Antinociception induced by local injections of carbachol into the nucleus raphe magnus in rats: Alteration by intrathecal injection of monoaminergic antagonists

Electrical stimulation of neurons located in the nucleus raphe magnus (NRM) produces antinociception which appears to result from inhibition of spinothalamic tract neurons located in the spinal cord dorsal horn. Iontophoretic application of acetylcholine also activates NRM neurons and microinjection of cholinergic agonists such as carbachol into the NRM produces a profound, long-lasting antinociception. Since the antinociception induced by electrical stimulation of NRM neurons is mediated, at least in part, by bulbospinal serotonergic and noradrenergic neurons, the role of these monoaminergic neurons in mediating the antinociception induced by microinjecting carbachol in the NRM was examined in the present study. To this end, various antagonists of serotonin and norepinephrine were injected into the spinal cord subarachnoid space following the induction of antinociception by the local injection of carbachol into the NRM. The serotonergic antagonist methysergide had no effect on carbachol-induced antinociception. However, the alpha 2-noradrenergic antagonist yohimbine attenuated, while the alpha 1-noradrenergic antagonists prazosin and WB4101 increased the effects of carbachol. The non-selective noradrenergic antagonist phentolamine also attenuated the effects of carbachol. These results lead to the suggestion that the antinociception induced by the local injection of carbachol into the NRM is mediated by selective activation of bulbospinal noradrenergic neurons. Furthermore, the antinociception resulting from the activation of these descending noradrenergic neurons appears to be mediated by alpha 2-noradrenergic receptors located in the spinal cord dorsal horn. Finally, the local injection of carbachol into the NRM also appears to activate another population of noradrenergic neurons which produces hyperalgesia mediated by alpha 1-noradrenergic receptors.     

An assessment of the antinociceptive and aversive effects of stimulating identified sites in the rat brain

At many sites in the brain electrical stimulation with low current intensity is both aversive and causes antinociception. In view of the well documented antinociception caused by various types of stress and pain it is possible that in some parts of the brain the antinociception is secondary to the stress of the stimulation. At 114 sites in the rat brain the intensity of stimulation required to evoke an aversive response has been compared with the antinociceptive current intensity. Only stimulation in the dorsal hippocampus and pretectal area caused antinociception without significant aversion. Strong aversion resulted from stimulation of 46% of the sites including the central gray and nucleus raphe magnus. Antinociception was significantly correlated with the aversiveness of the stimulation although in 15% of the stimulation sites strong aversion was seen with no antinociception. It is concluded that there can be little justification in assigning a primary antinociceptive role to a brain area which evokes strong escape reactions when stimulated.     

罗哌卡因复合右美托咪定行收肌管阻滞预防全膝关节置换术后下肢深静脉血栓形成

目的探讨罗哌卡因复合右美托咪定行收肌管阻滞预防全膝关节置换术(TKA)后下肢深静脉血栓形成(DVT)的效果。 方法选取行TKA患者84例,随机均分为联合组(罗哌卡因+右美托咪定)和对照组(右美托咪定)。比较两组不同时间静息和运动疼痛评分、术后首次下床活动时间、术前和术后7天凝血功能指标、术后不良反应及DVT发生率。 结果静息状态下两组疼痛评分随时间增加逐渐降低；与术后6 h比较,运动状态下两组术后12、24、48、72 h疼痛评分均较低；且均联合组低于对照组(P＜0.05)。与术前比较,两组术后凝血酶原时间、活化部分凝血活酶时间降低,纤维蛋白原升高,且对照组较联合组显著(P＜0.05)。联合组术后首次下床活动时间和DVT发生率均低于对照组(P＜0.05)。两组不良反应发生率差异无显著性(P＞0.05)。 结论罗哌卡因复合右美托咪定行收肌管阻滞可改善TKA患者术后疼痛症状,促进康复,改善凝血功能,降低DVT发生率。     

间断给药收肌管阻滞用于全膝关节置换术后的镇痛效果

目的比较超声引导下连续收肌管阻滞(continuous adductor canal block,CACB)的两种给药方式对全膝关节置换术(total knee arthroplasty,TKA)后镇痛效果及早期活动的影响。方法接受蛛网膜下腔麻醉下行单侧全膝关节置换术的患者67例,男13例,女54例,年龄18～85岁,BMI 18～30kg/m~2,ASAⅠ～Ⅲ级,按随机数字表法分为恒速输注给药组(A组,n=34)和间断给药组(B组,n=33)。术毕行超声引导下CACB,负荷剂量0.2%罗哌卡因20ml。两组均连接电子输注泵行术后镇痛,镇痛泵配方为0.2%罗哌卡因240ml。A组恒速输注5 ml/h;B组自动给药每次5ml,间隔时间60min。两组单次按压剂量5ml,锁定时间30min,持续输注48h。记录术后不同时点镇痛泵用药总量、地佐辛使用量、股四头肌肌力、膝关节屈曲角度和步行距离以及恶心呕吐、头晕、嗜睡、置管处渗血渗液等不良反应的发生情况。结果 B组术后12、24h镇痛泵用药总量明显少于A组(P0.05),术后48h地佐辛使用量明显少于A组(P0.05);B组术后24、48h膝关节屈曲角度明显大于A组(P0.05),术后48、72h步行距离明显长于A组(P0.05)。两组股四头肌肌力差异无统计学意义。A组恶心呕吐发生率明显高于B组(P0.05);两组其他不良反应发生率差异无统计学意义。结论 CACB用于TKA术后镇痛,与恒速输注给药方式比较,间断给药的输注方式可以提供更好的镇痛效果,减少术后阿片类镇痛药的使用,同时不增加对运动神经的阻滞作用,有利于患者术后早期活动。     

Surgical versus conservative management of traumatic proximal adductor longus avulsion injuries: A systematic review

BackgroundProximal avulsion injuries of the adductor longus have been managed both conservatively and operatively with good clinical outcomes, but there is no consensus on which option yields the best results. Thus, the present study aimed to review the available literature, comparing the outcomes and the time to return to sports with different management options.Material and methodsThis study was conducted according to the PRISMA statement. The literature search was conducted in September 2020. All the clinical trials investigating the management of traumatic proximal adductor longus avulsion injuries were considered for inclusion. Only studies reporting data from athletes were considered. The outcomes of interest were the time to return to sport and return to preinjury activity level.ResultsData from 46 patients were retrieved. The mean follow-up was 24.6 ± 23.8 months. The study population was represented by male athletes with a mean age of 30.0 ± 4.8. Mean stump retraction was 3.3 ± 0.6 cm in the surgical and 1.7 ± 0.6 in the conservative cohort (P = 0.07). The rate of patients returning to prior activity level was similar in the two groups, but surgically treated patients required a longer time to return to sport (3.9 ± 1.5 months vs. 2.2 ± 1.0 months, P = 0.0001).ConclusionConservative management for traumatic avulsion of the proximal adductor longus insertion may produce shorter time to return to sport. Both conservative and operative strategies allowed to achieve similar pre-injury activity level.Level of evidenceIV, systematic review.     

TOF count at corrugator supercilii reflects abdominal muscles relaxation better than at adductor pollicis

Background: A recovery profile from neuromuscular block similar to thatof abdominal (AB) muscles, but different to that of the adductorpollicis (AP) muscle, has been demonstrated at the corrugatorsupercilii (CSC) muscle. We hypothesized that neuromusculartransmission (NMT) monitoring of CSC might provide useful informationon AB relaxation compared with AP. We compared the visual estimationof NMT at CSC and AP with electromyographic measurements ofAB during recovery from a vecuronium block. Methods: Ten adult patients were studied during balanced anaesthesia.After induction of anaesthesia and tracheal intubation withoutneuromuscular blocking agents, supramaximal stimulations wereapplied to three nerves: left 10th intercostal, ulnar, and facial.Electromyographic activity (EMG) of AB was measured (ABEMG).After a bolus dose of vecuronium 0.1 mg kg^–1, an independentobserver blinded to the EMG measurements counted visually detectabletrain-of-four (TOF) responses at CSC and AP. Values of ABEMGassociated with 1 to 4 TOF responses at CSC and AP were compared.Values are means (SD). Results: Reappearance of the first and second TOF responses at CSC occurredsignificantly (P < 0.05) earlier and at lower ABEMG recoverythan that of AP [35 (8) and 41 (9) min vs 51 (10) and 56 (12)min; and 17 (8) and 26 (9)% vs 56 (10) and 75 (11)%, respectively]. Conclusions: We demonstrated that the TOF response count at the CSC, comparedwith the AP, allowed a better quantification of the degree ofAB muscle relaxation during recovery from vecuronium block.     

大收肌腱复合组织瓣游离移植修复手前臂皮肤肌腱缺损

目的为手前臂皮肤伴肌腱缺损修复提供一种新的有效的手术方法。方法在对以膝降动脉为蒂的大收肌腱复合组织瓣修复手部肌腱伴皮肤(骨)缺损的新术式进行解剖学研究的基础上,临床应用吻合血管的大收肌肌腱复合组织瓣游离移植修复手前臂皮肤肌腱缺损3例。结果全部病例术后皮瓣全部成活,随访3~14个月,平均5.4个月,根据手部功能评价为优1例,良1例,可1例。结论应用吻合膝降血管的大收肌肌腱复合组织瓣游离移植修复手前臂皮肤肌腱缺损的术式具有供区隐蔽创伤小等优点,此手术为手前臂皮肤肌腱缺损修复提供了一种良好的方法。     

Intramuscular nerve distribution pattern of the oblique and transverse heads of the adductor hallucis muscles in the human foot

To understand which layer of the intrinsic muscles of the foot the adductor hallucis muscle belongs to, it is essential to investigate the innervation patterns of this muscle. In the present study, we examined the innervation patterns of the adductor hallucis muscles in 17 feet of 15 Japanese cadavers. We investigated the intramuscular nerve supplies of the adductor hallucis muscles in six feet and performed nerve fiber analysis in three feet. The results indicate that: (i) the oblique head of the adductor hallucis muscle is divided into three compartments (i.e. lateral, dorsal and medial parts) or two compartments (i.e. dorsal and medial parts) based on its intramuscular nerve supplies, but we could not classify the transverse head into any parts; (ii) the communicating twig between the lateral and medial plantar nerves penetrated the oblique head of the adductor hallucis muscle in 13 of 17 feet (76.5%); (iii) the penetrating twig entered between the lateral and dorsal parts of the oblique head, passed between the lateral and medial parts of this muscle and then connected with the medial plantar nerve; and (iv) the majority of the nerve fibers of the penetrating twig derived from the lateral plantar nerve. The present study demonstrated that only the lateral part of the oblique head of the adductor hallucis muscle had a unique innervating pattern different from other parts of this muscle, suggesting that the lateral part of the oblique head has a different origin from other parts of this muscle.     

气海俞电针治疗股内收肌损伤40例

目的:观察气海俞电针治疗股内收肌损伤的临床疗效.方法:将40例股内收肌损伤患者采用气海俞深刺后,单穴电针治疗.结果:治疗10天后,治愈31例(77.5％),总有效率为(95.0％).结论:气海俞电针治疗股内收肌损伤有显著的临床疗效.