Comparison of the effects of lornoxicam versus diclofenac in pain management after cardiac surgery: A single-blind, randomized, active-controlled study

Background:

Inadequate pain management after cardiac surgery may result 10 in increased morbidity and length of hospital stay. Although opioids are the mainstay of postoperative analgesia, nonsteroidal anti-inflammatory drugs (NSAIDs) may be used instead to avoid the adverse effects (AEs) associated with opioids. Lornoxicam is a newly developed NSAID, the use of which is increasing. However, lornoxicam has not been studied for use in pain management after cardiac surgery.

Objective:

The objective of this study was to compare the efficacy and tolerability 10 of lornoxicam and diclofenac sodium, an NSAID well established for use in pain management after major surgery, in pain management after coronary artery bypass grafting (CABG).

Methods:

This single-blind, randomized, active-controlled study was conducted 10 at the Gaziantep University Hospital, Gaziantep, Turkey. Adult patients scheduled to undergo valve or CABG surgery for the first time were included. Patients were premedicated with diazepam 10 mg PO at 10 PM on the evening before surgery. General anesthesia was induced using fentanyl, midazolam, and propofol, and maintained using fentanyl and isoflurane in pure oxygen. After extubation and when they stated that they felt pain, patients were randomly assigned to 1 of 2 treatment groups: lornoxicam 8 mg IM q8h or diclofenac 75 mg IM q12h, for 48 hours. Meperidine 1 mg/kg IM was given for additional analgesia when needed (rescue medication). Pain relief was assessed using an I1-point visual analog scale (0 = no pain to 10 = worst pain imaginable) immediately before the first injection (baseline), and at 15 and 30 minutes and 1, 2, 3, 4, 6, 12, 18, 24, and 48 hours after the first injection. Sedation was assessed using a 5-point scale (0 = awake and alert to 4 = deep sedation) at the same time points. Tolerability was assessed by monitoring of AEs using patient interview and laboratory analyses.

Results:

Forty patients were enrolled in the study (30 men, 10 women; 10 mean [SD] age, 54.4 [11.1 ] years; 20 patients per treatment group). The demographic and clinical characteristics and mean baseline pain relief scores were statistically similar between the 2 treatment groups. The mean pain relief scores at 15 and 30 minutes were statistically similar to baseline values in the 2 treatment groups. However, the mean pain relief scores at ≥1 hour after the first injection were significantly lower compared with baseline values (both groups, P < 0.05 at time points ≥1 hour). No significant between-group differences in mean pain relief scores were found at any time point. The overall mean pain relief scores were statistically similar between the 2 treatment groups. The mean sedation scores were significantly higher at 30 minutes, 1 hour, and 2 hours after the first injection in the diclofenac group compared with the lornoxicam group (all, P < 0.05). No AEs were observed. The need for rescue medication was statistically similar between the 2 treatment groups (lornoxicam, 2 patients; diclofenac, 3 patients).

Conclusions:

In this study of adult patients who underwent CABG, the efficacy 10 of lornoxicam and diclofenac were similar in postoperative pain management. Both study drugs were well tolerated.     

舒芬太尼复合罗哌卡因用于术后硬膜外病人自控镇痛

目的:观察舒芬太尼或芬太尼复合罗哌卡因用于腹部手术后PCEA的临床镇痛效果和不良反应.方法:选择ASA Ⅰ-Ⅱ级,在连续硬膜外阻滞或复合全身麻醉下行腹部手术的病人100例,术后行硬膜外病人自控镇痛(PCEA).随机分为两组,使用0.5μg/ml舒芬太尼或2μg/ml芬太尼复合0.12%罗哌卡因.背景剂量4 ml/h,自控药量2 ml/次,锁定时间20 min.观察病人术后镇痛效果,记录镇痛泵使用情况、不良反应以及是否使用其它镇痛药物.结果:舒芬太尼组在术后24小时和48小时的静息、咳嗽和活动时镇痛效果优于芬太尼组(P＜0.05).恶心呕吐发生率低,程度轻(P＜0.05).两组镇痛泵使用情况以及其他不良反应如下肢麻木、呼吸抑制等无明显差异.结论:舒芬太尼可安全有效地用于腹部手术后PCEA,镇痛效果优于芬太尼,不良反应少,程度较轻.     

Effect of platelet-rich fibrin on epidural fibrosis and comparison to ADCON® Gel and hyaluronic acid

Objective

In this experimental study, PRF (Platelet Rich Fibrin), HA (Hyaluronic Acid) gel and ADCON® Gel were compared in terms of preventing epidural fibrosis.

连续与单次腹横肌平面阻滞用于腹腔镜胆囊切除术后镇痛的效果比较

目的比较连续腹横肌平面阻滞(CTAPB)与单次腹横肌平面阻滞(STAPB)用于腹腔镜下胆囊切除术(LC)的术后镇痛效果。方法纳入拟行LC患者90例,分成对照组、S组和C组,每组30例,S组和C组患者气管插管后分别行STAPB和CTAPB,术毕三组患者均行患者自控静脉镇痛(PCIA),记录三组患者术后1,6,12,24,48,72 h切口部位及腹部深处疼痛视觉模拟(VAS)评分,术后72 h内PCIA镇痛泵按压次数,术后麻醉不良反应发生情况和术后镇痛的满意度。结果 S组和C组患者术后1、6和12 h切口部位和腹部深处VAS评分均显著低于对照组患者(P0.05),S组和对照组患者术后24、48和72 h切口部位和腹部深处VAS评分差异无统计学意义(P0.05),C组患者术后24、48和72 h切口部位和腹部深处VAS评分显著低于S组和对照组患者(P0.05)。术后72 h内S组和C组患者PCIA按压次数均显著少于对照组患者(P0.05),C组患者术后PCIA镇痛泵按压次数显著少于S组患者(P0.05)。S组和C组患者术后恶心发生率均低于对照组患者(P0.05)。术后S组和C组患者满意度均高于对照组患者(P0.05),C组患者满意度高于S组患者(P0.05)。结论超声引导下CTAPB可有效增强LC术后患者的镇痛效果,减少患者阿片类药物使用,降低阿片类药物不良反应发生率,提高患者术后满意度,可作为LC术后较为理想的镇痛方式。     

格拉司琼预防曲马多术后静脉自控镇痛恶心呕吐的疗效观察

目的观察格拉司琼用于预防曲马多术后静脉自控镇痛恶心呕吐的疗效。方法择期手术患者90例,ASA分级Ⅰ-Ⅱ,随机分为A、B、C 3组,每组30例。A组曲马多900 mg＋生理盐水至100 mL电子泵静脉镇痛;B组手术结束静脉注射氟哌利多2.5 mg后,以氟哌利多5 mg＋曲马多900 mg＋生理盐水至100 mL电子泵静脉镇痛;C组手术结束静脉注射格拉司琼3 mg后,以曲马多900 mg＋生理盐水至100 mL电子泵静脉镇痛,观察术后4、8、12、244、8 h恶心呕吐的发生情况。结果与对照组比较,格拉司琼组嗜睡的发生率无明显变化（P〉0.05）,但氟哌利多组嗜睡的发生率明显增加（P〈0.01）。格拉司琼组恶心、呕吐的发生率分别为16.7%、13.3%,与氯哌利多组（83.3%、73.3%）、对照组（96.7%、93.3%）相比,均有极显著性差异（P〈0.01）。对照组和氟哌利多组各有6例和3例因呕吐明显而用格拉司琼止吐。结论格拉司琼作为新型的强效止吐药与曲马多术后静脉自控镇痛复合应用具有用药方便,镇痛防恶心呕吐效果完全、耐受性好等优点,临床应用具有广阔前景。     

罗哌卡因复合芬太尼硬膜外分娩镇痛120例分析

目的：评价罗哌卡因复合芬太尼硬膜外分娩镇痛的效果及安全性。方法：选择无阴道分娩禁忌证自愿要求镇痛分娩的初产妇120例作为观察组，未要求镇痛分娩的186例作为对照组，比较两组产妇的镇痛效果、分娩结局、产程时间、催产素的使用率、产后出血量及新生儿结局。结果：观察组镇痛效果明显，活跃期短。顺产率高（P〈0．01），而催产素使用率、器械助产率、产后出血量、新生儿结局两组无显著差异（P〉0．05）。结论：罗哌卡因复合芬太尼硬膜外分娩镇痛效果确切，降低了剖宫产率，缩短了产程，新生儿结局好，是一种安全有效的分娩镇痛方法。     

术前硬膜外激素注射是否增加腰椎术后手术部位感染风险的Meta分析

目的 :通过Meta分析明确术前腰椎硬膜外激素注射(lumbar epidural steroid injection,LESI)是否增加后续腰椎手术术后手术部位感染(surgical site infection,SSI)风险。方法:检索Pubmed、Embase、Cochran Trail数据库,检索时间均是从建库到2018年7月。筛选出比较腰椎术前行LESI及未行LESI患者术后90d内SSI发生率的对照研究,各研究的观察(暴露)组为接受LESI并后续相同节段行首次腰椎手术,对照(非暴露)组为未行LESI而于相同节段行首次腰椎手术。各组病例数均大于100,随访时间至少90d。评价指标为术后90d内SSI发生率。依据LESI注射距后续腰椎手术时间分亚组(1个月内,1～3个月,3～6个月,6～12个月),合并SSI比值比(OR)。使用Newcastle-Ottawa Quality Scale(NOS)评分评价纳入研究质量。分别行亚组分析探讨异质性,敏感性分析测定合并结果稳定性,Egger′s回归检测发表偏倚。结果:共5篇文献纳入研究,其中4篇为回顾性病例对照研究,1篇为回顾性队列研究,研究质量NOS评分均在6分以上。共纳入225801例患者,其中暴露组38452例,对照组187349例。经Meta分析,术前1个月内行LESI,暴露组与对照组术后90d内SSI发生率比较OR=2.15(95%CI,1.30～3.55),P0.05;术前1～3个月行LESI,暴露组与对照组术后90d内SSI发生率比较OR=1.54(95%CI,1.36～1.74),P0.05;术前3～6个月行LESI,暴露组与对照组术后90d内SSI发生率比较OR=1.09(95%CI,0.94～1.26),P0.05;术前6～12个月行LESI,暴露组与对照组术后90d内SSI发生率比较OR=1.30(95%CI,0.88～1.93),P0.05。Meta分析亚组分析证实基线资料不匹配为显著异质性来源,敏感性分析证实Meta分析结果稳定,发表偏倚检测提示未见发表偏倚。结论:术前3个月内行LESI显著增加后续腰椎手术术后90d内SSI风险。     

非手术性癌痛患儿自控镇痛方式及比较研究

目的探究两种镇痛方式治疗儿童非手术性癌痛的效果及安全性。方法对36例非手术性癌痛患儿疼痛发生情况及程度进行评估,对疼痛原因及应用自控镇痛(PCA)或照顾者代理镇痛(AACA)效果进行分析。结果 36例中52.78%的疼痛原因为口腔炎,22.22%为局部感染;初始疼痛、复评疼痛、镇痛期间疼痛程度差异有统计学意义(P<0.01);PCA/AACA相关不良反应包括便秘及神经系统不良反应,PCA与AACA镇痛效果及不良反应比较,差异无统计学意义(均P>0.05)。结论非手术性癌痛患儿中到重度疼痛的主要原因是口腔炎和局部感染。PCA/AACA可安全且有效地用于非手术性中重度癌痛控制。     

罗哌卡因自控硬膜外无痛分娩分析

目的探讨罗哌卡因自控硬膜外镇痛(PCEA)用于分娩镇痛的效果及对分娩的影响。方法选择280例健康、单胎、足月临产初产妇,随机分为两组:治疗组(140例),对照组(140例),采用0.15%罗哌卡因 芬太尼硬膜外腔给药用于分娩镇痛。观察治疗组不同时段视觉模拟评分(VAS)和不良反应,同时记录两组产程时间、分娩方式、催产素使用情况、新生儿Apgar评分。结果治疗组VAS镇痛评分满意,两组在产程时间、分娩方式、新生儿Apgar评分均差异无统计学差异。结论罗哌卡因PCEA用于分娩镇痛,具有起效快,用药总量小,无运动阻滞,镇痛效果确切的优点,对母婴无不良影响。     

罗哌卡因复合不同药物骶管内超前注入用于小儿术后镇痛的比较

目的:比较罗哌卡因复合芬太尼、氯胺酮和曲马多骶管内超前注入用于小儿术后镇痛的效果及安全性。方法:120例择期行下腹部手术的患儿随机分为4组,每组30例。0.25%罗哌卡因(A组)、0.25%罗哌卡因 芬太尼2μg/kg(B组)、0.25%罗哌卡因 氯胺酮0.5mg/kg(C组)和0.25%罗哌卡因 曲马多1mg/kg(D组)。结果:用OPS法及Ramsay法分别进行镇痛及镇静评分并随访副作用的发生率。OPS<4分的百分率B、C、D组明显高于A组(P<0.05),D组与B、C组在术后12h、24h时亦有显著差异。镇静评分B、C、D组在术后6h内各时点明显高于A组(P<0.05)。D组术后6h内各时点镇静评分明显低于C组(P<0.05),皮肤瘙痒、恶心呕吐发生率B组明显高于A、C和D(P<0.05)。结论:罗哌卡因复合曲马多镇痛效果较好,且副作用较少,优于罗哌卡因复合氯胺酮和芬太尼。