肋间神经冷冻治疗对开胸术后疼痛与应激的影响

目的评价肋间神经冷冻治疗对开胸术后疼痛与应激的影响。方法将412例行开胸患者术前随机平均分为2组,A组行冷冻肋间神经后关胸,B组直接关胸。结果 A组在术后第1、2天对血糖、血浆皮质醇、血管紧张素影响较小,明显优于对照组。结论肋间神经冷冻治疗能有效控制术后血糖、血浆皮质醇、血管紧张素的增高,有效缓解开胸术后应激状态。     

肋间神经冷冻和硬膜外及静脉自控镇痛对治疗开胸术后疼痛比较

目的：观察肋间神经冷冻、连续硬膜外自控镇痛(patient control epidural analgesia,PCEA)与静脉自控镇痛(patient control introvenous analgesia，PCIA)治疗开胸术后胸痛的效果及副作用。方法：83例常规后外侧切口开胸的手术病人，随机分为3组。C组29例使用北京KOOLAND公司JT-I型冷冻手术治疗仪在关胸前对切口所在肋间及上、下各一个肋间和放置胸腔引流管所在肋间的肋间神经冷冻。E组28例使用美国ABBOT公司电子泵，用0．19％布比卡因+2ug／mL芬太尼行术后T5-6PCEA。Ⅰ组26例使用美国ABBOT公司电子泵，用芬太尼行PCIA。视觉模拟评分法(visual analogue scale，VAS)比较3组患者术后的疼痛程度。观察记录3组术后2h、4h、12h、24h、48h时疼痛程度评分、镇静程度评分、恶心、呕吐、头晕、呼吸抑制的发生率。结果：3组中C组止痛效果最差，C组与E组比较均P<0．05；C组与Ⅰ组比在2h、12h时P<0.05；Ⅰ组次之，E组最佳，Ⅰ组与E组比在24h时P<0.05。3组中副反应以Ⅰ组头晕、呼吸抑制发生率最高，与C组比P<0．05；镇静程度以Ⅰ组最佳。结论：PCEA对治疗开胸术后疼痛效果优于PCIA和肋间神经冷冻。     

肋间神经冷冻预防开胸术后疼痛的观察与护理

观察肋间神经冷冻预防开胸术后疼痛的应用效果,并总结128例单纯后外侧切口开胸手术患者护理措施.采用冷冻手术治疗机,在开胸术关闭切口前将开胸的肋间、上一肋间和下两肋间及胸腔引流管放置处的肋间神经进行冷冻治疗,经处理后患者术后疼痛程度显著降低;术后早期即能主动进行咳嗽、排痰,术后肺炎、肺不张等并发症明显减少(P<0.01),护理要点包括:加强切口并发症的观察和护理;及时准确进行视觉模拟评分;认真做好呼吸道护理;给予心理支持,解除患者疑虑;详尽落实出院指导.     

冷冻肋间神经治疗开胸术后疼痛的观察和护理

我科采用开胸手术中冷冻肋间神经的方法治疗开胸术后的严重疼痛,取得了较满意的效果,现将相关I临床观察及护理体会报告如下。     

肋间神经冷冻术与自控镇痛对开胸术后早期镇痛效果的比较

  目的  比较开胸术后早期3种新镇痛方法的疗效, 探求最佳镇痛方案。  方法  81例开胸术后患者, 随机分为3组, 分别采用患者自控镇痛静脉给药(patient controlled intravenous analgesia, PCIA)、患者自控硬膜外给药(patient controlled epidural analgesia, PCEA)及肋间神经冷冻术(intercostal nerve cryoanalgesia, INC)镇痛, 根据视觉模拟评分法(visual analogue scales, VAS)进行手术日及术后3日疼痛评分, 同时用量表对3种镇痛方法的不良反应进行评价。  结果  PCEA组与PCIA组比较, 所用镇痛药剂量差异无统计学意义(P>0.05), 但用药次数明显减少(P < 0.01);VAS评分示PCEA组镇痛效果明显优于PCIA和INC组(P < 0.01)。术后第2、3天PCEA组较INC组自行排痰能力显著提高(P < 0.01), PCIA组亦较INC组明显提高(P < 0.05)。PCIA组的不良反应显著高于PCEA和INC组(P < 0.01), INC组不良反应显著低于PCIA和PCEA组(P < 0.01)。综合评估指标显示PCEA组显著优于PCIA和INC组(P < 0.01)。  结论  开胸术后早期PCEA的镇痛效果最好, 不良反应较低, 患者排痰能力最强, 综合评价最高, 是3种镇痛方法中的最佳选择。     

肋间神经冷冻减轻开胸切口术后疼痛的效果观察

[目的]探讨肋间神经冷冻用于剖胸切口术后的镇痛效果。[方法]选择110例接受开胸手术的病人，随机分为观察组和对照组，观察组进行肋间神经冷冻，对照组行术后病人自控静脉镇痛（PCIA），以VAS评分判断两组术后胸部切口疼痛情况，并记录并发症。[结果]观察组术后24hVAS评分、副反应发生率与对照组比较差异有统计学意义（P〈0．01或P〈0．05）。[结论]肋间神经冷冻减轻开胸切口术后疼痛的效果明显优于PCIA，且并发症更少。     

肋间神经冷冻镇痛在开胸术后镇痛中的应用

目的:探讨肋间神经冷冻法在开胸术后应用的镇痛效果及安全性.方法:100例开胸手术患者分成肋间神经冷冻镇痛组(A组,n=50)与肋间神经阻滞联合静脉镇痛泵镇痛组(B组,n=50).A组关胸前冷冻切口及上下各一肋间和放置胸引管的肋阃神经根部[(-60±10)℃,90s],B组关胸前用罗哌卡因,在切口及上下各一肋间和放置胸引管的肋间神经阻滞+术后静脉镇痛泵.根据VAS法对术后胸痛进行评价,并观察术后不良反应、追加镇痛药物、肺部并发症和术后肺功能FEV1的情况,及进行术后肋间神经功能恢复的随访.结果:在VAS评分、追加镇疼药物使用和肺部并发症及术后肺功能FEV1等,两组间差异无显著性(P＞0.05);而在恶心呕吐等不良反应发生,B组高于A组,差异有显著性(P＜O.05);A组患者可出现较长时间切口周围及上腹部麻木感,但基本可以耐受.结论:肋间神经冷冻镇痛法在开胸术后镇痛效果良好,是一种安全有效的开胸术后镇痛方法.     

肋间神经冷冻止痛术在开胸手术中的临床研究

目的探讨肋间神经冷冻止痛术在开胸手术中的临床应用。方法对377例开胸手术患者应用肋间神经冷冻止痛术进行术后镇痛，并与其他镇痛方法进行比较。结果肋间神经冷冻组患者主观感受疼痛显著减轻，总有效率达97％；术后止痛药需要量及并发症明显少于对照组，并且少于另两组，由于减少剧烈疼痛的刺激，有利于机体功能的自身调节，患者咳嗽有力，气道通畅，肺扩张好，肺泡有效通气量增加，从而发生肺不张、肺部感染机会减少；在肺功能的检测中，肋间神经冷冻组与对照组亦有显著性差异。结论肋间神经冷冻术对胸外科开胸手术后切口疼痛缓解疗效确切，手术操作简便、安全，术中、术后不良反应少，可以在胸外科领域广泛应用。     

肋间神经冷冻减轻开胸切口术后疼痛的效果观察

[目的]探讨肋间神经冷冻用于剖胸切口术后的镇痛效果。[方法]选择110例接受开胸手术的病人,随机分为观察组和对照组,观察组进行肋间神经冷冻,对照组行术后病人自控静脉镇痛(PCIA),以VAS评分判断两组术后胸部切口疼痛情况,并记录并发症。[结果]观察组术后24hVAS评分、副反应发生率与对照组比较差异有统计学意义(P<0.01或P<0.05)。[结论]肋间神经冷冻减轻开胸切口术后疼痛的效果明显优于PCIA,且并发症更少。     

肋间神经冷冻在开胸术后镇痛效果观察

目的 观察肋间神经冷冻在开胸术后的止痛效果.方法 将40例接受开胸术后采用不同镇痛方法的患者随机分为2组:肋间神经冷冻镇痛组(冷冻镇痛组)20例和术后镇痛泵(PCA)及镇痛药物组(对照组)20例.冷冻镇痛组采用Erbokryo CA型冷冻手术治疗机冷冻,每根肋间神经冷冻温度为-80 ℃左右,冷冻时间为90 s;对照组采用术后镇痛泵或者临时肌肉注射度冷丁镇痛.以视觉模拟疼痛评分法(VAS)评价干预后的疼痛程度,并比较2组术后肺部并发症发生率.结果 2组镇痛药物使用量[冷冻镇痛组使用度冷丁平均(41.25±70.37)mg、对照组平均(185.00±79.22)mg]差异有统计学意义(t=6.07,P＜0.01).冷冻镇痛组患者疼痛程度显著弱于对照组(平均VAS评分冷冻镇痛组为(2.80±2.88)分,对照组为(8.00±2.05)分,差异有统计学意义(t=6.58,P＜0.05);总的止痛有效率冷冻镇痛组为90%,对照组为30%,差异有统计学意义(P＜0.05),肺部并发症的发生率(冷冻镇痛组为10%,2/20)也显著低于对照组(40%,8/20),差异有统计学意义(χ2=4.8,P＜0.05).结论 肋间神经冷冻术可明显减轻开胸术后患者疼痛,减少肺部并发症发生.     

Intercostal Nerve Block and Neurolysis for Intractable Cancer Pain

Management of intractable cancer-associated chest wall pain is difficult once patients have reached dose-limiting side effects of opioids and coanalgesic medications. This case series describes 11 patients with intractable cancer-associated chest wall pain who were treated with a diagnostic intercostal nerve block. Six patients subsequently received chemical neurolysis with phenol using the same approach. No serious adverse events were observed. Radiopaque contrast dye spread into the paravertebral space in all 11 patients, and in 1 patient contrast dye spread into the epidural space. Seven of 11 patients experienced pain relief from the diagnostic blockade. Four of six patients experienced pain relief from the neurolytic blockade. The principal reportable finding from this case series is the observation that contrast dye spread liberally from the intercostal space into other anatomic spaces, even though very small volumes of injectate (less than 5 mL) were used. Definitive evidence of safety and efficacy of intercostal nerve block and neurolysis for cancer pain will require a prospective randomized clinical trial.     

疼痛缓解对慢性非特异性腰痛患者步态特征的影响

目的 观察针刺治疗后疼痛缓解对慢性非特异性腰痛(CNLBP)患者的步速、跨步长和地面反作用力(GRF)特征值的影响.方法 2019年5月至12月,网络招募CNLBP受试者28例,随机分为等待治疗组(n=14)和针刺治疗组(n=14).针刺治疗组接受针刺治疗,每次30 min,每周3次,共4周;等待治疗组入组后仅进行健康...     

Retrospective Comparison of Ultrasound and Fluoroscopic Image Guidance for Intercostal Steroid Injections

Introduction: Steroid injection around the intercostal nerves is one of the treatment options for intercostal neuralgia. The technique may be performed blindly, under fluoroscopic guidance (FSG) or with the use of ultrasound guidance (USG). This study is a retrospective comparison of image guidance for intercostal steroid injections. Methods: After Institutional Review Board approval, a retrospective review of all patient charts who received intercostal steroid injections from 2005 to 2009 was performed. A total of 39 blocks were performed in that period. Of that 12 were USG blocks and 27 FSG blocks. The preprocedure visual analog scale (VAS) and postprocedure VAS and the duration of pain relief were compared between the 2 techniques. A Mann–Whitney test and Kruskal–Wallis test were performed looking for differences between the techniques. Results: The median change in the VAS for FSG and USG were ?5.000 and ?4.000, respectively, and duration of pain relief with a median difference of 2 weeks (95% confidence interval of ?4, 7). There were 2 occasions of intravascular spread noticed with the FSG although this should not affect the study result as the needle was repositioned and steroid injected only after contrast dye confirmation. Conclusion: With similar change in VAS scores and duration of pain relief between the 2 guidance methods based on this retrospective study, both image guidance techniques may offer similar pain relief.     

Pulsed Radiofrequency Treatment of Articular Branches of the Obturator and Femoral Nerves for Management of Hip Joint Pain

▪ Abstract:   Groin and thigh pain are frequently the major symptoms of hip joint pathology. The hip joint is innervated by articular branches of the obturator, femoral, superior gluteal, and sciatic nerves. The nerve responsible for hip joint pain can be determined by a diagnostic nerve block. Radiofrequency ablation of the identified articular branches of the hip was demonstrated to provide relief of hip pain. However, continuous radiofrequency denervation by thermal coagulation carries the potential risk of neuritis. We report on two patients with groin and thigh pain related to hip joint pathology treated with a novel technique for hip pain relief, pulsed radiofrequency treatment (PRF) of articular branches of the obturator and femoral nerves. At the time this case was written, both patients demonstrated at least 50% pain relief 3 to 4 months after the intervention along with improved function (increased ambulation and ability to participate in physical therapy). Our clinical observation suggests that PRF of articular branches of the hip joint may be an alternative treatment for patients with intractable hip pain. ▪     

Opposite Effects of Stress on Pain Modulation Depend on the Magnitude of Individual Stress Response

The effect of acute stress on pain threshold and intolerance threshold are reported as producing either hypoalgesia or hyperalgesia. Yet, the contribution of individual stress reactivity in this respect has not been established. The aim was to test 2 pain modulation paradigms under acute stress manipulation, to our knowledge, for the first time, to study whether stress differentially affects pain modulation, and whether the effect is related to individual stress response. Participants were 31 healthy subjects. Conditioned pain modulation (CPM) and pain adaptation were measured before and after inducing an acute stress response using the Montreal Imaging Stress Task. Subjects' stress response was evaluated according to salivary cortisol, autonomic function, and perceived stress and anxiety. The Montreal Imaging Stress Task induced a validated stress response. On a group level, stress induced reduction in CPM magnitude and increase in pain adaptation compared with baseline. These responses correlated with stress reactivity. When the group was subdivided according to stress reactivity, only high stress responders exhibited reduced CPM whereas only low stress responders exhibited increased pain adaptation. The results suggest that acute stress may induce opposite effects on pain modulation, depending on individual stress reactivity magnitude, with an advantage to low stress responders.

Topical Cocaine for Relief of Mucosal Pain

ABSTRACT

Painful mucosal lesions negatively affect quality of life. When located in the oral cavity, they can cause pain that interferes with speech and swallowing. Acute pain from intra-oral lesions is difficult to treat with conventional methods such as systemic opioids or viscous lidocaine. These cases exemplify a safe, fast and effective method for treating painful mouth lesions that are not responsive to standard treatments.

Mr. D and Mr. G had from painful oral lesions caused by squamous cell carcinoma. Severe pain interfered with their ability to speak and swallow, resulting in poor nutrition and dehydration. 4% liquid cocaine, self-applied topically to the open mouth sores, resulted in relief within minutes in both cases. Repeated dosing every six hours allowed both patients to restart oral nutrition without any reported side effects.

Topical cocaine has not been described for repeated dosing for oral or other mucosal pain. Potential side effects of mucosal administration include gingival recession and erythematous lesions. If the recommended topical doses are exceeded, liquid cocaine may be absorbed systemically causing a stimulant response or addiction. When used appropriately, however, this intervention can result in a dramatic improvement in quality of life and functional status.     

Dissociation and Posttraumatic Stress Symptoms in Patients With Chronic Pain

The present study examined the number and frequency of dissociative experiences reported by patients with chronic pain and the association between dissociation and emotional distress in this population. The mean Dissociative Experiences Scale (DES) score obtained by patients with chronic pain was comparable to mean DES scores obtained by persons diagnosed with affective disorders, eating disorders, personality disorders, and schizophrenia. Based on their median DES score, patients with chronic pain reported more frequent dissociation than did normal adults and persons diagnosed with alcohol use disorders, specific phobias, and agoraphobic avoidance. Traumatized patients with chronic pain evidenced significantly more frequent dissociation than did nontraumatized patients, the traumatized group reporting dissociative experiences as occurring 17% of the time and the nontraumatized group reporting dissociative experiences as occurring 11% of the time. DES absorption, depersonalization, and amnesia scores accounted for 21% of the variance in posttraumatic stress symptoms reported by patients with chronic pain. Findings are discussed in terms of their implications for assessment and cognitive–behavioral management of traumatic stress responding in persons with chronic pain.