小剂量布比卡因腰麻复合硬膜外麻醉在重度子痫前期产妇剖宫产术中的应用

目的：比较小剂量布比卡因腰麻复合硬膜外麻醉与单纯硬膜外麻醉在重度子痫前期产妇剖宫产术中的麻醉效果、产妇血流动力学变化及对新生儿的影响。方法：80例重度子痫前期产妇,随机分2组：小剂量布比卡因腰麻复合硬膜外麻醉组（CSEA组）与单纯硬膜外麻醉组（CEA组）,每组40例。观察麻醉诱导时间及术中麻醉效果;心率（HR）、平均动脉压（MBP）等血流动力学变化及麻黄素的用量情况;新生儿1、5rainApger评分等。结果：麻醉诱导时间及胎儿娩出时间CSEA组比CEA组明显缩短,术中麻醉效果CSEA组明显优于CEA组,低血压的发生率和严重程度及麻黄素的用量两组相似,新生儿1、5minApger评分两组无明显区别。结论：小剂量布比卡因腰麻复合硬膜外麻醉用于重度子痫前期产妇剖宫产手术,术中麻醉效果好,产妇血压控制理想,血流动力学稳定,对新生儿影响小,是一种安全有效的麻醉方法。     

胶体或晶体预扩容对联合腰麻下剖宫产母体和胎儿的影响

【目的】研究使用胶体或晶体预扩容对联合腰麻下剖宫产母体循环和胎儿的影响。【方法】择期单胎足月剖宫产产妇60例,ASAⅠ～Ⅱ级,在b～4行腰硬联合麻醉,随机分为晶体组（R组29例）和胶体组（H组31例）。麻醉操作时分剐给予林格液（R组）、6％羟乙基淀粉130／0．4（H组）各500mL预扩容,在20min内输注完成。监测产妇麻醉前（T1）、给药后（T2）、胎儿娩出时（T3）的血压、心率变化,胎儿娩出后行Apgar平分,并抽取胎儿脐动脉血行血气分析。【结果】两组产妇血压在T2时与T1比较降低有统计学意义;与R组相比,H组血压T2时增高有统计学意义;心率变化在组内和组间比较差异均无显著性。胎儿娩出后,Apgar评分及脐动脉血气分析两组差异无显著性。【结论】在联合腰麻下,虽然产妇使用胶体预扩容时循环系统比晶体预扩容稳定,但从胎儿的Apgar评分及脐动脉血气分析结果上看,胶体预扩容并无明显的优势。     

Pretreatment of Lacerations with Lidocaine, Epinephrine, and Tetracaine at Triage: A Randomized Double-blind Trial

OBJECTIVE: Pretreatment of lacerations with topical anesthetics reduces the pain of subsequent anesthetic injection yet requires time. This study was conducted to determine the ability of triage nurses to identify lacerations necessitating closure and pretreat them with a topical anesthetic and to compare the pain levels of lidocaine injection in lacerations pretreated with LET (lidocaine 2%, epinephrine 1:1,000, tetracaine 2%) vs a placebo. METHODS: This was a double-blind, randomized clinical trial that included consecutive emergency department patients aged > or = 1 year with clean, non-bite lacerations < or = 6 hours old. At triage the lacerations were randomized to LET solution or a placebo containing epinephrine 1:1,000. At examination an emergency practitioner assessed the laceration edges for the presence of blanching and adequacy of anesthesia to a 27-gauge needlestick. At the practitioner's discretion, supplemental lidocaine was infiltrated through the wound and the patient (or guardian) recorded the pain of infiltration on a 100-mm visual analog scale marked "most pain" at the high end. The mean levels of pain of lidocaine infiltration were compared between groups with a t-test and the proportions of adequately anesthetized wounds were compared with a chi2 test. A sample of 40 patients had 80% power to detect a 20-mm between-group difference in the pain of injection (alpha = 0.05). RESULTS: Of 43 patients enrolled (mostly children and males), 22 received LET and 21 placebo. The groups were similar for baseline characteristics. Lacerations in the LET group were more frequently adequately anesthetized (46% vs 14%, p = 0.03), and LET patients experienced less pain from injection than controls (22 mm vs 42 mm, p = 0.02). CONCLUSIONS: Application of LET by triage nurses is more effective than placebo in adequately anesthetizing simple lacerations in normal hosts and decreases the pain of local anesthetic infiltration.     

Digital versus Local Anesthesia for Finger Lacerations: A Randomized Controlled Trial

Objectives To compare the pain of needle insertion, anesthesia, and suturing in finger lacerations after local anesthesia with prior topical anesthesia with that experienced after digital anesthesia. Methods This was a randomized controlled trial in a university‐based emergency department (ED), with an annual census of 75,000 patient visits. ED patients aged ≥8 years with finger lacerations were enrolled. After standard wound preparation and 15‐minute topical application of lidocaine‐epinephrine‐tetracaine (LET) in all wounds, lacerations were randomized to anesthesia with either local or digital infiltration of 1% lidocaine. Pain of needle insertion, anesthetic infiltration, and suturing were recorded on a validated 100‐mm visual analog scale (VAS) from 0 (none) to 100 (worst); also recorded were percentage of wounds requiring rescue anesthesia; time until anesthesia; percentage of wounds with infection or numbness at day 7. Outcomes were compared by using Mann‐Whitney U and chi‐square tests. A sample of 52 patients had 80% power to detect a 15‐mm difference in pain scores. Results Fifty‐five patients were randomized to digital (n= 28) or local (n= 27) anesthesia. Mean age (±SD) was 38.1 (±16.8) years, 29% were female. Mean (±SD) laceration length and width were 1.7 (±0.7) cm and 2.0 (±1.0) mm, respectively. Groups were similar in baseline patient and wound characteristics. There were no between‐group differences in pain of needle insertion (mean difference, 1.3 mm; 95% confidence interval [CI] =?17.0 to 14.3 mm); anesthetic infiltration (mean difference, 2.3 mm; 95% CI =?19.7 to 4.4 mm), or suturing (mean difference, 7.6 mm; 95% CI =?3.3 to 21.1 mm). Only one patient in the digital anesthesia group required rescue anesthesia. There were no wound infections or persistent numbness in either group. Conclusions Digital and local anesthesia of finger lacerations with prior application of LET to all wounds results in similar pain of needle insertion, anesthetic infiltration, and pain of suturing.     

Leg Compression Versus Control for Prevention of Spinal Anesthesia Induced Hypotension in Elective Cesarean Delivery: A Meta-Analysis of Randomized Controlled Trials

PurposeThe aim of this meta-analysis was to assess the effectiveness of leg compression versus control in preventing spinal anesthesia induced hypotension during cesarean delivery.DesignA meta-analysis of randomized controlled trials (RCTs).MethodsPubMed, Embase, Web of Science and CENTRAL were searched for RCTs that compared leg compression with control for prevention of hypotension in patients undergoing elective cesarean delivery under spinal anesthesia. The primary outcome was the incidence of hypotension. Subgroup analysis was performed according to leg compression methods. Secondary outcomes included nausea and vomiting, the number of vasopressor requirement, and the rates of neonatal Apgar scores ≤7 and umbilical cord blood pH ≤ 7.2.FindingsTwelve studies involving 787 patients were included in this meta-analysis. There was a significant reduction of the incidence of hypotension with leg compression versus control (RR 0.45, 95% CI 0.32 to 0.62, I² = 81%). Subgroup analysis suggested that leg wrapping may be more effective in preventing hypotension compared with elastic stockings and sequential compression mechanical devices. Leg compression also reduced maternal nausea and vasopressors requirement, but did not impact on neonatal outcomes.ConclusionsLeg compression, especially leg wrapping, decreases the incidence and severity of hypotension after spinal anesthesia in caesarean delivery. As a simple, non–pharmacologic and cost-effective intervention, leg wrapping can be used for prevention of spinal anesthesia induced hypotension in caesarean delivery, either alone or in combination with vasopressors.     

Thirst Relief Effect of 0.75% Citric Acid Spray During the Anesthesia Recovery Period: A Randomized Controlled Trial

PurposePostoperative thirst is a common clinical issue. The discomfort caused by thirst during the perioperative period is strong and significant. Postoperative thirst is associated with emotional changes, giving rise to a series of adverse psychological and physical problems to patients. This study aimed to explore the effect of 0.75% citric acid spray on thirst relief during the anesthesia recovery period in China.DesignA randomized controlled trial was conducted on subjects immediately after the removal of the endotracheal tube in a postanesthesia care unit.MethodsA total of 112 patients with TI scores ≥3 on 0–10 numeric rating scale were randomized to the intervention group (0.75% citric acid spray group; n = 56) or control group (cool water spray; n = 56) by computerized randomization. Thirst assessment was performed before and 5 minutes after the intervention. Five minutes after the intervention, if the TI score was still ≥3 points, the spray would be added and the thirst assessment would be performed again until the TI score was <3 points. The onset time, duration time, and the number of additional sprays within 20 minutes was recorded.FindingsFive minutes after the intervention, the thirst intensity score of the 0.75% citric acid spray group decreased from 5.57 ± 1.35 to 3.09 ± 1.20. The onset and duration times were 0.77 ± 0.47 min and 4.41 ± 2.59 min, respectively, and the number of spray additions in 20 min was 1.09 ± 0.92. The thirst intensity score of the cool water spray group decreased from 5.29 ± 1.52 to 3.73 ± 1.54. The onset and duration time were 0.84 ± 0.42 min and 2.77 ± 1.80 min, respectively, and the number of spray additions was 1.91 ± 1.24. No incidence of adverse events, including choking, aspiration, and allergies occurred.ConclusionFor thirsty patients during the anesthesia recovery period, the spray method is safe and has fewer side effects, including choking, aspiration, and allergies. Thus, 0.75% citric acid spray and cool water spray are both safe and effective; however, the 0.75% citric acid spray has a better thirst relief effect that lasts longer than the cool water spray.     

Comparison of non-invasive blood pressure measurements on the arm and calf during cesarean delivery

Objective. Shivering may occur in 75% of women undergoing spinal anesthesia for cesarean delivery and may render an automated noninvasive blood pressure (ANIBP) device incapable of determining blood pressure (BP). When patients shiver under spinal anesthesia, the lower extremities do not exhibit the same involuntary muscle movements as do the upper extremities. This study was undertaken to determine if a correlation exists between ANIBP measurements in the arm and calf of women undergoing cesarean delivery under spinal anesthesia. Methods. We enrolled 73 women in this blinded, prospective study. Simultaneous arm and calf BP were measured with an ANIBP and differences between the two were determined. Results. We found significant differences between the average difference in systolic and in diastolic BP, no significant difference between the average mean BP, and a tendency for the systolic BP to be higher and the diastolic BP to be lower in the calf than in the arm; however, there was a large degree of variability among patients. Conclusion. We conclude that there is a poor correlation between the BP measured by an ANIBP on the calf and one on the arm. In the parturient undergoing cesarean section, lower extremity BP as measured by an ANIBP does not correlate with the arm ANIBP and should not be used to assure fetal wellbeing. This revised version was published online in July 2006 with corrections to the Cover Date.     

Comparison of Topical Anesthetics and Vasoconstrictors vs Lubricants Prior to Nasogastric Intubation: A Randomized, Controlled Trial

OBJECTIVE: To determine whether pre-treatment of the nose and throat with topical anesthetics and vasoconstrictors would reduce the pain associated with nasogastric (NG) intubation. METHODS: This was a prospective, randomized, controlled trial assessing the pain of NG intubation in patients pretreated with topical anesthetics and vasoconstrictors vs surgical lubricants alone. The subjects were 40 alert, cooperative adult patients requiring NG intubation without allergies to the study medications or contraindications to their use from a suburban university-based ED. The patients in the experimental group had phenylephrine 0.5% sprayed in their noses followed by instillation of 5 mL of 2% lidocaine jelly. Their throats were sprayed with 2% tetracaine and 14% benzocaine. The control patients received intranasal lubrication only. The primary outcome measured was pain of NG intubation on a 100-mm visual analog scale. Other outcomes included nasal pain, discomfort from gagging, and the incidences of vomiting, choking, and epistaxis. RESULTS: The mean age (+/-SD) was 54.8+/-22.3 years; 20 (50%) were female. The patients who had a combination of topical anesthetics and vasoconstrictors inserted prior to NG intubation experienced significantly less overall pain/ discomfort than did the control patients [28.6 mm (95% CI = 17.3 to 39.9 mm) vs 57.5 mm (95% CI = 44.9 to 70.1 mm), p = 0.001]. The patients in the experimental group also experienced significantly less nasal pain than did the patients in the control group [18.1 mm (95% CI = 8.0 to 28.2 mm) vs 44.4 mm (95% CI = 30.4 to 58.6 mm), p = 0.003] and significantly less discomfort from gagging than the patients receiving pretreatment with a lubricant alone [24.1 mm (95% CI = 11.1 to 37.1 mm) vs 50.9 mm (95% CI = 36.7 to 65.1 mm), p = 0.006]. There was no between-group difference in the frequencies of adverse effects. CONCLUSIONS: Use of topical lidocaine and phenylephrine for the nose and tetracaine with benzocaine spray for the throat prior to NG intubation results in significantly less pain and discomfort than use of a nasal surgical lubricant alone. Widespread use of topical anesthetics and vasoconstrictors prior to NG intubation is recommended.     

指外伤单点皮下阻滞与传统皮下阻滞局麻效果比较的随机对照试验

目的比较对指外伤患者行单点皮下注射指神经阻滞与传统指神经阻滞两种不同麻醉方法的麻醉效果。方法选择伤及1或2个手指的指外伤患者,用抛硬币法随机分为传统皮下阻滞组和单点皮下阻滞组。由同一试验人员实施所有麻醉,对患者及结果评估者设盲,采用符合方案集(PP)分析和意向性治疗(ITT)分析比较两种不同方法在麻醉过程中所引发的疼痛程度(10cm视觉模拟评分)、麻醉起效时间和麻醉失败率。结果共纳入指外伤患者93例(109指),其中传统皮下阻滞组51例(61指),单点皮下阻滞组42例(48指)。除2例(3指)分别因醉酒和语言障碍未能评价结局指标外,PP分析及ITT分析均显示,两种麻醉方法在麻醉过程中引发的疼痛、麻醉起效时间及麻醉失败率方面差异无统计学意义(P﹥0.05)。结论单点皮下阻滞与传统的指神经阻滞方法的效果相当,且操作更简单,适用于指外伤患者的手指掌指横纹以远掌侧及中末节背侧的麻醉。对于损伤累及手指近节背侧或拇指背侧的患者则需要辅以指背神经阻滞。     

Effect of Dexmedetomidine IV on the Duration of Spinal Anesthesia with Prilocaine: A Double-Blind, Prospective Study in Adult Surgical Patients

Background: The duration of spinal anesthesia with prilocaine has been poorly documented and no English-language study has been published regarding the effects of dexmedetomidine on the duration of anesthesia with spinal prilocaine.Objective: The aim of this study was to assess the effects of dexmedetomidine IV on the duration of action of prilocaine and its associated adverse events (AEs) in spinal anesthesia.Methods: In this double-blind, prospective study, patients classified as American Society of Anesthesiologists grade I to II who were to undergo lower abdominal, anorectal, or extremity surgery with a spinal anesthetic were assigned to 1 of 2 groups. All patients were administered prilocaine 2% for spinal anesthesia. Within 10 minutes after spinal anesthesia was initiated, group 1 received a loading dose of dexmedetomidine 1 μg/kg IV, followed by a maintenance dose of 0.4 μg/kg · h for 50 minutes; group 2 (control) received the same amount of physiologic saline in the same time frame. Mean arterial pressure (MAP), heart rate (HR), duration of sensory and motor blockade, and sedation scores were tracked. Patients were observed for 4.5 hours after surgery, with follow-ups occurring up to 96 hours after surgery.Results: Eighty-three patients were assessed for study inclusion, 23 of whom were excluded. Sixty patients (42 men, 18 women; mean [SD] age, 40.56 [16.86] years) were included in the study. MAP was similar in the 2 groups throughout the study. Mean (SD) HR was significantly lower in group 1 compared with group 2 at 20 minutes (70.43 [19.28] vs 77.63 [18.14] beats per minute, respectively; P = 0.02). The mean (SD) duration of the persistence of sensory anesthesia (ie, the time required for the maximal level of anesthesia to regress 2 dermatomes) was significantly longer in group 1 compared with group 2 (148.33 [21.18] vs 122.83 [18.73] minutes; P < 0.001). The mean (SD) time to complete abolishment of motor blockade was also significantly longer in group 1 than in group 2 (215.16 [25.10] vs 190.83 [18.57] minutes; P < 0.001). The average sedation score in group 1 was significantly higher than in group 2 (P < 0.001) during anesthesia. Significantly more patients in group 1 required atropine than those in group 2 (9 vs 2 patients; P < 0.001) to treat bradycardia. There was no significant between-group difference in the number of patients who received ephedrine to treat hypotension. One patient in each group reported waist and back pain; 2 patients in each group reported nausea. Shivering occurred in 0 and 5 patients in groups 1 and 2, respectively; the between-group difference in AEs was not statistically significant. Paresthesia, postdural puncture headache, allergic reactions, total spinal anesthesia, urinary retention, or vomiting—AEs commonly associated with spinal anesthesia—were not observed or reported by either group.Conclusions: The results of this study suggest that dexmedetomidine IV significantly prolonged the duration of spinal anesthesia and provided a significantly higher level of sedation compared to placebo in this group of adult surgical patients. The treatment was generally well tolerated in all patients.     

Clinical Effect of Different Drugs and Infusion Techniques for Patient-controlled Analgesia After Spinal Tumor Surgery: A Prospective,Randomized, Controlled Clinical Trial

PurposeTo evaluate the outcomes of the different drug combination and infusion techniques for patient-controlled analgesia (PCA).MethodsNinety-seven patients who had undergone spinal tumor surgery were randomized to 4 groups with different PCA drugs and infusion techniques: subcutaneous sufentanil (SS) group; (n=25), subcutaneous sufentanil and dexmedetomidine (SDS) group (n=24), intravenous sufentanil (SI) group (n=23), and intravenous sufentanil and dexmedetomidine (SDI) group (n=25). The primary outcome measured the cumulative amount of sufentanil delivered to the patients through PCA 24 and 48 hours after the surgery. Secondary outcomes measured the visual analog scale pain scores 24 and 48 hours after the surgery, Pittsburgh Sleep Quality Index before and 1 month after surgery, Athens Insomnia Score before and the first 2 nights after surgery, and the rate of adverse events within 48 hours after surgery.FindingsAt 24 and 48 hours after surgery, the cumulative amount of sufentanil in the SDS group (mean [SD], 76.44 [10.75] at 24 hours and 151.96 [20.92] at 48 hours) and the SDI group (mean [SD], 75.08 [9.00] at 24 hours and 149.56 [18.22] at 48 hours) were significantly lower than in SS group (mean [SD] 95.52 [12.40] at 24 hours and 183.23 [23.06] at 48 hours) and the SI group (mean [SD], 97.25 [10.80] at 24 hours and 186.67 [20.14] at 48 hours; P < 0.001). The visual analog scale pain scores and Athens Insomnia Scale scores were also lower in the SDS and SDI groups than in the SS and SI groups 24 and 48 hours after surgery (P < 0.05). The Pittsburgh Sleep Quality Index was lower in the SDS and SDI groups 1 month after surgery. Lastly, the rate of nausea and vomiting was higher in the SI group than in the SS, SDS, and SDI groups (P = 0.018).ImplicationsDexmedetomidine in PCA could decrease sufentanil intake and improve analgesic effect and sleep quality. Subcutaneous PCA can provide the same benefit with a lower rate of nausea and vomiting. ClinicalTrials.gov identifier: NCT04111328.     

Short-Term Effect of Spinal Manipulation on Pain Perception,Spinal Mobility,and Full Height Recovery in Male Subjects With Degenerative Disk Disease: A Randomized Controlled Trial

Objective

To evaluate the short-term effect on spinal mobility, pain perception, neural mechanosensitivity, and full height recovery after high-velocity, low-amplitude (HVLA) spinal manipulation (SM) in the lumbosacral joint (L5-S1).

Design

Randomized, double-blind, controlled clinical trial with evaluations at baseline and after intervention.

Setting

University-based physical therapy research clinic.

Participants

Men (N=40; mean age ± SD, 38±9.14y) with diagnosed degenerative lumbar disease at L5-S1 were randomly divided into 2 groups: a treatment group (TG) (n=20; mean age ± SD, 39±9.12y) and a control group (CG) (n=20; mean age ± SD, 37±9.31y). All participants completed the intervention and follow-up evaluations.

Interventions

A single L5-S1 SM technique (pull-move) was performed in the TG, whereas the CG received a single placebo intervention.

Main Outcome Measures

Measures included assessing the subject's height using a stadiometer. The secondary outcome measures included perceived low back pain, evaluated using a visual analog scale; neural mechanosensitivity, as assessed using the passive straight-leg raise (SLR) test; and amount of spinal mobility in flexion, as measured using the finger-to-floor distance (FFD) test.

Results

The intragroup comparison indicated a significant improvement in all variables in the TG (P<.001). There were no changes in the CG, except for the FFD test (P=.008). In the between-group comparison of the mean differences from pre- to postintervention, there was statistical significance for all cases (P<.001).

Conclusions

An HVLA SM in the lumbosacral joint performed on men with degenerative disk disease immediately improves self-perceived pain, spinal mobility in flexion, hip flexion during the passive SLR test, and subjects' full height. Future studies should include women and should evaluate the long-term results.     

Laser-assisted Anesthesia Reduces the Pain of Venous Cannulation in Children and Adults: A Randomized Controlled Trial

Objectives: Application of topical anesthetics before intravenous (IV) cannulation is effective yet limited by delayed transdermal absorption. The authors evaluated a handheld laser device to enhance topical anesthetic absorption by ablating the stratum corneum, the major barrier to drug absorption through the skin. The hypothesis was that laser‐assisted anesthesia would reduce the pain of IV cannulation in emergency department (ED) patients. Methods: This was a blinded, randomized, controlled trial. ED patients aged 1 year and older requiring nonemergent IV cannulation were included. Patients were randomized to pretreatment of the skin with laser or sham laser, and standardized venous cannulation was performed on the dorsum of the patients' hands or antecubital fossa. In the experimental group, the area over the target vein was pretreated with a lightweight, portable Er:YAG unit, with a fluence of 3.5 J/cm², a pulse width of 600 microseconds, and a spot diameter of 6 mm. Lidocaine 4% cream was applied to the area immediately after laser application. Five minutes later, the cream was wiped off and a trained nurse inserted an IV catheter. In the control group, a sham laser and lidocaine were used. Pain of laser application and IV cannulation was recorded on age‐appropriate pain scales; presence of infection or abnormal pigmentation was determined at one week. Pain of cannulation was compared using parametric and nonparametric tests. Results: Sixty‐one patients were randomized to laser (30) and sham (31) pretreatment. Mean (± SD) age was 27 (± 21) years, 49% were female, and one half were children younger than 18 years. The mean pain of IV cannulation was significantly less (mean difference, 28.3 mm; 95% confidence interval = 17.9 to 38.7) in patients pretreated with the laser (10.0 mm; 95% confidence interval = 4.4 to 15.6) than with sham laser (38.3 mm; 95% confidence interval = 29.3 to 42.2). The difference in children was also significant. Application of the laser was painless in most patients. No patient developed infection or abnormal pigmentation. Conclusions: Pretreatment of the skin with a laser device followed by a five‐minute topical lidocaine 4% application reduces the pain of IV cannulation in ED adult and pediatric patients.     

硬膜外预充液对腰硬联合阻滞剖宫产术患者硬膜外置管血管损伤及腰麻效果的影响

目的 观察硬膜外预充液预防剖宫产术患者硬膜外导管致硬膜外血管损伤及腰麻效果的影响.方法 将180例单胎足月妊娠拟在腰硬联合麻醉下行剖宫产术的产妇,按随机数字表法分为3组,每组60例.3组产妇均取左侧卧位,L2-3椎间隙行腰硬联合穿刺.硬膜外穿刺成功后将脊麻针穿过硬膜外针内腔行蛛网膜下隙穿刺,见脑脊液回流后,注入0.75％左布比卡因2.0 mL,拔出腰麻针.Ⅰ组产妇硬膜外置管前在硬膜外腔注入生理盐水5 mL;Ⅱ组产妇硬膜外置管前在硬膜外腔注入含麻黄素15 mg的生理盐水5 mL;Ⅲ组产妇硬膜外腔直接置入导管.记录3组产妇血管损伤发生率,观察麻醉注药前(T0),经穿刺针注药液后2 min(T1),5 min(T2)HR、SBP、DBP的变化,以及采用针刺法测定注药后5、10 min时的感觉阻滞平面.结果 Ⅰ、Ⅱ、Ⅲ组血管损伤发生率分别为3.3％、1.6％及13.3％,Ⅲ组血管损伤发生率明显高于Ⅰ组和Ⅱ组(均P＜0.05),Ⅰ组和Ⅱ组比较差异无统计学意义(P＞0.05).3组产妇T1及T2的SBP较T0有明显的下降(均P＜0.05),3组间比较差异均无统计学意义(均P＞0.05).Ⅰ、Ⅱ组感觉阻滞平面较Ⅲ组明显升高(P＜0.05),Ⅰ、Ⅱ组注药后感觉阻滞平面比较差异无统计学意义(P＞0.05).结论 腰硬联合麻醉剖宫产产妇在硬膜外预充少许液体,可以预防硬膜外导管置入时损伤血管,提高剖宫产产妇腰硬联合阻滞麻醉的安全性,同时还可改善腰麻的效果.     

Effects of Educational Intervention on State Anxiety and Pain in People Undergoing Spinal Surgery: A Randomized Controlled Trial

Preoperative educational intervention for anxiety and pain affects patients undergoing spinal surgery. The effects, however, have never been examined using randomized controlled designs. To investigate the effects of education on anxiety and pain for patients undergoing spinal surgery, a randomized trial with block design was used. Patients were recruited from a medical center in central Taiwan. We invited 90 patients to participate in this study. Inclusion criteria were (a) age ≥20 years, (b) voluntary participation, (c) able to understand Taiwanese Mandarin Chinese or Taiwanese, and (4) no hearing or vision impairments after using aids. Patients (n = 86) undergoing lumbar spinal surgery were randomized into either an Intervention group (using educational intervention; n = 43) or a Control group (n = 43); four patients voluntarily dropped out after surgery (one in Intervention group; three in Control group). Patients had their anxiety (using the State-Trait Anxiety Inventory; STAI) and pain (using a visual analog scale) measured the day before surgery, 30 minutes before surgery, and the day after surgery. After controlling for demographics, the adjusted anxiety and pain levels were significantly lower for the Intervention group: mean STAI scores were 52.67 at baseline and 47.54 at 30 minutes before surgery (p < .001); mean pain scores were 6.07 at baseline and 5.28 on day after surgery (p < .001). Preoperative educational intervention is effective in informing patients undergoing spinal surgery that can lead to a reduction in pain, anxiety, and fear postoperatively.     

Efficacy of Internet-Delivered Mindfulness for Improving Depression in Caregivers of People With Spinal Cord Injuries and Chronic Neuropathic Pain: A Randomized Controlled Feasibility Trial

Objectives

To explore the feasibility and efficacy of web-based mindfulness training for carers of people with spinal cord injury (SCI).