硬膜外自控镇痛(patient controlled epiduralanalgesia,PCEA)的安全性、可行性以及治疗效果. 方法 选择择期剖宫产产妇60例,采用蛛网膜下腔联合硬膜外麻醉(combined spinal epidural anesthesia,CSEA),术后连接恒速镇痛泵与硬膜外导管.所有产妇采用随机数字表法分为3组(每组20例):芬太尼复合罗哌卡因组(FR组),2 mg/L芬太尼+0.15％罗哌卡因;盐酸羟考酮复合罗哌卡因组(OR组),100 mg/L盐酸羟考酮+0.15％罗哌卡因;盐酸羟考酮复合低浓度罗哌卡因组(ORL组),100 mg/L盐酸羟考酮+0.1％罗哌卡因.镇痛泵参数为:背景剂量2 ml/h,单次剂量为2 ml,锁定时间为30 min.记录产妇入手术室时(T0)、手术开始时(T1)及术后2 h(T2)、4 h(T3)、8 h(T4)、16 h(T5)、24 h(T6)、48 h(T7)和去除镇痛泵后2 h(Ts)共9个时间点的MAP、HR、下肢运动神经阻滞评分(Bromage评分)、产妇静息时和按摩子宫时的VAS评分,统计药物总用量及副作用发生例数. 结果 按摩子宫时,VAS评分OR组[(3.4±0.5)分]和ORL组[(3.3±0.6)分]较FR组[(5.3±0.6)分]明显减轻(P＜0.05);OR组和ORL组患者在整个镇痛期间镇痛药物用量[(103±5) ml和(102±6) ml]较FR组[(124±7)ml]明显减少(P＜0.05);VAS评分和药物用量方面,OR组和ORL组差异无统计学意义(P＞0.05).结论 盐酸羟考酮复合罗哌卡因用于剖宫产术后硬膜外自控镇痛安全可行,并且可以减少局部麻醉药的浓度和用量.     

Entropy monitoring decreases isoflurane concentration and recovery time in pediatric day care surgery--a randomized controlled trial

Aim: To assess if titrating anesthesia with entropy would result in faster awakening in children undergoing day care surgery. Background: Entropy, an EEG‐based anesthesia depth monitor, has been used in children; however, only one other study has evaluated the effectiveness of entropy monitoring in decreasing awakening time and for titrating anesthetic agents in children undergoing short procedures under anesthesia. Methods: In a randomized prospective single‐blind parallel group trial, 50 ASA grade I‐II children, aged 2–12 years, scheduled for lower abdominal or urological surgeries were studied after ethics committee approval and parental consent. The children were randomized to the entropy or control group. Following laryngeal mask airway insertion and caudal analgesia, anesthesia was maintained with nitrous oxide, oxygen, isoflurane. In the control group, anesthesia was titrated according to the hemodynamic parameters and the simultaneously monitored entropy values obscured from the anesthesiologist. In the entropy group, the entropy values (between 45 and 65) were used to titrate the anesthesia. Results: Time to awakening from anesthesia was 7 (3–18) min in the entropy group when compared to 10 (5–21) min in the control group. (P < 0.05) The difference in the mean time to awakening was 2.72 min 95% CI (0.34, 5.1). The end tidal isoflurane concentrations were lower in the entropy group when compared to the control group 15 s following airway insertion (0.78 ± 0.14 vs 1.24 ± 0.19), 15 s post caudal and skin incision (0.68 ± 0.40 vs 0.84 ± 0.05, 0.68 ± 0.03 vs 0.77 ± 0.32, respectively) as well as 5 min after skin incision 0.67 ± 0.04 vs 0.79 ± 0.02), (P ≤ 0.05). Conclusion: In pediatric day care surgery, entropy monitoring resulted in statistically though not clinically significant faster awakening and significantly lower end – tidal isoflurane concentrations.     

Comparison between Ultrasound-Guided Pericapsular Nerve Group Block and Local Infiltration Analgesia for Postoperative Analgesia after Total Hip Arthroplasty: A Prospective Randomized Controlled Trial

Objectives

Pericapsular nerve group (PENG) blocking is a novel nerve block modality for analgesia after total hip arthroplasty (THA); however, its analgesic efficacy is unclear. We aimed to compare the analgesic effect of ultrasound-guided PENG blocking and periarticular local infiltration analgesia after THA.

Methods

This study involved patients undergoing unilateral primary THA at our institution between October 2022 and December 2022. Based on a prospective double-blind, randomized approach, patients were randomly divided into two groups: the PENG and infiltration groups. The former received ultrasound-guided pericapsular nerve block before surgery while the latter received local anesthesia and local infiltration analgesia during surgery. The primary outcome was the amount of morphine used for rescue analgesia within 48 h after surgery and the visual analog scale (VAS) pain score at 3, 6, 12, 24, and 48 h after surgery. Secondary outcomes consisted of postoperative hip function on the first and second postoperative days, including hip extension angle and flexion, as well as distance traveled by the patient. Tertiary outcomes included length of hospital stay and postoperative adverse reactions. The data were analyzed using SPSS 26.0. Using the appropriate statistical methodology, continuous and categorical data were analyzed, and p < 0.05 was considered statistically significant.

Results

There was no clear difference in morphine requirements during the first 24 hours postoperatively (5.8 ± 5.9 vs. 6.0 ± 6.3, p = 0.910), in the total postoperative morphine consumption (7.5 ± 6.3 vs. 7.8 ± 6.6, p = 0.889), and in the postoperative resting VAS pain scores (p > 0.05). However, the exercise VAS score in the PENG group was significantly higher than that in the infiltration group within 12 hours after surgery (6.1 + 1.2 vs. 5.4 + 1.0, p = 0.008). There was no significant difference in hip function, length of hospital stay, or incidence of complications between the two groups.

Conclusion

The analgesic effect and functional recovery of ultrasound-guided pericapsular nerve block for THA was not superior to that of periarticular local infiltration analgesia.     

Comparison of etoricoxib vs. ketorolac in postoperative pain relief

Background: COX‐2 inhibitors have been claimed to have equal analgesic efficacy as non‐selective nonsteroidal anti‐inflammatory drugs, but this has been disputed in animal experiments. Methods: One hundred thirty‐three women scheduled for ambulatory, laparoscopic gynaecological surgery were included in this randomised, double‐blind study. Group E received 120 mg etoricoxib orally as premedication. Group K received 30 mg ketorolac i.v. after induction of anaesthesia. General anaesthesia was induced and maintained with propofol and remifentanil. Fentanyl 0.5 μg/kg i.v. and local wound anaesthesia was administered at the end of surgery. Postoperatively, the patients received fentanyl 0.5 μg/kg i.v. if visual analogue scale (VAS) ≥30 mm. Before discharge, Group K received 30 mg ketorolac i.v. Twenty‐four hours postoperatively, Group E received 120 mg etoricoxib. Results: The first 4 h postoperatively, Group K required 83±65 μg and Group E required 123±91 μg fentanyl [mean (SD), P=0.004]. After 30 min VAS in Group K was 31.3±19.7 mm and 43.8±16.9 mm in Group E [mean (SD), P<0.001]. Discharge readiness was significantly shorter in Group K (222±40 min) compared with Group E (244±47 min) [mean (SD), P=0.004]. There were no differences in pain scores or rescue pain medication at 24 or 48 h postoperatively. Less nausea was observed in the 4–24‐h period in Group E. Conclusions: Thirty milligram ketorolac i.v. after induction of anaesthesia resulted in significantly less immediate pain and opioid consumption during the first 4 h postoperatively compared with 120 mg etoricoxib preoperatively.     

Anesthesia with Sevoflurane in Bariatric Surgery

Background: Sevoflurane is a good halogen agent for bariatric surgery anesthesia because of its physical and chemical characteristics and its repartition coefficient (blood/gas = 0.65). Method: From November 1997 to April 1998, 98 bariatric surgery procedures with sevoflurane anesthesia were done: 17 lipectomies, 71 vertical gastroplasties, and 10 biliopancreatic diversions in 71 women and 27 men, average age 30.3 ± 8.3 years, with body mass index 43.9 ± 5.7. The average operating time was 50 ± 15 minutes for vertical gastroplasty, 160 ± 20 minutes for biliopancreatic diversion, and 80 ± 12 minutes for lipectomy. The technique of anesthesia was as follows: preanesthesia with atropine sulfate 0.01 mg/kg (dosage refers to ideal weight), ranitidine 50 mg, fentanyl 0.1 mg, ketorolac 60 mg; induction with propofol 0.5-1 mg/kg, succinylcholine 1 mg/kg; orotracheal intubation; maintenance with O2-N2O 50%, sevoflurane 1% to 1.5%, actracurium 0.5 mg/kg (dosage refers to ideal weight); awakening and decurarization with atropine sulfate 1 mg and prostigmine 2 mg. Results: This method permitted correct control of the anesthesia, a quick awakening with a low incidence of nausea and vomiting, a prompt regain of physical and psychological functioning, an early discharge from the hospital, and a larger turnover of patients with lower costs. Conclusion: Sevoflurane balanced anesthesia seems to be the best anesthesiologic method for bariatric surgery.     

The effect of propofol vs desflurane on recovery from anesthesia with remifentanil in outpatient surgery]

OBJECTIVES: To compare the effect on parameters of postanesthetic recovery of propofol and desflurane administered with high doses of remifentanil for major outpatient surgery. PATIENTS AND METHODS: Seventy patients were randomly assigned to receive propofol (target concentration 1.5-2 microg/ml) or desflurane in perfusion (end expiratory concentration 0.5 MAC) during maintenance of anesthesia with remifentanil (0.25-1 microg/kg/min). The anesthetic agents were withdrawn after surgery. We recorded the times until eye opening, respiration, tracheal extubation, ability to cough, response to verbal orders and orientation. We also recorded the time until a score of 10 on the Aldrete recovery scale was attained, pain on a visual analog scale, sedation on the Ramsay scale, and instances of nausea or vomiting during the first 24 h after surgery. RESULTS: No statistically significant differences in patient characteristics, type of surgery or anesthesia were found. Times until early signs of postanesthetic recovery (eye opening, spontaneous breathing, tracheal extubation) were significantly less (p < 0.05) in the desflurane group. The groups were similar for all other parameters compared (times until ability to cough, respond to verbal orders, orientation and a score of 10 on the Aldrete scale). Duration of stay in the postanesthetic recovery unit, time in the day surgery ward and intensity of postoperative pain were also similar. The rate of postoperative nausea or vomiting was significantly lower in the propofol group. CONCLUSION: During anesthesia with remifentanil, the administration of desflurane is associated with better psychomotor recovery parameters than is propofol, but the rate of nausea and vomiting is higher with desflurane.