Measurement of post-operative pain and narcotic administration in infants using a new clinical scoring system

We developed a clinical neurologic and behavioral scoring system composed of 10 items to measure the post-operative pain levels in infants: (1) sleep during preceeding hour, (2) facial expression of pain, (3) quality of cry, (4) spontaneous motor activity, (5) Spontaneous excitability, (6) flexion of fingers and toes, (7) sucking, (8) global evaluation of tone, (9) consolability and (10) sociability. Using this system, a group of infants ranging from one to seven months in age and undergoing minor surgical procedures was studied. The infants were randomly assigned to two groups: Group I received Fentanyl intravenously (3 μg/kg) prior to surgery, and Group II received a placebo. The infants then were studied post-operatively in the recovery room at 30, 60, 90 and 120 min intervals. Over the entire post-operative observation period, 54% of the infants in Group I had satisfactory analgesia compared to 18% in Group II. There were no significant differences in Group I and Group II in oxygenation, carbon dioxide elimination, blood pressure, heart rate or temperature.     

Acute fatal chest pain: optimized procedure in emergency department

Objective

To explore the diagnostic procedure of acute fatal chest pain in emergency department (ED) in order to decrease the misdiagnosis rate and shorten the definite time to diagnosis. The ultimate aim is to rescue the patients timely and effectively.

Methods

Three hundreds and two patients (56.9±11.8 Years, 72% men) complained with acute chest pain and chest distress presenting to our ED were recruited. They were divided into two groups according to visiting time (Group I: from October 2010 to March 2011, Group II: from October 2011 to March 2012). The misdiagnosis rate, definite time for diagnosis and medical expense were analyzed. Patients of Group I were diagnosed by initial doctors who made their diagnosis according to personal experience in outpatient service or rescue room in ED. While patients of Group II were all admitted to rescue room and were diagnosed and rescued according to the acute chest pain screening flow-process diagram. Differences inter-group was compared.

Results

The misdiagnosis rate of fatal chest pain in Group I and Group II was 6.8% and 0% respectively, and there was statistic difference (P=0.000). The definite time to diagnosis was 65.3 min and 40.1 min in control and Group II respectively, the difference had statistic significance (P=0.000). And the mean cost for treatment was 787.5/124.5 ¥/$ and 905.5/143.2 ¥/$ respectively, and there was statistic difference too (P=0.012).

Conclusion

Treating emergency patients with acute chest pain according to the acute chest pain screening flow-process diagram in rescue room will decrease misdiagnosis apparently, and it can also shorten the definite time to correct diagnosis. It has a remarkable positive role in rescuing patients with acute chest pain timely and effectively.

     

Nebulized Fentanyl for Relief of Abdominal Pain

OBJECTIVE: To compare the efficacies of nebulized vs. intravenous fentanyl for the relief of abdominal pain. METHODS: This randomized, double-blind, double-placebo-controlled study compared nebulized and intravenous fentanyl (1.5 micro g/kg). Group I received intravenous fentanyl and nebulized saline. Group II received nebulized fentanyl and intravenous saline. Pain scores were measured at baseline and at 15 and 30 minutes after the study drug, using a 100-mm visual analog scale. Thirty minutes after the study drug, the subjects were offered rescue medication. The groups were compared for changes in pain scores at 30 minutes (primary outcome, t-test), changes in pain scores at 15 minutes (t-test), and need for rescue medication (Fisher's exact test). Significance was defined as p < 0.05. RESULTS: Fifty subjects (24 group I, 26 group II) were enrolled. The groups were similar with respect to mean baseline pain (72 mm group I, 74 mm group II) and demographics. A statistically significant difference in changes in pain scores at 15 minutes favoring group I (25 mm vs. 10 mm, p = 0.005) was not evident by 30 minutes (25 mm vs. 16 mm, p = 0.24). The groups were not different with respect to need for rescue medication (50% in group I compared with 69% in group II, p = 0.25). CONCLUSIONS: Nebulized fentanyl provides comparable analgesia to that of intravenous fentanyl.     

悬吊运动训练对颈源性头痛的疗效

目的观察悬吊运动训练治疗颈源性头痛的临床疗效。方法颈源性头痛患者60 例,按就诊顺序分为两组。Ⅰ组(n=30)行C2椎旁阻滞,每周1 次;Ⅱ组(n=30)在颈椎旁阻滞基础上配合悬吊运动训练,悬吊运动训练每周3 次。均治疗4 周。观察治疗前与治疗后1 个月、3 个月、6 个月的疼痛视觉模拟评分(VAS)、每月疼痛发作次数及临床疗效。结果治疗后VAS评分,Ⅰ组治疗后1 个月、3 个月,Ⅱ组治疗后1 个月、3 个月、6 个月均较治疗前显著改善(P<0.001);治疗后3 个月、6 个月,Ⅱ组较Ⅰ组改善更显著(P<0.001)。治疗后疼痛发作次数,Ⅰ组治疗后1 个月、3 个月,Ⅱ组治疗后1 个月、3 个月、6 个月均较治疗前减少(P<0.05);治疗后3 个月、6 个月,Ⅱ组较Ⅰ组减少更明显(P<0.05)。治疗后Ⅰ组优良率33.3%,Ⅱ组73.3% (P<0.01)。结论配合悬吊运动训练治疗颈源性头痛优于单一采用颈椎旁阻滞,远期效果更佳。     

Results of extracorporeal shock-wave application in lateral elbow tendopathy

AIM: This review article focuses on a possible pain-alleviating effect of shock-wave application in persistent lateral epicondylopathy of the elbow and compares the effects with data on other non-operative and operative procedures. METHODS: Patients who suffered from chronic tennis elbow for more than 12 months and were therefore referred for a surgical procedure were assigned at random to two groups of low-energy shock-wave therapy. Group I received a total of 3000 (3 x 1000) impulses of 0.08 mJ/mm(2), while group II (control group) received a total of 30 (3 x 10) impulses of 0.08 mJ/mm(2). Follow-up examinations were carried out after 3, 6, and 24 and 52 weeks. RESULTS: There was a significant improvement of pain and function in group I, with a good or excellent outcome in 52% of cases compared to 6% in group II at the last evaluation. CONCLUSION: Extracorporeal shock-wave application has a dose-dependent pain-relieving effect on chronic tendopathy of the lateral elbow.     

Tramadol

Résumé  Lors d'une étude randomisée effectuée en double aveugle, 35 patientes de classe ASA I et II re?oivent une dose de charge de 150 mg de tramadol par voie intraveineuse, suivie dans le premier groupe d'une infusion de tramadol à 15 mg/heure ou dans le deuxième groupe d'une perfusion de solution saline. Les malades des deux groupes re?oivent 100 mg à la demande pour le traitement de la douleur post-opératoire. Les patientes du groupe I nécessitent 60% de moins de tramadol à la demande (p<0,01) et bénéficient d'une meilleure analgésie post-opératoire que celles du group II. La consommation globale de tramadol est cependant de 30% plus élevée dans le 1er groupe (p<0,05), ce qui est associé à une incidence croissante d'effets secondaires mineurs. Dans les deux groupes, les pics de taux sériques sont enregistrés à la quinzième et soixantième minute et les concentrations diminuent progressivement après le deuxième pic (p<0.001). 6% des patientes du premier groupe et 20% de celles du deuxième sont réfractaires au traitement. Nous affirmons qu'un traitement par infusion continue de tramadol associé à des injections à la demande est la voie thérapeutique de la douleur post-opératoire la plus s?re et la moilleure.

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Summary  Thirty-five ASA Grade I-II females received tramadol 150 mg intravenously followed randomly and doubleblind by an infusion of either tramadol 15 mg h⁻¹ (Group I) or saline (Group II) and tramadol 100 mg bolus on demand for infusion in addition to on-demand i.v. tramadol treatment of post-operative pain. Patients in Group I required 60% less tramadol on demand (P<0.01) and had better pain relief after operation (P<0.05) than those in the group given saline. Total tramadol consumption, however, was about 30% higher in Group I (P<0.05) and was associated with an increased incidence of minor side-effects. In both groups median serum tramadol concentrations peaked at 15 and 60 min and decreased after the second peak steadily (P<0.001). Tramadol failed to relieve pain within 2 h after the beginning of treatment in 6% (Group I) and 20% (Group II) of the patients. It is suggested that use of an i.v. maintenance tramadol boluses is a safe and recommended mode of post-operative intra-venous pain therapy.

     

Effect of energy administration on the amino acid level in the postoperative phase

A total of 34 cancer patients, all of them subjected to radical surgery of the stomach or large bowel were studied. Group I (n = 5) received during the first postoperative days total parenteral nutrition with a caloric support of 35-45 kcal/kg/day and 12,5 gr N in a 8,5% L-aminoacid solution (Freamine II). Group II (n = 9) received an isotonic solution of 3% L-aminoacid without caloric support. Serum amino acids (AA) were determined daily (Perkin-Elmer KLA-1 Analyzer), as well as nitrogen balance (NB) and serum albumin (Alb) on the preoperative, 1st, and 6th postoperative day: Both groups experienced a progressive increase of serum AA during the period of study. Group II showed levels of branched-AA significantly higher than group I, as well as the total of essential-AA. MET, GLY and PHE were considerably elevated in both groups. ALA did not change in group I showing subnormal values in group II. NB was significantly higher in group I, but none of the groups studied has recovered the initial values of Alb after six days of treatment.     

Effect of the class and individual applications of task-oriented circuit training on gait ability in patients with chronic stroke

[Purpose] This study aimed to determine differences in gait abilities by comparing class-based task-oriented circuit training (CTCT) and individual-based task-oriented circuit training (ITCT). [Subjects and Methods] The subjects were 30 patients who were diagnosed with hemiplegia due to stroke more than six months previously. They were divided into Group I (n=10), which received conventional physiotherapy, Group II (n=10), which received conventional physiotherapy and ITCT, and Group III (n=10), which received conventional physiotherapy and CTCT. To determine the qualitative aspect of gait ability, a GAITRite (CIR Systems Inc., Sparta NJ, USA) was employed, while a two-minute walking test (2MWT) was conducted to determine the quantitative aspect. [Results] The gait ability showed significant differences in velocity, cadence, and 2MWT between groups in the significance test. As a result, the Bonferroni post test showed that gait velocity was significantly different between Groups I and II and between Groups I and III, while cadence showed a significant difference between Groups I and III. In the 2MWT, Groups I and II and Groups I and III also showed significant differences. [Conclusion] Both the individual and class applications task-oriented circuit training were effective for improving gait ability. This result indicates that CTCT can improve the physical ability of stroke patients as much as ITCT.Key words: Gait, Stroke, Task-oriented circuit training     

Simvastatin and fluvastatin reduce interleukin-6 and interleukin-8 lipopolysaccharide (LPS) stimulated production by isolated human monocytes from chronic kidney disease patients.

BACKGROUND: Statins reduce lipid levels, inflammation and cardiovascular events in patients with coronary artery disease; CKD patients show increased risk of cardiovascular and increased plasma levels of IL-6 and IL-8. AIM: To evaluate the in vitro effect of simvastatin (S) or fluvastatin (F) on the lipopolysaccharide (LPS) stimulated secretion of IL-6 and IL-8 from monocytes of chronic kidney disease patients (CKD) in K-DOQI stages 3-5. METHODS AND SUBJECTS: Monocytes enriched peripheral blood (PBMC) from 28 CKD (15 in K-DOQI stages 3-4, Group I, and 13 in K-DOQI stage 5 on hemodialysis, Group II) and 10 healthy subjects (HS), were isolated by Ficoll-gradient centrifugation. Cells were incubated with LPS 100 ng/ml or with LPS plus increasing doses of statins (from 10(-6) to 10(-8) M ) for 24 h. Surnatant IL-6 and IL-8 concentrations were determined by EIA. RESULTS: Basally the mean concentration of IL-6 and IL-8 was higher in patients than in HS and in Group II than in Group I (IL6: HS 285 +/- 77 pg/ml, Group I 365 +/- 178 pg/ml, Group II 520 +/- 139 pg/ml- IL8 HS 180 +/- 75 pg/ml, Group I 1722 +/- 582 pg/ml, Group II 4400 +/- 1935 pg/ml). After addition of LPS the mean concentration of IL-6 and IL-8 increased in all groups (IL6: HS 1740 +/- 178 pg/ml, Group I 3754 +/- 672 pg/ml, Group II 4800 +/- 967 pg/ml; IL8: HS 450+/-132 pg/ml, Group I 9700+/-2837 pg/ml, Group II 11608 +/- 2316 pg/ml). After the addition of LPS plus increasing doses of S or F from 10(-10) to 10(-6) M, a significantly lower cytokine concentration compared to the data after LPS alone was observed (IL6: HS 45%, Group I 75%, Group II 50%; IL8: HS 100%, Group I 65%, Group II 35%). CONCLUSIONS: These data confirm that cytokine release is increased in CKD patients and that is highest in the most severe patients. Furthermore they suggest that fluvastatin or simvastatin can be used in order to reduce the high cardiovascular risk.     

The effects of kinesio taping on architecture,strength and pain of muscles in delayed onset muscle soreness of biceps brachii

[Purpose] This study aimed to confirm the effects of kinesio taping (KT) on muscle function and pain due to delayed onset muscle soreness (DOMS) of the biceps brachii. [Subjects and Methods] Thirty-seven subjects with induced DOMS were randomized into either Group I (control, n=19) or Group II (KT, n=18). Outcome measures were recorded before the intervention (application of KT) and at 24, 48, and 72 hours after the intervention. DOMS was induced, and muscle thickness was measured using ultrasonic radiography. Maximal voluntary isometric contraction (%MVIC) was measured via electromyography (EMG). Subjective pain was measured using a visual analogue scale (VAS). [Results] Group I exhibited a positive correlation between muscle thickness and elapsed time from intervention (24, 48, and 72 hours post induction of DOMS); they also showed a significant decrease in MVIC(%). Group II showed significant increases in muscle thickness up to the 48-hour interval post induction of DOMS, along with a significant decrease in MVIC (%). However, in contrast to Group I, Group II did not show a significant difference in muscle thickness or MVIC (%) at the 72-hour interval in comparison with the values prior to DOMS induction. [Conclusion] In adults with DOMS, activation of muscles by applying KT was found to be an effective and faster method of recovering muscle strength than rest alone.Key words: Delayed Onset Muscle Soreness (DOMS), Kinesio taping, Muscle change     

Effects of electroacupuncture on intraoperative and postoperative analgesic requirement

Acupuncture has been shown to be effective in experimental and clinical acute pain settings. This study aims to evaluate the effect of preoperative electroacupuncture (EA) on intraoperative and postoperative analgesic (alfentanil and morphine) requirement in patients scheduled for gynaecologic lower abdominal surgery. Ninety patients were randomly assigned to one of three groups: Group I (control group)--received placebo EA for 45 minutes before induction of general anaesthesia (GA); Group II--preoperative EA instituted 45 minutes before induction of GA; Group III--45 minutes of postoperative EA. The Bispectral Index monitor was used intraoperatively to monitor the hypnotic effect of anaesthetic drugs, and alfentanil was titrated to maintain the blood pressure and pulse rate within +/- 15% of basal values. Postoperative pain was managed by intravenous morphine via a patient-controlled analgesia (PCA) device. Patients in Group II (0.44 +/- .15microg/kg/min) received less alfentanil than those in Group III (0.58 +/- .22 microg/kg/min) (p = p.024), but not significantly less than those in Group I 10.51 +/- 0.21 microg/kg/min) (p = 0.472). Postoperative morphine consumption was numerically lower in Group II compared with the other groups; however, the difference was statistically significant only during the period of 6-12 hours between Group II [0.03 (0.05) mg/kg] and Group I [0.10 (0.11) mg/kg] (p = 0.015), and Group II and Group III [0.08 (0.10) mg/kg] (p = 0.010). The 24-hour cumulative morphine consumption for Group II (0.52 +/- .19mg/kg) was less than that for either Group I I0.68 +/- 38mg/kg) or Group III (0.58 +/- .27mg/kg), but the difference did not reach significance. In conclusion, preoperative EA leads to a reduced intraoperative alfentanil consumption, though this effect may not be specific, and has a morphine sparing effect during the early postoperative period.     

The Effects of Sensorimotor Training on Anticipatory Postural Adjustment of the Trunk in Chronic Low Back Pain Patients

[Purpose] This study aimed to examine the effects of sensorimotor training on the anticipatory postural adjustment (APA) of chronic low back pain (CLBP) patients. [Subjects and Methods] Fourteen CLBP patients were randomly assigned to Group II (ordinary physical therapy, n=7) and Group III (sensorimotor training, n=7). In addition, a normal group (Group I) consisting of seven subjects was chosen as the control group. The two CLBP groups received their own treatment five times per week, for four weeks, for 40 minutes each time. Changes in pain and functional performance evaluation were examined by the visual analogue scale (VAS) and the Oswestry Disability Index (ODI). In order to look at the change in APA, muscle onset time was examined using electromyography (EMG). [Results] Group III showed significant changes in both VAS and ODI. According to comparison of the results for muscle onset time, there were significant decreases in Group III''s transversus abdominis muscle (TrA) and external oblique muscle (EO) in the standing and sitting positions. There were significant differences between Group II and III in terms of the TrA in the sitting position. [Conclusion] Sensorimotor training makes patients capable of learning how to adjust muscles, thereby alleviating pain and improving muscle performance.Key words: Anticipatory postural adjustments, Chronic low back pain, Sensorimotor training     

The role of cardiovascular magnetic resonance in candidates for Fontan operation: Proposal of a new Algorithm

Background

To propose a new diagnostic algorithm for candidates for Fontan and identify those who can skip cardiac catheterization (CC).

Methods

Forty-four candidates for Fontan (median age 4.8 years, range: 2-29 years) were prospectively evaluated by trans-thoracic echocardiography (TTE), Cardiovascular magnetic resonance (CMR) and CC. Before CC, according to clinical, echo and CMR findings, patients were divided in two groups: Group I comprised 18 patients deemed suitable for Fontan without requiring CC; group II comprised 26 patients indicated for CC either in order to detect more details, or for interventional procedures.

Results

In Group I ("CC not required") no unexpected new information affecting surgical planning was provided by CC. Conversely, in Group II new information was provided by CC in three patients (0 vs 11.5%, p = 0.35) and in six an interventional procedure was performed. During CC, minor complications occurred in one patient from Group I and in three from Group II (6 vs 14%, p = 0.7). Radiation Dose-Area product was similar in the two groups (Median 20 Gycm², range: 5-40 vs 26.5 Gycm², range: 9-270 p = 0.37). All 18 Group I patients and 19 Group II patients underwent a total cavo-pulmonary anastomosis; in the remaining seven group II patients, four were excluded from Fontan; two are awaiting Fontan; one refused the intervention.

Conclusion

In this paper we propose a new diagnostic algorithm in a pre-Fontan setting. An accurate non-invasive evaluation comprising TTE and CMR could select patients who can skip CC.     

Two-year survival and neurodevelopmental outcomes after cardiopulmonary resuscitation in neonatal patients after complex cardiac surgery

Aim

To examine survival and neurodevelopmental outcomes in neonates having post-operative cardiopulmonary resuscitation (CPR).

Methods

This inception cohort study included all neonates (6 weeks old or less) who received postoperative CPR (Group 1) after cardiac surgery from 1996 to 2005, matched for heart defect, year of surgery, chromosomal abnormality, and socioeconomic status to two neonates who did not receive postoperative CPR (Group 2). Two-year neurodevelopment was prospectively assessed with Bayley Scales of Infant Development II and Adaptive Behavior Assessment System II. Pre-, intra-, and post-operative variables were collected prospectively. Cardiac arrest variables were collected retrospectively. Predictors of mortality were analyzed by univariate analysis and conditional multiple logistic regression.

Results

There were 29 patients in Group 1, and 58 patients in Group 2. In survivors, there were no significant differences between Groups 1 and 2 in outcomes [mean (SD)] of mental developmental index [84.5 (12.2) vs. 81.0 (18.9)], psychomotor developmental index [82.8 (13.8) vs. 80.1 (21.9)], General Adaptive Composite [84.6 (15.3) vs. 84.3 (19.2)], Motor scale [8.4 (3.2) vs. 8.0 (3.8)], or delay on any of these scales. Two-year mortality [58.6% Group 1; 8.6% Group 2], was associated on conditional multiple logistic regression with CPR (OR 26.6; 95% CI, 5.4, 129.5). In Group 1, on multiple logistic regression, 2-year mortality was associated with minutes of chest compressions (OR 1.04, 95% CI, 1.01, 1.08).

Conclusions

Among neonates having cardiac surgery, CPR is associated with greater mortality. There is no evidence that CPR survivors have different 2-year neurodevelopmental outcomes than those neonates not having CPR.     

Procedures for preventing postoperative nausea and vomiting after laparoscopic cholecystectomy: dexamethasone and ondansetron

This randomized double-blind study was undertaken to evaluate the efficacy of ondasetron and dexamathesone in reducing the incidence of postoperative nausea and vomiting after laparoscopic cholecystectomy. The study covered 60 patients (ASA I/II) who had undergone laparoscopic cholecystectomy under general anesthesia. The patients were divided into two groups: 1) 30 patients who received dexamethasone, 4 mg i.v.; and 2) 30 patients who took ondansetron, 4 mg i.v., prior to general anesthesia. Postoperatively, nausea, vomiting, and severe pain (VAS) were observed every 6 hours within the first 24 hours. Postoperative nausea and vomiting occurred in 6 (20) patients in Group I and in 13 (43.33) patients in Group 2 (p < 0.05), while vomiting did only in 5 (16.66%) patients in Group I and 4 (13.33%) in Group 2 (p > 0.05). The least intensity of postoperative pain was observed in Group 1, but the difference between the study groups was insignificant. It is concluded that dexamethasone is more effective in preventing postoperative nausea and vomiting after laparoscopic cholecystectomy than ondansetron. This is mainly determined by a significant reduction in the incidence of postoperative nausea.     

氯诺昔康对异丙酚静脉注射痛的预防作用

目的：与利多卡因和安慰剂对照比较，观察氯诺昔康对异丙酚静脉注射引起的疼痛缓解程度。方法：选择120例ASAⅠ～Ⅱ级的择期手术病人，随机分为4组：Ⅰ组在施行异丙酚诱导之前60s,给予氯诺昔康4mg(2m1)；Ⅱ组在施行异丙酚诱导之前60s给予氯诺昔康8mg(2m1)；Ⅲ组在施行异丙酚诱导之前60s给予利多卡因40mg(2m1)；Ⅳ组在施行异丙酚诱导之前60s给予生理盐水(2m1)。观察每组疼痛的发生率和根据Ambesh法进行疼痛评分。结果：与安慰剂对照组相比，氯诺昔康和利多卡因一样可以降低异丙酚静脉注射疼痛发生率，不同剂量的氯诺昔康与降低疼痛程度无显著差异，氯诺昔康与利多卡因之间也无显著差异。结论：氯诺昔康作为麻醉的辅助用药，可降低异丙酚引起的静脉注射痛，与利多卡因比较无明显差异，而氯诺昔康4mg与8mg剂量疼痛缓解率相同。     

Immune response to blood transfusion invery-low-birthweight infants

BACKGROUND: Allogeneic blood transfusion is common in the treatment of neonatal anemia of prematurity or anemia due to multiple phlebotomies. The immune response of neonates to passenger leukocytes from allogeneic red cells was investigated. STUDY DESIGN AND METHODS: Fourteen infants (4 male, 10 female) prospectively were randomly assigned to receive either white cell-reduced (Group 1) or non-white-cell reduced (Group 2) irradiated blood. Blood samples were taken before and at various time intervals after transfusion (Days 1, 5-7,and 10-14). Cord blood from 11 healthy term infants was used for comparison. The following surface markers were used to assess immune modulation by flow cytometry: CD45RA/CD45RO, CD4/CD8, CD25/CD28, CD3/DR, CD14/B7, and CD3/CD56+CD16. Donor cell microchimerism was studied using semi-quantitative polymerase chain reaction Y-chromosome detection in female infants who received male donor blood. Donor and recipient HLA class II typing was performed with polymerase chain reaction with sequence specific primers. RESULTS: The lymphocyte counts in both groups were significantly increased after transfusion, and there was a significant increase in lymphocytes expressing CD45RA, CD3-/CD16+CD56, CD80, and CD3-/DR on Day 14. The premature infants' pretransfusion natural killer cell population (CD3-/CD16+CD56) was significantly lower than that of term infants, but it reached a similar level by Days 10-14. CD8 subpopulations were increased but not CD4+ cells. Two female infants (of 6) had circulating Y chromosomes 1 day after transfusion, and most of the infants effectively cleared the donor cells within 24 hours of transfusion. Two Group 2 infants who by chance received presumably HLA-haploidentical donor blood developed necrotizing enterocolitis. CONCLUSION: Blood transfusion alters immune cell antigen expression in premature neonates and may initially be immunostimulatory and later immunosuppressive.     

利多卡因联合不同浓度罗库溴铵缓解注射痛的研究

目的探讨利多卡因联合不同浓度罗库溴铵对注射痛的缓解作用。方法选择行经1：2插管全麻的择期手术患者120例（ASAI-Ⅱ级）,按随机数字表法分为A、B、C组各40例。三组患者均静脉注射利多卡因30mg10s后,静脉注射罗库溴铵10mg（A组浓度为10mg／ml,B组浓度为5mg／ml,C组浓度为1mg／m1）,10s内推注完,立即测评患者疼痛评分,记录MAP、HR、SpO：及输注并发症。结果三组患者注射痛发生率分别为35．0％,25．0％和2．5％;A、B组疼痛程度比较差异无统计学意义（P〉0．05）;C组疼痛程度与A、B组比较差异均有统计学意义（P〈0。01）;各组MAP、HR、Sp02及输注并发症比较差异无统计学意义（P〉0．05）。结论预先注射利多卡因30mg／ml,罗库溴铵稀释到1mg／ml推注能简单、有效的预防男崖淖咎辟射痛．     

The effect of caudal bupivacaine versus tramadol in post-operative analgesia for paediatric patients

In this study 20 paediatric surgical patients were randomized to two groups after induction of general anaesthesia. Group 1 received 0.25% bupivacaine (2 mg/kg) and group 2 received 5% tramadol (2 mg/kg) both as a caudal block. Heart rate, mean arterial pressure, arterial oxygen saturation, respiratory rate and pain and sedation scores were recorded at 1, 2, 4, 6, 12 and 24 h post-operatively. Acetaminophen was administered rectally (20 mg/kg) if the pain score was > 3/10. The pain and sedation scores in group 2 were significantly lower compared with group 1. There were no significant differences in heart rate, mean arterial pressure, arterial oxygen saturation and respiratory rate between the two groups. In conclusion, caudal tramadol was superior to bupivacaine in analgesic efficacy and in reducing the need for additional analgesia during the post-operative period in paediatric patients.