复方曲马多片用于老年髋关节置换术后镇痛的临床观察

目的 观察复方曲马多片防治老年髋关节骨折术后疼痛的疗效、不良反应及安全性.方法 对2010年2月至2011年11月,在本院行髋关节置换手术的45例老年患者采用复方曲马多片口服镇痛(A组)、硬膜外止痛泵(B组)及静脉镇痛泵(C组)3种不同镇痛方式的临床资料进行回顾性分析.结果 3组患者的镇痛效果、血流动力学参数变化、恶心呕吐等并发症发生率无显著性差异,A组患者镇痛费用显著低于B组及C组(P＜0.05).结论 口服复方曲马多片防治老年髋关节术后疼痛,具有镇痛效果确切,费用低廉等优点.     

护理干预对普外术后患者疼痛的影响

目的:探讨护理干预对普外术后患者疼痛的影响.方法:将320例胃肠道,食道及乳腺癌手术后患者随机分为干预组和对照组,对照组进行常规镇痛治疗和护理,干预组进行综合护理干预.结果:干预组患者术后镇痛效果优于对照组,其差异有统计学意义(P<0.01),各护理干预措施与疼痛控制情况之间呈显著正相关(P<0.01).结论;综合护理干预可提高术后镇痛治疗效果,有效缓解患者术后疼痛.     

老年巨大肝癌切除术后患者基于活动性疼痛评估的护理干预

目的降低老年巨大肝癌切除术后患者疼痛程度,以促进患者康复。方法将74例老年巨大肝癌切除术患者随机分为观察组和对照组,每组37例。对照组按常规进行疼痛护理,观察组在常规疼痛护理基础上,由疼痛专科护士分别于术后第1~3天的10:00和16:00采用功能活动评分法(FAS)和数字评定量表(NRS)评估患者有效咳嗽时的活动性疼痛,针对评估结果实施护理干预。结果观察组术后第2~3天FAS评级、患者活动性疼痛评分及疼痛对患者影响程度评分显著低于对照组(P0.05,P0.01),观察组术后首次下床活动时间、肠功能恢复情况等显著优于对照组(P0.05,P0.01)。结论开展活动性疼痛评估有助于为术后患者采取及时有效的护理干预措施,提高疼痛管理质量,有利于促进患者康复。     

腰方肌阻滞与腹横肌平面阻滞用于老年患者腹腔镜结肠癌根治术后镇痛的效果对比

目的：比较腰方肌阻滞（QLB）与腹横肌平面阻滞（TAPB）用于老年患者腹腔镜结肠癌根治术后镇痛的效果。方法：将2020年8月至2021年12月于我院行腹腔镜结肠癌根治术治疗的82例老年患者随机分为2组,术后分别采用QLB和TAPB法进行术后镇痛。比较2组患者术后2h、8h、12h、24h疼痛程度及深呼吸或咳嗽时的舒适度。疼痛程度采用疼痛数字评估量表（NRS）评价,舒适度采用Bruggrmann舒适量表（BCS）评价。结果：QLB组患者术后2h、8h、12h、24hNRS评分均明显低于TAPB组（P <0.05）,而且各观察点BCS评分均明显高于TAPB组（P <0.05）。结论：QLB用于老年患者腹腔镜结肠癌根治术后镇痛效果优于TAPB。     

山东省164家医院术后镇痛管理现状调查分析

目的 了解山东省164家医院术后镇痛管理现状. 方法 依据急性疼痛管理指南和疼痛质量评估体系拟定调查问卷,调查内容包括医疗机构的性质、规模大小,疼痛管理的组织架构,急性疼痛服务组织(acute pain service,APS)的人员组成、运行模式、疼痛评估的实施和镇痛技术、流程等.采用多阶段分层整群抽样方法对山东省164家医疗机构进行术后镇痛管理现状调查分析. 结果 APS方面:32.9％的医院成立了类似APS的术后疼痛管理组织.疼痛评估方面:58.5％的医院将疼痛作为第5项生命体征进行评估,42.7％的医院对患者的静息痛和活动痛进行评估.自控镇痛技术方面:44.5％的医院采用自控镇痛模式;其中臂丛神经阻滞、腰丛神经阻滞、股神经阻滞镇痛分别为4.9％、1.2％和4.3％.疼痛知识教育方面:52.4％的医院对患者进行疼痛知识宣教,其中术后病房护士宣教占11.0％,APS查房宣教占1.2％. 结论 山东省医疗机构术后镇痛管理欠规范,护士极少参与疼痛管理,疼痛评估和疼痛知识宣教不到位,缺乏先进的镇痛管理技术.建议成立规范的术后疼痛管理组织和管理评估体系,规范术后疼痛管理.     

疼痛教育对肺癌术后患者疼痛控制的影响

目的 探讨疼痛教育对肺癌术后疼痛控制的影响.方法 将2008年3～4月103例拟实施肺癌部分肺叶切除术的患者设为对照组,入院后接受常规健康教育;将2008年6～7月98例拟实施肺癌部分肺叶切除术的患者设为观察组,在常规健康教育的基础上,由经过统一培训的疼痛教育小组成员开展疼痛教育,内容包括基础知识、镇痛方法及用药知识等.结果 两组接受教育前后的镇痛知识掌握程度及术后疼痛评分比较,差异有统计学意义(均P<0.05);观察组患者的睡眠时间较对照组显著延长(P＜0.01);首次下床活动时间、拔胸腔引流管时间较对照组显著提前(均P<0.01).结论 疼痛教育能转变医护人员和患者对疼痛的认识,显著改善肺癌术后患者疼痛控制效果,提高镇痛质量,促进患者康复.     

多模式镇痛在腹腔镜胃癌手术疼痛管理中的应用研究

目的:探讨多模式镇痛在腹腔镜胃癌手术疼痛管理中的临床效果。方法:选取2015年5月至2016年11月收治的40例腹腔镜胃癌手术患者作为对照组,另选取2017年1月至2018年7月40例腹腔镜胃癌手术患者作为试验组。对照组行常规疼痛管理措施,试验组在接受常规疼痛管理措施的基础上,施行多模式镇痛方案。采用数字评分法(NRS)评估患者静息及活动状态的疼痛,采用中文版功能活动评分法(FAS)评估患者活动时的疼痛,并根据评估结果实施多模式镇痛方案。结果:试验组患者术后8 h、16 h、24 h、32 h、48 h、72 h静息NRS评分低于对照组,差异有统计学意义(P<0.05);试验组术后3 d内FAS等级评价优于对照组,差异有统计学意义(P<0.05);试验组活动NRS评分低于对照组,差异有统计学意义(P<0.05);试验组术后总活动时间、距离、活动频次均优于对照组(P<0.05);试验组术后首次排便时间短于对照组(P<0.05)。结论:多模式镇痛可有效减轻患者疼痛程度,提高疼痛管理质量,增强术后活动的积极性,加快康复。     

超前镇痛对胰腺癌患者术后快速康复的影响

目的探讨超前镇痛对促进胰腺癌患者术后快速康复的作用。方法将60例胰十二指肠切除术患者随机分为观察组和对照组各30例。对照组术后常规采用镇痛泵镇痛;观察组在使用镇痛泵的同时,每天静脉注射帕瑞西布钠2次,按时给药。评价两组患者术后疼痛评分,首次离床活动时间,首次肛门排气时间,住院日及患者对镇痛护理满意度。结果观察组术后各时间段疼痛评分及不良反应发生率显著低于对照组(P0.05,P0.01),两组首次离床活动时间、首次肛门排气时间均提前于对照组,住院日显著短于对照组,满意度显著高于对照组(均P0.01)。结论超前镇痛可有效缓解胰十二指肠切除患者术后疼痛程度,促进快速康复。     

老年腹腔镜胆囊切除术围手术期的护理体会

目的探讨老年人行腹腔镜胆囊切除术围手术期的护理要点。方法对行腹腔镜胆囊切除术的54例老年患者进行全面的围手术期护理,并对护理效果进行分析与评估。结果 54例老年患者经过全面护理后,心理状态稳定,手术顺利,术后无1例患者出现并发症。结论腹腔镜胆囊切除术具有创伤小,安全性高,术后恢复快特点,对老年患者加强腹腔镜胆囊切除术围手术期护理是有助于保证手术顺利进行,可提高手术成功率,效果肯定。     

竖脊肌阻滞对日间腹腔镜胆囊切除术后恢复的影响

目的探究竖脊肌阻滞对日间腹腔镜胆囊切除术的镇痛效果,以及对术后恢复情况的影响。方法将2016年6月至2018年6月期间在本院行日间腹腔镜胆囊切除术的患者138例随机分成观察组与对照组,观察组采用竖脊肌阻滞联合静脉镇痛,对照组单纯使用静脉镇痛。比较两组患者的术后疼痛情况、术后恢复指标以及不良反应。结果观察组患者在术后清醒时、术后6小时以及术后12小时的VAS评分均明显的低于对照组;观察组术后当日下床活动患者比例术后疼痛延迟出院比例、术后住院时间等指标明显优于对照组;比较差异均具有显著性(P0.05)。结论竖脊肌阻滞用于日间腹腔镜下胆囊切除术镇痛效果好,住院时间短,术后恢复快,安全性好。     

The analgesic effect of gabapentin and mexiletine after breast surgery for cancer

We investigated the analgesic efficacy of mexiletine and gabapentin on acute and chronic pain associated with cancer breast surgery in 75 patients. They were randomized to receive, in a double-blinded manner, mexiletine 600 mg/d, gabapentin 1200 mg/d, or placebo for 10 days. Anesthesia was standardized, and all patients had access to routine postoperative analgesics on demand. The visual analog scale score assessed pain at rest and after movement. Three months later, all patients were interviewed to identify intensity of chronic pain and analgesic requirements. Mexiletine and gabapentin reduced codeine consumed from the second to tenth day by 50% (P = 0.029; P = 0.018 and P = 0.035 for mexiletine versus control and gabapentin versus control comparisons, respectively). Total paracetamol consumption was also reduced during the same time (P = 0.0085; P = 0.007 and P = 0.011 for the mexiletine and gabapentin groups when compared with the control, respectively). Pain at rest and after movement was reduced by both drugs on the third postoperative day. Pain after movement also was reduced by gabapentin between the second and fifth postoperative day. Three months later, the incidence of chronic pain, its intensity, and need for analgesics were not affected by either treatment. However, burning pain was more frequent in the control group (P = 0.033). IMPLICATIONS: Patients undergoing breast surgery for cancer may develop chronic pain. We evaluated the effect of mexiletine and gabapentin on the acute and chronic pain after breast surgery for cancer. Both drugs reduced the postoperative analgesic requirements, and particularly, gabapentin reduced pain after movement. The overall incidence of chronic pain was unaffected except for burning pain.     

Additive analgesic effect of codeine and paracetamol can be detected in strong, but not moderate, pain after Caesarean section

Background : A randomized, double-blind, placebo-controlled single oral dose study was done in order to examine whether codeine has an additive analgesic effect to that of paracetamol for moderate and strong postoperative pain after abdominal surgery. The maximum recommended single dose of paracetamol 1000 mg (Paracet®) was compared with a combination of a submnximal dose of paracetamol 800 mg plus codeine 60 mg (Paralgin forte®) and placebo for pain relief after Caesarean section in 125 patients. Methods : Visual analogue pain intensity score (VAS 0–100 mm) and categorical pain relief score were recorded for 6 hours after the study drug intake. The main efficacy variables analyzed were: pain intensity difference and summed pain intensity differences during the first 3 and 6 h after study drug intake, total pain relief during the first 3 and 6 h, global evaluation score at the end of the observation period, and time to rescue analgesic. Results : Because of protocol violations, 17 patients were excluded from the analysis of effects. Among the 108 patients included in the analysis of analgesic effect, 49 patients had moderate baseline pain (VAS between 40 and 60 mm on a 100 mm scale), and 59 patients had strong baseline pain (VAS more than 60 mm). In patients with strong baseline pain, statistically highly significant differences were documented in efficacy variables between the active drugs and placebo and between the two active drugs. However, in patients with moderate baseline pain, no differences were found between the study drugs in any of the analgesic efficacy variables. Conclusion : This study thus confirms that codeine has additive analgesic effect to paracetamol in pain after surgery. Our results show the importance of initial pain intensity in postoperative assessment of analgesic drugs. Assay-sensitivity and test power are increased by selecting patients with sufficiently high initial pain intensity and by comparing groups of patients with identical surgery and similar demographic variables.     

Intraoperative neurolysis of the celiac plexus in patients with unresectable pancreatic cancer

BACKGROUND: The analgetic treatment of inoperable pancreatic cancer patients is of paramount importance. The relative ineffectiveness of pharmacological agents has led many investigators to recommend chemical neurolysis of the celiac ganglions for pain control. However, the assessment of the results and the effectiveness of the block carried out during laparotomy have been unclear. PATIENTS AND METHODS: After 41 intraoperative celiac neurolytic blocks pain intensity was retrospectively analysed in 38 patients suffering from unresectable pancreatic carcinoma. The mean age of the patients was 59 years, the observation period after neurolysis ranged to 6 months. All patients underwent definitive neurolysis using 50 % ethanol in 0.5 % prilocaine. Immediate and long-term efficacy, analgetic consumption and mortality were evaluated at follow-up. The calculated parenteral equivalent morphine dosage (mg per day) was evaluated before as well as at different time points after treatment as an objective parameter to describe pain intensity. RESULTS: 7 to 34 days (at discharge from the hospital) after block pain intensity was statistically highly significant reduced (p=0.016). Long-term results were obtained from 17 (10 to 12 weeks after intervention) and 9 (up to 20 weeks after intervention) patients respectively, demonstrating a long-lasting effect of the neurolysis. A statistical analysis was not possible because of the small patient 's number.CONCLUSIONS: Intraoperative celiac neurolytic block is a safe and effective method of pain treatment in patients with unresectable pancreatic carcinoma. However, it alone provides complete pain relief until death only in a few cases. Therefore, it should be considered as an adjuvant treatment in the analgesic strategy. Combined palliative therapy is necessary in most of the cases.     

Naproxen premedication reduces postoperative tubal ligation pain

This study evaluated the effectiveness of naproxen sodium oral premedication in reducing postoperative pain, analgesic requirements and day surgery length of stay in patients undergoing outpatient laparoscopic tubal ligations. We undertook a randomized, double-blind clinical trial on ASA I and ASA II patients undergoing outpatient laparoscopic tubal ligations. The treatment group received two capsules containing naproxen sodium, 275 mg each, and the control group received two identical capsules containing placebo. Postoperative visual analogue pain scores, analgesic requirements, side-effects and length of day surgery stay were studied. Forty-four patients completed the study with 21 patients in the naproxen group and 23 in the placebo group. There was a statistically significant difference between groups in terms of pain score (naproxen group 0.9 +/- 0.2 vs placebo group 3.5 +/- 0.6); patients requiring postoperative opioids (naproxen group 0% vs placebo group 34.8%); and time spent in the day surgery unit (naproxen group 168 +/- 13 min vs placebo group 188 +/- 15 min). There was no difference in the incidence of nausea and vomiting. Only one person developed a side-effect from the naproxen sodium which was minor gastric discomfort. This study shows that naproxen decreased the postoperative tubal ligation pain with less subsequent postoperative analgesic requirements, less time to street fitness and no increase in analgesic side-effects. We recommend the use of this premedication in outpatient laparoscopic tubal ligations.     

Post-operative pain in children after day case surgery

The increasing use of paediatric day case surgery requires assessment of the effectiveness of post-operative analgesia. A prospective epidemiological study of ninety-eight patients undergoing day case surgery looked at pain assessment using a self report Faces scale and a numerical rating scale for parents and nursing staff. An inpatient record was combined with a home questionnaire detailing pain assessment and analgesic use over a 48 h period. Patients undergoing circumcision with a penile ring block experienced significant degrees of post-operative pain, had high levels of use of paracetamol at home, and their first night of sleep was frequently disturbed. High levels of opioid use were found. Comparison between assessors indicated parents tended to score their child's pain higher than nursing staff in hospital. Minor paediatric surgical procedures, particularly circumcision, may be associated with considerable post-operative pain and assumptions must not be made about the effectiveness of analgesia, especially in the home.     

The effect of preoperative intravenous use of tenoxicam: a prospective, double-blind, placebo-controlled study.

In this study, we aimed to investigate the postoperative pain relief effect of preoperative tenoxicam usage in patients who undergo elective laparoscopic cholecystectomy or groin hernia repair. Eighty patients undergoing laparoscopic cholecystectomy or groin hernia repair procedures were randomized to receive either physiologic serum at 100 mL (group I, n = 40) or 20 mg iv tenoxicam (group II, n = 40) immediately before induction. Postoperative analgesic requirement, peroperative side effects and complications of drugs, operating time, post-operative mobilization time and pain score, hospitalization time, and patient pleasure were recorded. Postoperative pain was assessed by the visual analogue scale (VAS) on the recovery unit (RU), at 4, 8, and 24 h and every day at the same times in the morning. The RU median VAS score was also not different when Group 1 was compared with Group 2 (p = .97). However, the postoperative 4-h and 8-h median VAS score was significantly less (p = .01 and p = .03, respectively); first postoperative mobilization time was earlier in group 2 (p = .32). The median pain score and intramuscular analgesic requirement of patients were also reduced in Group 2 in postoperative day 1 (p = .015). The median duration of intramuscular analgesic requirement and total amount of intramuscular analgesic used in patients were also significantly less in Group 2 (p = .0001 and p = .0001, respectively). Thus, this study showed that preoperative use of iv tenoxicam is safe, simple, and effective for postoperative pain relief after laparoscopic cholecystectomy or inguinal hernia repair.     

Significant Analgesic Benefits of Perioperative Duloxetine in Patients Who Have Depressive Symptoms Undergoing Total Hip Arthroplasty: A Randomized Controlled Trial

BackgroundMajor symptoms of depression are commonly observed in patients requiring total hip arthroplasty (THA), and this is associated with increased pain scores and opioid consumption. We aimed to investigate the analgesic effect of duloxetine in these high-risk patients.MethodsAmong 263 patients scheduled for primary unilateral THA, 67 patients who scored at least 8 on the 17-item Hamilton Depression Scale (HAMD) were enrolled in this study. Patients were randomized to the duloxetine group (60 mg daily, from the day of surgery to postoperative day 6) or the placebo group. The postoperative visual analog scale (VAS) score during walking, the VAS score during hip flexion, and resting VAS score was measured. Postoperative morphine consumption, hip range of motion (ROM), Harris hip score (HHS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) function, postoperative length of stay (LOS), and adverse events were recorded.ResultsThe duloxetine group had significantly lower VAS scores during walking and hip flexion from postoperative day 3 to week 3 than the placebo group. With regard to the resting VAS score, duloxetine showed a better analgesic effect from postoperative day 3 to week 2 than placebo. Patients in the duloxetine group had less consumption of morphine. The duloxetine group exhibited better hip function scores, including ROM, HHS, and WOMAC function scores than the placebo group. No significant difference was observed in LOS or adverse events between groups.ConclusionPerioperative short-term duloxetine provides advantages in decreasing pain, reducing morphine consumption, and increasing hip function in THA patients who have depressive symptoms.     

Prophylacticip injection of bupivacaine and/or morphine does not improve postoperative analgesia after laparoscopic gynecologic surgery

PURPOSE: To determine the effectiveness of ip bupivacaine and/or morphine for postoperative analgesia after laparoscopic surgery. A controversy exists on the effectiveness and clinical value of ip injection of local anesthetics for postoperative analgesia. A possible peripheral analgesic effect of morphine after ip injection remains debated as well. METHODS: We conducted a randomized, double-blinded, study to compare the efficacy of prophylactic ip administration of 0.9% saline (n = 16), 0.5% bupivacaine (100 mg, n = 15), morphine (3 mg, n = 16) and a mixture with 0.5% bupivacaine (100 mg) and morphine (3 mg, n = 18) to reduce both postoperative pain scores and analgesic requirements after gynecologic laparoscopic surgery. A multimodal analgesia regimen (acetaminophen, nonsteroidal anti-inflammatory drugs and morphine) was used for postoperative analgesia. RESULTS: No difference was observed in postoperative pain scores (visual analogue scale at rest and on coughing), or analgesic requirements during the first 24 postoperative hours between the four groups. There was also no significant intergroup difference in sedation scores and incidence of nausea and vomiting. CONCLUSION: When multimodal postoperative analgesia is used, prophylactic ip administration of 100 mg bupivacaine and/or 3 mg morphine does not significantly improve postoperative analgesia in patients undergoing laparoscopic gynecologic surgery.     

Patient outcomes after axillary lymph node dissection for breast cancer: use of postoperative continuous local anesthesia infusion

BACKGROUND: Although considered a safe surgical procedure, axillary lymph node dissection (ALND) is associated with postoperative numbness, paresthesias, pain, and muscle weakness. Despite meticulous surgical technique and the absence of long thoracic or thoracodorsal nerve injury, the risk of these complications are reported as great as 35% to 50%, with a subset of patients developing chronic pain syndromes. METHODS: Female patients (n = 27) undergoing Level I-II ALND for breast cancer were recruited. After ALND, patients were randomized to three groups. Group 1 received standard axillary lymph node dissection. Patients assigned to group 2 or 3 (double-blinded) received 120 h continuous 0.9% saline solution or 0.5% bupivacaine using a catheter placed into the axilla and delivered by an elastomeric pump device. After routine postoperative care, patients were discharged with oral opioid analgesics. Twice-daily assessment of pain, sedation, and nausea were conducted using validated visual-analog scale measures. Daily and total opioid analgesic requirements after surgery were recorded. RESULTS: Patients treated with a continuous infusion of bupivacaine experienced significantly lower pain scores (P < 0.001) during the first 5 postoperative days. Postoperative opioid analgesic requirements also were significantly decreased in the bupivacaine group, and these effects persisted until postoperative day 14 (P < 0.001). Concomitant to the observed decreases in pain and oral opioid requirements, nausea and morning sedation also were significantly reduced. There were no pump-related complications, wound infections, or postoperative axillary fluid collections. CONCLUSIONS: The use of continuous administration of bupivicaine after ALND significantly decreases pain and opioid analgesic requirements, with concomitant decreases in nausea and sedation. This study provides encouraging evidence of the therapeutic benefits of continuous infusion of local anesthesia and may represent a valuable adjunct for surgical patients who require ALND, including those with breast cancer and melanoma.