耳针分娩镇痛效果及对母儿的影响

目的 :探讨耳针镇痛的临床效果。方法 :对 6 8例正常足月初产妇临产后取耳穴、子宫穴、神门穴、交感穴、内分泌穴针刺镇痛 ,同时以 6 0例足月妊娠的正常产妇为对照组 ,不采取任何方法进行镇痛。记录 2组镇痛效果及产程、分娩方式、产后出血及新生儿评分的数值。结果 :耳针能协调子宫收缩、减轻疼痛、缩短产程 ,对分娩方式、产后出血量及新生儿阿氏评分均无影响。结论 :耳针用于分娩镇痛安全、简便、有效、便于推广     

硬膜外注射曲马多和咪唑安定用于术后镇痛效果观察

目的 :观察硬膜外注射曲马多和咪唑安定用于腹部手术术后镇痛效果、不良反应和对血流动力学及呼吸的影响。方法 :随机选择 40例连续硬膜外麻醉下行中、下腹部手术患者 ,ASAⅠ～Ⅱ级。分为 2组 ,Ⅰ组 (曲马多和咪唑安定组 ) 2 0例 ;Ⅱ组 (曲马多组 ) 2 0例。于关腹时 ,Ⅰ组将曲马多 10 0ml和咪唑安定 2 .5mg ,用生理盐水稀释至 10ml;Ⅱ组将曲马多 10 0mg用生理盐水稀释至 10ml,均一次缓慢注入硬膜外腔。监测注药后 10min ,2 0min和30min的平均动脉压 (pMA)、心率 (fH)、血氧饱和度 (xO2 )、呼吸频率 (fR)和心电图 (ECG)变化。PrinceHennry疼痛评分标准评价镇痛效果 ,同时记录镇痛时间及不良反应。结果 :Ⅰ组镇痛评分为 (1.2 5± 1.10 ) ,疼痛完全缓解率为85 % ,Ⅱ组评分为 (1.75± 1.12 ) ,疼痛完全缓解率为 75 %。镇痛完全时间Ⅰ组为 (15 .4± 4.4)h ,Ⅱ组为 (10 .9± 0 .9)h ,Ⅰ组明显长于Ⅱ组 (P <0 .0 1)。监测各项指标与注药前比较差异无显著性 (P >0 .0 5 )。 2组患者均未发现肺部并发症及心律失常。结论 :术后硬膜外注入曲马多和咪唑安定可提供确切的镇痛效果 ,且患者呼吸及循环功能稳定 ,是一种安全可靠的术后镇痛方法     

电针对疼痛患者血浆及小鼠脊髓甲硫氨酸脑啡肽、强啡肽及痛阈的影响

目的 :探讨 4～5Hz电针下 ,患者血浆及小鼠脊髓的甲硫氨酸脑啡肽 (MEK)及强啡肽 (Dyn)的变化与疼痛的关系。方法 :将针灸门诊患者电针前后的血浆和随机分为电针、对照两组的雄性BALB/C小鼠的脊髓匀浆 ,分别定量点于硝酸纤维素膜上 ,应用免疫反应性蛋白质斑点印迹技术 ,用Shimadu薄层层析扫描仪进行检测。患者在电针前后、小鼠在电针 /牵拉前后均用测痛仪检测痛阈。结果 :电针后患者血浆D(MEK)及D(Dyn)均升高 (P <0 .0 1) ,而小鼠脊髓两者均降低(P <0 .0 1,P <0 .0 5 ) ,患者血浆及小鼠脊髓的D(MEK)比D(Dyn)变动显著。血浆或脊髓的D(MEK)与D(Dyn)变动呈正相关。血浆及脊髓D(MEK)分别与痛阈呈正相关 (r=0 846 ,P <0 0 1)或呈负相关 (r=- 0 6 2 5 ,P <0 0 5 )。但血浆及脊髓的D(Dyn)与痛阈不相关。结论 :在较低频率电针下MEK可能在镇痛中起重要作用     

头位难产的分娩方式和新生儿窒息风险关系

目的 :探讨头位难产分娩方式与新生儿窒息风险关系。方法 :应用头位分娩评分法对 135例足月单胎头位难产初产妇进行评分 ,按评分分组处理。结果 :　≤ 8分 ,剖宫产率 10 0 % ,新生儿窒息率 16 7%。 9分 ,10分 ,11分3组分娩方式具有显著性差异 ,P <0 0 5。 3组阴道分娩的新生儿窒息率 ,差异无显著性 ,P >0 0 5。结论 :评分≤ 9分者应放宽剖宫产指标 ,评分 10分者应作短期试产。评分 >10分者大胆试产 ,阴道分娩不因评分低而增加新儿窒息率。     

Assessing opioid administration in pediatric burn patients with nonsurgical management

BackgroundDespite the vast literature studying the opioid crisis, sparse data describe this in the pediatric burn population. This study sought to assess patient-level characteristics and their potential effects on opioid administration in nonsurgical pediatric burn inpatients.MethodsAdmitted burn patients from 2013 to 2018 with nonsurgical management at an American Burn Association (ABA) verified pediatric burn center were retrospectively identified. Morphine milligram equivalents by weight (MME/kg) per admission were evaluated through a multiple loglinear regression with race, sex, age, total body surface area burned (TBSA), and burn depth as predictors. Simple linear regression was used to evaluate the temporal trend of median opioid utilization.ResultsA total of 806 patients (55% White, 35% Black, 5% Hispanic, 5% Other) were included. In an adjusted analysis, no differences in opioid administration were seen by sex, burn degree, or for Blacks and Hispanics when compared with Whites. Increased MME/kg was associated with older age (10–18 years; p < 0.0001) and larger burns (>5% TBSA burned; p < 0.0001). From 2013 to 2018, median MME/kg per admission declined significantly (2013:0.21, 2018:0.09; p = 0.0103).ConclusionsNonsurgical burn patients who were older and presented with larger TBSA experienced marked increases in opioid utilization. Overall, opioid administration decreased over time.     

Efficacy of Two Unique Combinations of Nerve Blocks on Postoperative Pain and Functional Outcome After Total Knee Arthroplasty: A Prospective,Double-Blind,Randomized Controlled Study

BackgroundThis study aimed to explore the efficacy of two unique combinations of nerve blocks on postoperative pain and functional outcome after total knee arthroplasty (TKA).MethodsPatients scheduled for TKA were randomized to receive a combination of adductor canal block (ACB) + infiltration between the popliteal artery and capsule of the posterior knee block (IPACK) + sham obturator nerve block (ONB) + sham lateral femoral cutaneous nerve block (LFCNB) (control group), or a combination of ACB + IPACK + ONB + sham LFCNB (triple nerve block group), or a combination of ACB + IPACK + ONB + LFCNB (quadruple nerve block group). All patients received local infiltration analgesia. Primary outcome was postoperative morphine consumption. Secondary outcomes were the time until first rescue analgesia, postoperative pain assessed on the visual analog scale (VAS), QoR-15 score, functional recovery of knee, and postoperative complications.ResultsCompared with the control group, the triple and quadruple nerve block groups showed significantly lower postoperative morphine consumption (17.2 ± 9.7 mg vs. 11.2 ± 7.0 mg vs. 11.4 ± 6.4 mg, P = .001). These two groups also showed significantly longer time until first rescue analgesia (P = .007 and .010, respectively, analyzed with Kaplan-Meier method), significantly lower VAS scores on postoperative day 1 (P < .01), significantly better QoR-15 scores on postoperative days 1 and 2 (P < .001), and significantly better functional recovery of knee including range of motion (P = .002 and .001 on postoperative days 1 and 2), and daily ambulation distance (P < .001 and P = .004 on postoperative days 1 and 2). However, the absolute change in morphine consumption, VAS scores, and QoR-15 scores did not exceed the reported minimal clinically important differences (MCIDs) (morphine consumption: 10 mg; VAS scores: 1.5 at rest and 1.8 during movement; QoR-15 scores: 8.0). The MCIDs of other outcomes have not been reported in literature. The triple and quadruple nerve block groups showed no significant differences in these outcomes between each other. The three groups did not show a significant difference in complication rates.ConclusionAdding ONB or ONB + LFCNB to ACB + IPACK can statistically reduce morphine consumption, improve early pain relief, and functional recovery. However, the absolute change in morphine consumption, VAS scores, and QoR-15 scores did not exceed the MCIDs. Based on our findings and considering the sample size of this study, there is not enough clinical evidence to support the triple or quadruple nerve block use within a multimodal analgesic pathway after TKA.     

Risk of Gastrointestinal Bleeding With Extended Use of Nonsteroidal Anti-Inflammatory Drug Analgesia After Joint Arthroplasty

BackgroundChronic nonsteroidal anti-inflammatory drug (NSAID) use is associated with gastrointestinal bleeding via inhibition of endogenous mucosal protection and platelet aggregation. This study aimed to determine whether extended NSAIDs after joint arthroplasty is associated with increased risk of gastrointestinal bleeding.MethodsThis was a retrospective study examining 28,794 adults who underwent joint arthroplasty by one of 50 surgeons from 2016 to 2018. Episodes of gastrointestinal bleeding within 90 days postoperatively were identified prospectively. Postoperative medications were reported directly by patients with electronic questionnaires. The primary analysis was performed using binary logistic regression.ResultsA total of 74 (0.26%) episodes of gastrointestinal bleeding occurred within 90 days (median 8 days) postoperatively. Of 5086 patients with complete data included in the primary analysis, 59.6% had used NSAIDs with median duration of 2 weeks (interquartile range, 0-6 weeks). Patients with gastrointestinal bleeding were significantly older (71.3 vs 67.0 years), required longer hospitalizations (2.1 vs 1.5 days), and more commonly had a history of peptic ulcers (10.8% vs 0.9%). However, there was no positive association between NSAID use and gastrointestinal bleeding. In fact, the odds of gastrointestinal bleeding were lower in patients taking NSAIDs. Gastrointestinal bleeding was associated with anticoagulants, antiplatelet agents, and, to a lesser extent, aspirin.ConclusionNSAIDs were not associated with gastrointestinal bleeding and may be prescribed safely for a majority of patients after joint arthroplasty. The greatest odds of gastrointestinal bleeding occurred in patients with peptic ulcer disease and those who received antiplatelet and anticoagulation agents. Increasing age and bilateral surgery were also associated with gastrointestinal bleeding.Level of EvidenceLevel III.     

Creating a model to predict time intervals from induction of labor to induction of anesthesia and delivery to coordinate workload

BackgroundInduction of labor continues to become more common. We analyzed induction of labor and timing of obstetric and anesthesia work to create a model to predict the induction-anesthesia interval and the induction-delivery interval in order to co-ordinate workload to occur when staff are most available.MethodsPatients who underwent induction of labor at a single medical center were identified and multivariable linear regression was used to model anesthesia and delivery times. Data were collected on date of birth, race/ethnicity, body mass index, gestational age, gravidity, parity, indication for labor induction, number of prior deliveries, time of induction, induction agent, cervical dilation, effacement, and fetal station on admission, date and time of anesthesia administration, date and time of delivery, and delivery type.ResultsA total of 1746 women met inclusion criteria. Associations which significantly influenced time from induction of labor to anesthesia and delivery included maternal age (anesthesia P <0.001, delivery P =0.002), body mass index (both P <0.001), prior vaginal delivery (both P <0.001), gestational age (anesthesia P <0.001, delivery P <0.018), simplified Bishop score (both P <0.001), and first induction agent (both P <0.001). Induction of labor of nulliparous women at 02:00 h and parous women at 04:00 or 05:00 h had the highest estimated probability of the mother having her first anesthesia encounter and delivering during optimally staffed hours when our institution’s specialty personnel are most available.ConclusionsTime to obstetric and anesthesia tasks can be estimated to optimize induction of labor start times, and shift anesthesia and delivery workload to hours when staff are most available.     

Wide Awake Open Carpal Tunnel Release: The Effect of Local Anesthetics in the Postoperative Outcome

Introduction  Wide awake open carpal tunnel decompression is a procedure performed under local anesthesia. This study aimed to present the effect of various local anesthetics in peri and postoperative analgesia in patients undergoing this procedure. Materials and Methods  A total of 140 patients, with 150 hands involved, underwent carpal tunnel release under local anesthesia. Patients were divided in five groups according to local anesthetic administered: lidocaine 2%, ropivacaine 0.75%, ropivacaine 0.375%, chirocaine 0.5%, and chirocaine 0.25%. Total 400 mg of gabapentin were administered to a subgroup of 10 cases from each group (50 cases totally), 12 hours before surgery. Patients were evaluated immediately, 2 weeks and 2 months after surgery according to VAS pain score, grip strength, and two-point discrimination. Results  In all patients, pain and paresthesia improved significantly postoperatively, while the use of gabapentin did not affect outcomes. Grip strength recovered and exceeded the preoperative value 2 months after surgery, without any difference between the groups. No case of infection, hematoma, or revision surgery was reported. Conclusion  Recovery after open carpal tunnel release appears to be irrelevant of the type of local anesthetic used during the procedure. Solutions of low local anesthetic concentration (lidocaine 2%, ropivacaine 0.375%, and chirocaine 0.25%) provide adequate intraoperative analgesia without affecting the postoperative course.     

Intra-articular infiltration analgesia for arthroscopic shoulder surgery: a systematic review and meta-analysis

Phrenic-sparing analgesic techniques for shoulder surgery are desirable. Intra-articular infiltration analgesia is one promising phrenic-sparing modality, but its role remains unclear because of conflicting evidence of analgesic efficacy and theoretical concerns regarding chondrotoxicity. This systematic review and meta-analysis evaluated the benefits and risks of intra-articular infiltration in arthroscopic shoulder surgery compared with systemic analgesia or interscalene brachial plexus block. We sought randomised controlled trials comparing intra-articular infiltration with interscalene brachial plexus block or systemic analgesia (control). Cumulative 24-h postoperative oral morphine equivalent consumption was designated as the primary outcome. Secondary outcomes included visual analogue scale pain scores during the first 24 h postoperatively; time-to-first analgesic request; patient satisfaction; opioid-related side-effects; block-related adverse events; and any indicators of chondrotoxicity. Fifteen trials (863 patients) were included. Compared with control, intra-articular infiltration reduced 24-h postoperative analgesic consumption by a weighted mean difference (95%CI) of −30.9 ([−38.9 to −22.9]; p < 0.001). Intra-articular infiltration also reduced the weighted mean difference (95%CI) pain scores up to 12 h postoperatively, with the greatest reduction at 4 h (−2.2 cm [(−4.4 to −0.04]); p < 0.05). Compared with interscalene brachial plexus block, there was no difference in opioid consumption, but patients receiving interscalene brachial plexus block had better pain scores at 2, 4 and 24 h postoperatively. There was no difference in opioid- or block-related adverse events, and none of the trials reported chondrotoxic effects. Compared with systemic analgesia, intra-articular infiltration provides superior pain control, reduces opioid consumption and enhances patient satisfaction, but it may be inferior to interscalene brachial plexus block patients having arthroscopic shoulder surgery.