三种不同浓度的氯诺昔康和吗啡用于静脉镇痛的比较

目的　探讨氯诺昔康在病人自控静脉镇痛 (PCIA)的临床应用。方法　选择骨科手术病人 12 0例 ,随机分成四组 ,每组 30例。L1组 ,0 0 2 4 %氯诺昔康 +0 0 1%氟哌利多 ;L2 组 ,0 0 32 %氯诺昔康 +0 0 1%氟哌利多 ;L3 组 ,0 0 4 0 %氯诺昔康 +0 0 1%氟哌利多 ;M组 ,0 0 5 %吗啡+0 0 1%氟哌利多。应用PCA泵LCP给药模式设置 :总量 15 0ml,负荷量 5ml,背景输注 2ml/h ,PCA 1ml,锁定时间 10min。手术后感觉疼痛明显时 (VAS 5 0mm左右 )启动PCA泵。观察PCIA开始、2、4、8、12、16、2 4、36、4 8h各时间点的镇痛效果和不良反应。结果　镇痛效果L1组较M组差 ,L2组与M组相当 ,L3 组优于M组 (P <0 0 5 )。L1、L2 、L3 组间不良反应无显著性差异 ,仅个别出现轻微的恶心呕吐反应 ,且明显少于M组 (P <0 0 1)。结论　 0 0 4 %的氯诺昔康为合适镇痛浓度 ,可安全有效地用于骨科手术术后PCIA的镇痛治疗     

芬太尼、吗啡、丁丙诺啡复合局麻药分别行硬膜外术后镇痛效果观察对比

目的 :探讨术后分别应用芬太尼、吗啡、丁丙诺啡复合局麻药及氟哌利多行硬膜外自控镇痛 ,观察其镇痛效果及不良反应发生率 ,综合比较哪种药物配方更理想。方法 :选择ASAⅠ～Ⅱ级 ,年龄 2 2～ 30岁 ,体重无较大差异的妇产科手术病人 6 0例 ,随机分为A、B、C三组 (每组 2 0例 ) ,均行硬膜外麻醉。术后接止痛泵行PCEA。单次剂量 1ml,锁定时间 2 0min ,术后随访 2d。结果 :从镇痛效果比较 ,A组为 50 % ,B组 75% ,C组为 80 %。结论 :芬太尼配方组不良反应少 ,但镇痛效果差 ;吗啡配方组镇痛好 ,但不良反应发生率高 ;丁丙诺啡组镇痛效果最好 ,不良反应发生率低 ,故选用丁丙诺啡 0 .6mg ,氟哌利多 2 .5mg ,复合 0 .1 1 2 5%布比卡因 1 0 0ml行妇产科手术后PCEA是一种较理想的药物配方。     

芬太尼与丁丙诺啡用于术后镇痛的比较

目的比较芬太尼、丁丙诺啡用于病人硬膜外镇痛的效果及不良反应。方法将80例行下腹部手术、ASAⅠ~Ⅱ级患者,随机分为A、B两组,每组40例,A组选用芬太尼0.5mg+氟哌啶2~3mg+布比卡因100mg+生理盐水100ml。B组:丁丙诺啡0.75mg+氟哌啶2~3mg+布比卡因100mg+生理盐水100ml。两组均采用驼人CBI泵(100ml),以负荷量5ml+持续剂量2ml/h进行镇痛。结果两组镇痛效果无明显差异。结论芬太尼与丁丙诺啡是两种安全强效镇痛剂,维持时间长,副作用少,是较为理想的术后镇痛剂。     

芬太尼、吗啡或丁丙诺啡复合罗哌卡因用于经尿道前列腺电切术后病人自控硬膜外镇痛

目的评价经尿道前列腺汽化电切术(TUVP)术后分别应用芬太尼、吗啡、丁丙诺啡复合罗哌卡因行硬膜外病人自控镇痛(PCEA)的效果。方法择期行TUVP的患者60例,随机均分为三组,分别在术后予硬膜外0.4mg芬太尼 0.125%罗哌卡因共100ml镇痛(A组)、4mg吗啡 0.125%罗哌卡因共100ml镇痛(B组)、0.45mg丁丙诺啡 0.125%罗哌卡因共100ml镇痛(C组),比较生命体征、视觉模拟评分(VAS)和不良反应。结果三组病人术后循环均稳定。三组术后VAS差异无统计学意义。A组不良反应少,但发生膀胱痉挛性疼痛及尿道紧迫感明显高于B组和C组(P<0.05);B组镇痛效果好,但恶心、呕吐、皮肤瘙痒等不良反应发生率高于A组和C组;C组镇痛效果好,不良反应发生率低。结论丁丙诺啡复合罗哌卡因对TUVP病人术后PCEA效果确切,循环呼吸稳定,不良反应少。     

硫酸吗啡控释片联合丁丙诺啡舌下含片用于中重度癌痛患者的疗效观察

目的 观察硫酸吗啡控释片联合丁丙诺啡治疗中重度癌痛的临床疗效,探讨临床合理治疗晚期癌痛的有效方法. 方法 选择止痛门诊的癌症晚期疼痛患者,视觉模拟评分(visual analog scale,VAS)＞3分,用单一吗啡控释片治疗后,VAS评分仍＞3分,止痛效果欠佳的150例患者,采用随机数字表法分为两组,每组75例:吗啡控释片组(M组),使用单一硫酸吗啡控释片;吗啡控释片联合丁丙诺啡组(MB组),采用硫酸吗啡控释片+丁丙诺啡.通过对两组止痛效果、副作用、生活质量及患者对镇痛治疗满意度的比较,探讨联合用药治疗晚期癌痛的优点和可行性. 结果 联合用药较单一用药镇痛效果显著,中重度VAS评分例数明显减少(M组/MB组:中度26/10,重度4/0)(P＜0.05);恶心、呕吐等副作用的发生例数明显减少(M组/MB组:恶性呕吐12/2,嗜睡4/2,呼吸抑制9/4,排尿困难8/3,便秘8/4)(P＜0.05);患者对镇痛效果的满意度明显提高(M组/MB组:很满意10/14,满意36/47)(P＜0.05);生活质量明显改善[M组/MB组:睡眠(5.5±1.2)/(4.6±0.7),情绪(5.4±0.5)/(4.6±1.2),日常活动(5.1±0.4)/(4.9±0.5),社交活动(5.5±0.4)/(4.8±1.6)](P＜0.05).结论 硫酸吗啡控释片联合丁丙诺啡治疗晚期癌痛可以提高镇痛效果,降低副作用的发生率,提高患者的生活质量.     

丁丙诺啡用于妇科开腹手术后病人自控镇痛的可行性

目的 评价丁丙诺啡用于妇科手术后病人自控镇痛(PCA)的效应和安全性。方法 154例妇科开腹子宫切除术病人术后随机分为丁丙诺啡组(B组,n=77)和吗啡组(M组.n=77),接受PCA治疗。B组使用丁丙诺啡(0.03mg/次,总量1.2 mg/24 h),M组使用吗啡(1mg/次,总量40mg/24h)。结果 丁丙诺啡组与吗啡组24h总的疼痛缓解程度(TOTPAR)分别为20.0(10.4)和19.0(10.0)(P>0.05),两组病人24h总的疼痛差值(SPID)分别为41.0(29.2)和42.3(18.7)(P>0.05)。B组恶心(41％和28％,P<0.05)及呕吐(29％和17％,P<0.05)的发生率均高于M组。结论 丁丙诺啡用于妇科手术后PCA的镇痛效应与吗啡相同,但恶心及呕吐的发生率高于吗啡。     

氟哌利多减轻吗啡所致恶心呕吐的临床观察

60例全麻开胸手术病人随机分为3组,每组20例。A组(对照组):吗啡用量0.025 mg/kg/h;B组:吗啡用量同A组,加氟哌利多5 mg;C组:吗啡用量同A组,加氟哌利多10mg。采用美国百特“便携式Infusor输注泵”2C1008K型,均匀流量2mg/h,配制术后48小时的镇痛药液96 ml,记录术后4、8、12、24、48小时镇痛、镇静、恶心呕吐的情况。结果显示三组均有较理想的镇痛效果,镇静作用B组、C组明显高于A组(P<0.05);恶心呕吐的发生率B组、C组明显低于A组(P<0.01)。所以本文结果提示氟哌利多加入吗啡药液中能明显减少病人恶心呕吐的发生。     

氟比洛芬酯复合芬太尼用于食管癌术后静脉自控镇痛的临床观察

目的 观察氟比洛芬酯用于食管癌术后静脉自控镇痛(PCIA)的效果和安全性.方法 ASA Ⅰ或Ⅱ级食管癌根治术患者60例,随机均分为三组,术后PCIA芬太尼1.0 mg、氟哌利多2.5mg组(A组);术后PCIA芬太尼0.5 mg、氟比洛芬酯100 mg、氟哌利多2.5 mg组(B组);麻醉前静注氟比洛芬酯50 mg,术后PCIA芬太尼0.5 mg、氟比洛芬酯50 mg、氟哌利多2.5 mg组(C组),镇痛药均用生理盐水稀释至100 ml.记录术后1、2、4、8、12、24,36、48 h的镇痛评分(VAS)、Ramsay镇静评分、PCIA按压次数及不良反应.结果 术后PCIA按压次数与各时点的VAS三组间差异均无统计学意义.B、C组Ramsay镇静评分及恶心、呕吐发生率低于A组(P＜0.05).结论 氟比洛芬酯复合芬太尼用于食管癌根治术术后静脉自控镇痛的效果良好,且能减少芬太尼用量,同时降低不良反应的发生.     

布托啡诺与吗啡用于腹部手术后硬膜外镇痛效果的比较

目的 研究不同剂量布托啡诺用于腹部手术患者术后硬膜外镇痛的效果及副作用,并与吗啡硬膜外镇痛进行比较. 方法 择期腹部手术ASAⅠ～Ⅱ级患者75例,按术后镇痛用药不同随机分为3组(n=25):M组(吗啡12 mg+0.1%罗哌卡因共150ml),B1组(布托啡诺9mg+0.1%罗哌卡因共150 ml),B2组(布托啡诺12mg+0-1%罗哌卡因共150ml).负荷量为0.25%罗哌卡因5 ml加吗啡2 mg或布托啡诺2 mg,持续背景输注剂量均为1-5 ml/h,按压追加药量均为2 ml/次,按压锁定时间20 min.观察记录3组患者术中芬太尼的总药量;术后1、4、8、12、18、24、36、48 h各时间点的疼痛视觉模拟评分(pain visual analogue scores,VAS);术后1、4、8、12 h的警觉镇静评分(observer's assessment ofalertness/sedation scores,OAA/S);术后48 h内按压总次数及总药量;肛门排气时间;术后镇痛副作用(头痛头晕、嗜睡、呼吸抑制、搔痒、恶心、呕吐、腹胀)的发生情况.结果 术后4 h时间点B1组VAS评分为2.8±1.0,高于M组的2.0±0.7及B2组的2.0±0.9(P<0-05),其余时间点3组间比较差异无统计学意义(P>0.05).M组的头痛头晕、恶心、呕吐,腹胀,搔痒发生例数分别为3、11、7、4、5例,而B1组仅有1例头痛头晕,B2组有2例头痛头晕,1例恶心,发生率均低于M组(P<0.05).3组患者术中芬太尼的总药量、48 h内按压总次数及总药量、术后不同时间点OAA/S评分及肛门排气时间的比较差异无统计学意义(P>0.05). 结论 每天3 mg～4 mg布托啡诺应用于腹部手术后硬膜外镇痛,镇痛效果确切,且其副作用发生率较吗啡明显降低.     

不同镇痛方法用于妇科手术病人术后镇痛的疗效观察

目的比较硬膜外单次注射吗啡与病人自控硬膜外镇痛(PCEA)、自控静脉镇痛(PCIA)在术后镇痛中的临床效果。方法选择美国麻醉医学会(ASA)Ⅰ～Ⅱ级行妇科手术的病人60例。随机分为吗啡组(A组)、吗啡PCEA组(B组)和吗啡PCIA组(C组)。每组20例。A组在手术结束时硬膜外腔注射吗啡2 mg+盐酸罗哌卡因15 mg,B组在手术结束时硬膜外腔注射吗啡0.5 mg+盐酸罗哌卡因15 mg,并经硬膜外导管接自控止痛泵,C组在手术结束时硬膜外腔注射吗啡0.5 mg+盐酸罗哌卡因15 mg,并经静脉接自控止痛泵。记录A、B、C 3组术后4、8、12、24、48h各时间点VAS评分和恶心呕吐、皮肤瘙痒、呼吸抑制、下肢麻木等不良反应的发生情况。结果B、C组8、12、24、48h各时间点VAS评分均低于A组(P0.01)。B组下肢麻木的发生高于A组、C组(P0.05)。结论PCIA泵、PCEA泵均能产生良好的术后镇痛效果。PCIA泵具有避免PCEA泵一些严重并发症的发生。     

P-糖蛋白表达对癌痛病人芬太尼或氯诺昔康镇痛效果的影响

目的 评价P-糖蛋白(P-gp)表达对癌痛病人芬太尼或氯诺昔康镇痛效果的影响.方法 癌痛病人100例,年龄的49～64岁,体重55～65 kg,其中肿瘤组织P-gp表达阳性的病人50例,采用随机数字表法,将其随机分为2组(n=25):芬太尼组(F1组)和氯诺昔康组(L1组);肿瘤组织P-gp表达阴性的病人50例,采用随机数字表法,将其随机分为2组(n=25):芬太尼组(F2组)和氯诺昔康组(L2组).F1组和F2组静脉注射芬太尼负荷量0.05mg后,采用芬太尼1.0 mg和氟哌啶5 mg行PCIA;L1组和L2组采用氯诺昔康64mg和氟哌啶5 mg行PCIA,所有药物均以生理盐水稀释成100 ml.各组背景输注速率2 ml/h,PCA量0.5 ml,锁定时间15 min,均输注48 h.采用VAS评分评价镇痛效果,镇痛期间维持VAS评分≤3分.当VAS评分≥4分时,静脉注射氟比洛芬酯50 mg进行补救,记录氟比洛芬酯用量.记录镇痛期间芬太尼和氯诺昔康的用量.分别于镇痛开始时、镇痛4、12、24和48 h时采集颈内静脉血样,检测芬太尼和氯诺昔康血药浓度.结果 F2组、L1组和L2组均未使用氟比洛芬酯;F1组氟比洛芬酯的用量为(184±41)mg.F1组和F2组镇痛期间芬太尼用量比较差异无统计学意义(P＞0.05).F1组和F2组各时点均未检测出芬太尼血药浓度.L1组和L2组镇痛期间氯诺昔康用量和血药浓度比较差异无统计学意义(P＞0.05).结论 P-gp表达可减弱癌痛病人芬太尼的镇痛效果,但对氯诺昔康的镇痛效果无影响.

Abstract：

Objective To evaluate the effect of the expression of P-glycoprotein (P-gp) in the tumor tissue on the analgesic efficacy of fentanyl and lornoxicam in patients with cancer pain. Methods One hundred advanced cancer patients with pain aged 49-64 yr weighing $$-65 kg were included in this study. The expression of Pgp was positive in the tumor tissue in 50 patients (groups F1 and L1, n = 25 each) and negative in 50 patients (groups F2 and L2, n = 25 each). The patients in 4 groups received 48 h of pstient-controlled intravenous analgesia (PCIA). A loading dose of fentanyl 0.05 mg was administered before PCIA was started in groups F1 and F2 .The PCIA solution contained fentanyl 1 mg and droperidol 5 mg in 100 ml of normal saline in groups Ft and F2, or lomoxicam 64 mg and droperidol 5 mg in 100 ml of normal saline in groups L1 and L2. The PCA pump was set to deliver a background infusion of 2 ml/h and a bolus dose of 0.5 ml at 15 min lockout interval. Pain was assessed with VAS scores (0 = no pain, 10 = worst pain), and VAS score was maintained at ≤3 during PCIA. Flurbiprofen 50 mg was injected intravenously when VAS score≥4 and the consumption of flurbiprofen was recorded. The consumption of fentanyl and lornoxicam during PCIA was recorded. Blood samples from the internal jugular vein were taken at the beginning of PCIA (T0), and at 4, 12, 24, 48 h of PCIA (T1-4) for determination of blood fentanyl and lornoxicam concentrations. Results Flurbiprofen was not used in groups F2, L1 and L2. The consumption of flurbiprofen was ( 184 ± 41 ) mg in group F1 . There was no significant difference in the consumption of fentanyl during PCIA between groups F1 and F2 ( P ＞ 0.05). Blood fentanyl concentrations were not detected at all the time points in groups F1 and F2 . The VAS score during PCIA ≤ 3 in groups L1 and L2, and there was no significant difference in blood concentrations of lornoxicam at each time point and the consumption of lornoxicam during PCIA between groups L1 and L2 ( P ＞ 0.05). Conclusion Positive P-gp expression in the tunor tissue can decrease the analgesic efficacy of fentanyl, but exerts no effect on the analgesic efficacy of lornoxicam in patients with cancer pain.     

吗啡对小鼠脑微血管内皮细胞P-糖蛋白表达的影响

目的 评价吗啡对小鼠脑微血管内皮细胞P-糖蛋白(P-gp)表达的影响.方法 小鼠脑微血管内皮细胞b.End3,培养于RPMI 1640无血清高糖培养基中,接种于10 cm培养皿中,分为3组,每组9皿,每皿2 ml,M组加入1 μg/ml吗啡,P+M组在加人吗啡前1 h加入5 μnol/L NF-κB抑制剂吡咯二硫氨基甲酸酯,药物浓度均为终浓度,C组不作药物处理.加入吗啡后24 h时收集细胞,测定P-gp和NF-κB p65-abcb1b DNA复合体的表达水平.结果 与C组比较,M组P-gp和NF-κB p65-abcb1bDNA复合体的表达水平上调(P＜0.01);与M组比较,P+M组P-gp和NF-κB p65-abcb1b DNA复合体的表达水平下调(P＜0.05或0.01).结论 吗啡可上调小鼠脑微血管内皮细胞P-gp表达,其机制与NF-κB介导的P-gp基因abcb1b激活有关.     

Thoracic epidural clonidine and morphine for postoperative pain relief

This study was undertaken to evaluate the potentiation of the postoperative analgesic effect of thoracic epidural morphine by coadministration of thoracic epidural clonidine in a randomized double-blinded design. Twenty patients underwent radical gastrectomy under combined general anaesthesia (enflurane and nitrous oxide/oxygen) and epidural anaesthesia with local anaesthetics. They received a thoracic epidural bolus injection of either 0.05 mg · kg^?1 morphine plus 3 μg · kg^?1 clonidine (M+C group; n =10) or 0.05 mg · kg^?1 morphine alone, (M group; n = 10) immediately before completion of surgery. All patients received iv morphine via patient-controlled analgesia (PCA) equipment for 24 hr postoperative period, and the PCA iv consumption of morphine was the primary variable of efficacy of the analgesic regimen. In addition, data analyses included mean arterial blood pressure, heart rate, respiratory rate, arterial blood gas measurement, sedation score, and visual analogue pain scale score (VAS). The cumulative number of iv morphine injections via PCA was less in the M+C group than in the M group at each hour for 24 hr postoperative period (P < 0.05), while the numbers of PCA morphine injections per hour beyond nine hours after surgery were higher in the M group than in the M+C group (P < 0.05). Sedation score was higher, and VAS and mean blood pressure were lower in the M+C group only at one hour after surgery compared with the M group. We conclude that the combined single thoracic epidural administration of morphine plus clonidine produces a more potent and longer lasting analgesia than does morphine alone.     

低剂量吗啡硬膜外单次注射联合布托啡诺鼻喷剂用于腹式子宫切除术后镇痛的有效性和安全性

目的 比较术后单次硬膜外注射吗啡-布托啡诺鼻喷剂联合镇痛与否对腹式子宫切除术后镇痛的有效性与安全性.方法 单盲、完全随机、安慰剂对照研究择期ASA Ⅰ～Ⅱ级行腹式子宫切除术的患者50例,分为A、B两组(n=25):均在L2-3硬膜外麻醉下进行手术,关腹前A组接受单次硬膜外注射吗啡0.5 mg(4 ml),鼻喷与B组等剂...     

Transdermal buprenorphine combined with spinal morphine and naropine for pain relief in chronic peripheral vasculopathy

The AIM: of this study was to evaluate the effectiveness and the safety of the association of buprenorphine transdermal delivery system (TDS) (Transtec TDS) and peridural infusion of morphine and naropine, for the control of ischemic pain in patients suffering from peripheral arteriopathy. The administration of an opioid, pure agonist, as morphine, with a partial agonist opioid, as the buprenorphine, was used. Buprenorphine has shown a higher liposolubility in supraspinal districts, while the morphine acts above all on the mu receptor subtype of the spinal cord. In this way it's possible a contemporary activation of spinal and supraspinal antinociceptive mechanisms. Furthermore, the incidence of side effects is reduced by buprenorphine, which antagonizes the central effect of morphine. In this study, 43 patients were recruited, suffering from chronic pain in Fontaine stage III-IV obstructive arteriopathy, scheduled for surgery. The patients have been divided into 2 equal groups for age, sex, pathology and intensity of pain. In the first group (TTDS), at first session, a buprenorphine patch 35 microg/h (Transtec TDS) has been applied, and after 24h, a peridural catheter with elastomeric system was positioned; 100 mL (2 mg/mL) of naropine and 2 mg of morphine, 4 mL/h in 24 h, were administered. In the second group (naropine morphine, NM), buprenorphine patch was not applied and analgesia was obtained only by using peridural catheter with elastomeric system at the same doses administered in the first group. At the daily control patients with visual analogical scale (VAS)=or>40 mm received an additional dose of morphine from 2 mg to 6+/-2 mg. VAS (0-100 mm) and the evaluation of the number of the hours of sleep were used to evaluate the analgesic effectiveness of the treatment. Side effects, opioid tolerance and abuse were always recorded. All parameters were evaluated daily for a period of 20+/-5 days. The results indicate that in group TTDS there was an improvement of pain symptomatology, also confirmed by the increased hours of sleep and the lower incidence of side effects. Instead in group NM, pain control was less effective, 18 patients needed a rescue dose of morphine, and the incidence of side effects increased.     

罗哌卡因硬膜外持续输注下氯诺昔康PCIA的临床效应

目的 研究硬膜外持续输注罗哌卡因期间氯诺昔康静脉PCA的临床效应和不良反应,并以吗啡对照比较。方法 选择60例(ASAⅠ～Ⅱ)妇科经腹子宫全切手术病人,随机分为L组与M组,双盲观察,均采用双泵行PCA治疗。其PCA设置为Bolus 1ml/次,锁定时间为5min,1h限量12ml。镇痛效果和副作用评定:(1)采用视觉模拟评分(VAS),0为无痛、10为剧痛。(2)BCS舒适评分。(3)病人对PCA总体印象评分。(4)记录可能出现的并发症和不良反应。结果 两组病人的一般情况相似,24h硬膜外罗哌卡因使用剂量均为192mg,L组与M组未按压PCA泵的病人各为5例(21.7％),静脉PCA用药剂量分别为(3.4±2.8)mg(L组)和(4.7±3.5)mg(M组),两药用量比值为1:1.4(P>0.05);相同时间段内两组间VAS、BCS、Bromage评分及D1/D2比值均无统计学差异。结论0.2％罗哌卡因硬膜外持续输注(4ml/h)能明显减少静脉PCA用量,新型非甾体类抗炎药氯诺昔康与吗啡静脉用药效价相似,但氯诺昔康对病人恶心呕吐的不良反应具有明显减少的优点。     

Comparison of low-dose intrathecal and epidural morphine and bupivacaine infiltration for postoperative pain control after surgery for lumbar disc disease

This prospective, blinded, placebo-controlled study was performed to compare the postoperative analgesic efficacy of low-dose intrathecal and epidural morphine with paraspinal muscle infiltration of bupivacaine in lumbar discectomy cases. Eighty ASA I-III adult patients undergoing elective surgery for lumbar disc disease were enrolled in the study. Patients were randomized to four groups by envelopes. Study groups were as follows: group 1 (n = 20), intrathecal morphine 0.1 mg; group 2 (n = 20), epidural morphine 2 mg; group 3 (n = 20), 30 mL of bupivacaine 0.25% paraspinal muscle infiltration; group 4 (n = 20), 30 mL of saline paraspinal muscle infiltration before wound closure. Recorded parameters were time to response to painful and verbal stimuli and postoperative pain assessed at 30 minutes and 2, 4, 6, 8, 12, and 24 hours by Visual Analog Scale (VAS) and Numeric Pain Scale (NPS). Hemodynamic data, sedation scores, and side effects were also recorded. Meperidine and naproxen sodium were used for postoperative analgesia. Follow-up was performed by a blinded investigator. Mean VAS scores were lower in groups 1 and 2 at 30 minutes (P < 0.05). Mean VAS score of group 2 was lower than that of group 4 at 4 hours postoperatively (P < 0.05). Mean NPS scores were lower in groups 1 and 2 at 2, 4, and 6 hours (P < 0.05) and in group 2 at 8 hours compared with the other groups. The number of patients requiring meperidine at early postoperative phase (0-6 hours) was less in groups 1 and 2 compared with groups 3 and 4 (P < 0.05).There were no statistically significant differences in the late postoperative analgesic requirements, after correction for multiple testing. In conclusion, low-dose intrathecal and epidural morphine provide lower postoperative pain scores and a reduction in early postoperative analgesic requirement with insignificant side effects compared with paraspinal bupivacaine or saline infiltration.     

Intra-articular buprenorphine after knee arthroscopy

Background: Demonstration of peripheral opioid receptors in inflamed synovia supports the concept of peripheral opioid analgesia. The aim of this study was to evaluate the analgesic effect of intra-articular administration of buprenorphine after knee arthroscopy.
Methods: In a double-blind randomised trial, 48 patients were assigned to four groups: group A patients received buprenorphine 100 μg i.a. and NaCl 0.9% i.m., group B patients received bupivacaine 0.25% 50 mg i.a. and NaCl 0.9% i.m., group C patients received NaCl 0.9% i.a. and buprenorphine 100 μg i.m., and group D patients received NaCl 0.9% i.a. and NaCl 0.9% i.m. Intensity of postoperative pain was evaluated by VAS at recovery (T₀) and 1, 3, 6, 12, 24 h after operation (T₁, T₂, T₃, T₄, T₅), at rest and during passive 10° knee flexion. Total analgesic requirements and side effects related to study drugs were recorded.
Results: The VAS scores were significantly higher in groups C and D than in group A and B patients. The differences were significant at T₀, T₁, T₂ and T₃. At T₁, group C and D patients had greater analgesic requirement than groups A and B. No patients developed side effects.
Conclusion: Intra-articular buprenorphine and i.a. bupivacaine, both produced equally good postoperative pain control and allowed a significant reduction of analgesic requirement after knee arthroscopy.     

氟比洛芬酯注射液对消化道肿瘤手术后炎症细胞因子表达的影响

目的观察氟比洛芬酯注射液用于消化道肿瘤切除手术术后镇痛的临床效果及其对术后细胞因子表达的影响。方法60例上腹部手术患者，随机分为三组，每组20例。M组术后使用吗啡自控静脉内镇痛（PCIA）泵（负荷剂量0．03mg／kg，1mg／次，锁定时间15min，背景剂量为0）；F组，手术结束时静脉注射氟比洛芬酯50mg，术后12，24，36h分别静脉注射氟比洛芬酯50mg，术后采用吗啡PCIA泵，设置同M组；P组，手术开始前30min，静脉注射氟比洛芬酯50mg，术后12、24、36h分别静脉注射氟比洛芬酯50mg，术后采用吗啡PCIA泵，设置同M组。观察6、12、24、36、48h各组静息时视觉模拟评分（VAS）、48h吗啡总用量，并采集麻醉诱导前和切皮后6、12、24h外周静脉血测定血浆细胞因子白细胞介素-6（IL-6）、白细胞介素-10（IL-10）浓度。结果术后6h，P组VAS明显低于M组。术后12h，P组及F组VAS均明显低于M组。此外，M组术后48h吗啡总用量明显多于P组及F组。三组患者术前IL-6、IL-10几乎不可测列，切皮后6h，三组血浆IL-10均达峰值，但M组明显低于P组及F组。切皮后12h三组IL-6达峰值，其中M组明显高于P组及F组，24hM组仍明显高于P组。结论术前预给予氟比洛芬酯注射液能更好的控制消化道肿瘤切除术术后的重度疼痛，并明显减少吗啡用量，此外还能明显减少术后炎症细胞因子IL-6生成，促进抗炎因子IL-10的释放。     

关节腔内注射盐酸氢吗啡酮在膝关节镜手术术后镇痛中的临床应用

目的 评价关节腔内注射不同剂量盐酸氢吗啡酮对膝关节镜手术术后镇痛的效果. 方法 择期硬膜外麻醉下行膝关节镜手术患者150例,按随机数字表法分为5组(每组30例):H1组、H2组、H3组、M组、C组.术毕H1组关节腔内注射盐酸氢吗啡酮0.1 mg(用生理盐水配制成10ml),H2组关节腔内注射盐酸氢吗啡酮0.2 mg,H3组关节腔内注射盐酸氢吗啡酮0.3 mg,M组关节腔内注射吗啡2 mg,C组关节腔内注射等量生理盐水10ml.记录术后4、6、8、12、24 h患者在屈膝关节90°状态下的VAS,记录术后24h内需要追加镇痛药物的患者例数以及术后副作用的发生情况. 结果 术后8h内H1组、H2组、H3组、M组VAS评分比较,差异无统计学意义(P＞0.05);术后12 h VAS评分,H2组(2.5±0.6)分、H3组(2.1±0.7)分、M组(2.3±0.8)分低于H1组(3.1±0.6)分,差异有统计学意义(P＜0.01);术后24 h VAS评分,H3组(2.2±0.5)分低于H2组(3.1±0.8)分和M组(3.0±0.6)分,差异有统计学意义(JP＜0.05).术后需要追加镇痛药物的患者例数随盐酸氢吗啡酮剂量的增加而减少.结论 关节腔内注射不同剂量盐酸氢吗啡酮和吗啡用于膝关节镜均能获得良好的术后镇痛效果,0.3 mg盐酸氢吗啡酮的镇痛效果更佳.