芬太尼透皮贴剂治疗带状疱疹及疱疹后神经痛的疗效观察

目的 :观察芬太尼透皮贴剂 (多瑞吉 )对带状疱疹及疱疹后神经痛的疗效 ,本文选择了 31例不宜行神经阻滞的病人作为研究对象。方法 :31例病人在抗病毒治疗的同时均使用 2 5 μg/h的多瑞吉作为首次量 ,如疼痛控制不满意 ,临时追加曲马多缓释片 ,下次换贴时再增加至 5 0 μg/h ,观察其对患者疼痛的缓解程度、生活质量的改善以及出现的并发症。结果 :31例病人经多瑞吉治疗后 ,2例因副反应而终止治疗 ,其余患者疼痛明显缓解 ,VAS评分从 8.5 1± 1.12降至 2 .4 7± 1.2 3,生活质量明显提高 ,部分并发症随时间延长而减少。结论 :多瑞吉能有效地控制带状疱疹及疱疹后神经痛 ,改善病人的生活质量 ,随着病人对多瑞吉的适应 ,部分并发症逐渐减少。     

自控硬膜外分娩镇痛对产程和母婴预后的影响

目的 研究罗哌卡因联合芬太尼于潜伏期即行硬膜外分娩镇痛的有效性及对母婴预后的影响.方法 回顾性分析2008年1月-2010年12月期间在该院妇产科分娩的1 800例初产妇,其中600例自愿接受罗哌卡因联合芬太尼自控硬膜外镇痛的600例产妇为镇痛组,条件类似却未行镇痛的1 200例为对照组,记录两组产妇的镇痛效果、各产程时间、催产素使用情况、分娩方式、产后出血量、新生儿Apgar评分以及不良反应;测定分娩过程中规律宫缩时（T1）、宫口开全时（T2）、胎儿娩出时（T3）、胎盘娩出后30 min（T4）时的空腹血糖（FPG）、空腹胰岛素（FINS）并计算出胰岛素抵抗指数HOMA-IR.结果 所有产程阶段镇痛组的VAS评分均显著低于对照组;镇痛组潜伏期及活跃期时间均较对照组缩短,第二产程时间较对照组长,差异具有统计学意义（P＜0.05）;两组在第三产程时间以及总产程时间上无明显差异（P＞0.05）;镇痛组阴道分娩率、催产素使用率高于对照组;两组新生儿Apgar评分及胎儿窘迫率无显著差别;镇痛组可以减轻胰岛素抵抗程度和血糖升高程度.结论 罗哌卡因联合芬太尼于潜伏期用于PCEA可降低剖宫产率,提高顺产率,减轻胰岛素抵抗程度和血糖升高程度,且不增加母婴并发症,是一种安全、有效、值得大范围推广的分娩镇痛方法     

Comparison of dexmedetomidine/fentanyl with midazolam/fentanyl combination for sedation and analgesia during tooth extraction

Dexmedetomidine is an α2-adrenergic receptor agonist that causes minimal respiratory depression compared with alternative drugs. This study investigated whether combined dexmedetomidine/fentanyl offered better sedation and analgesia than midazolam/fentanyl in dental surgery. Sixty patients scheduled for unilateral impacted tooth extraction were randomly assigned to receive either dexmedetomidine and fentanyl (D/F) or midazolam and fentanyl (M/F). Recorded variables were patient preoperative anxiety scores, vital signs, visual analogue scale (VAS) pain scores, Observer's Assessment of Alertness/Sedation Scale (OAAS) scores after drug administration, surgeon and patient degree of satisfaction, and the duration of analgesia after surgery. The OAAS scores were significantly lower for patients administered D/F compared to those who received M/F. The duration of analgesia after the surgical procedure was significantly longer in patients who received D/F (5.3 h) than in those who received M/F (4.1 h; P = 0.017). The number of surgeons satisfied with the level of sedation/analgesia provided by D/F was significantly higher than for M/F (P = 0.001). Therefore, dexmedetomidine/fentanyl appears to provide better sedation, stable haemodynamics, surgeon satisfaction, and postoperative analgesia than midazolam/fentanyl during office-based unilateral impacted tooth extraction.     

小剂量芬太尼在机械通气中的应用

目的　 了解机械通气患儿以小剂量芬太尼持续静脉滴注的作用。 方法 　观察用药前后呼吸顺应性 (Cdyn)、气道阻力 (Raw)及呼气末二氧化碳分压 (PetCO2 )的变化。 结果 　 1个月～ 3岁患儿用药前后Raw及PetCO2 明显下降 ,肺部感染患儿指标变化显著大于非感染患儿 ,Cdyn用药前后均未发现显著差异。 结论 　提示机械通气中用小剂量芬太尼可以减轻人机对抗 ,降低气道压 ,改善肺气体交换及肺功能 ,有利于患儿顺利地渡过危险期     

Investigation of the effects of propofol/ketamine versus propofol/fentanyl on nausea-vomiting administered for sedation in children undergoing magnetic resonance imaging: a prospective randomized double-blinded study

Background/aim In this study, we aimed to compare the effects of propofol-ketamine and propofol-fentanyl sedations on post-procedure nausea-vomiting in children undergoing magnetic resonance imaging (MRI).Materials and methodsThis study included 100 pediatric patients (2–10 years old) who had propofol-ketamine and propofol-fentanyl for sedation to undergo MRI. The patients were divided into two groups, and sedation was performed through propofol-ketamine (Group K; n = 50) or propofol-fentanyl (Group F; n = 50). For sedation induction, intravenous (IV) bolus of 1.2 mg/kg propofol and 1 mg/kg ketamine were administered in Group K, IV bolus of 1.2 mg/kg propofol, and 1 µg/kg fentanyl in Group F. All patients received 0.5 mg/kg IV bolus propofol in additional doses when the Ramsay Sedation Score (RSS) was below 4 for maintenance. Perioperative heart rate, systolic arterial pressure, peripheral oxygen saturation, respiratory rate, and nausea-vomiting scores were recorded for each patient.Results There was no difference between the groups in terms of nausea incidences at the 1st hour. However, the rate of vomiting was significantly higher in Group K.ConclusionIn our study, we showed that the vomiting rate was higher in the 1st hour in Group K compared to Group F.     

A review of systemic opioids commonly used for labor pain relief

Parenteral opioids for pain relief during labor have been the subject of research for many decades. Commonly used systemic opioids provide limited pain relief during labor yet are used extensively for managing labor pain. These opioids share similar pharmacologic profiles but differ in potency, pharmacokinetics, and side effects. This article reviews the pharmacokinetics, pharmacodynamics, and clinical research related to the commonly used systemic labor pain analgesics morphine, meperidine, fentanyl, remifentanil, butorphanol, and nalbuphine.     

Incidence and Risk Factors of Postoperative Nausea and Vomiting in Patients with Fentanyl-Based Intravenous Patient-Controlled Analgesia and Single Antiemetic Prophylaxis

Purpose

We evaluated the incidence and risk factors of postoperative nausea and vomiting (PONV) in patients with fentanyl-based intravenous patient-controlled analgesia (IV-PCA) and single antiemetic prophylaxis of 5-hydroxytryptamine type 3 (5 HT₃)-receptor antagonist after the general anesthesia.

Materials and Methods

In this retrospective study, incidence and risk factors for PONV were evaluated with fentanyl IV-PCA during postoperative 48 hours after various surgeries.

Results

Four hundred-forty patients (23%) of 1878 had showed PONV. PCA was discontinued temporarily in 268 patients (14%), mostly due to PONV (88% of 268 patients). In multivariate analysis, female, non-smoker, history of motion sickness or PONV, long duration of anesthesia (>180 min), use of desflurane and intraoperative remifentanil infusion were independent risk factors for PONV. If one, two, three, four, five, or six of these risk factors were present, the incidences of PONV were 18%, 19%, 22%, 31%, 42%, or 50%. Laparoscopic surgery and higher dose of fentanyl were not risk factors for PONV.

Conclusion

Despite antiemetic prophylaxis with 5 HT₃-receptor antagonist, 23% of patients with fentanyl-based IV-PCA after general anesthesia showed PONV. Long duration of anesthesia and use of desflurane were identified as risk factors, in addition to risk factors of Apfel''s score (female, non-smoker, history of motion sickness or PONV). Also, intraoperative remifentanil infusion was risk factor independent of postoperative opioid use. As the incidence of PONV was up to 50% according to the number of risk factors, risk-adapted, multimodal or combination therapy should be applied.     

Comparison of fentanyl-bupivacaine or midazolam-bupivacaine mixtures with plain bupivacaine for caudal anaesthesia in children

BACKGROUND: The aim of this study was to evaluate the intensity and effectiveness of 0.75 ml.kg-1 bupivacaine 0.25% with the addition of fentanyl or midazolam for caudal block in children undergoing inguinal herniorrhaphy. METHODS: Seventy-five children were allocated randomly to three groups to receive a caudal block with either 0.25% bupivacaine with fentanyl 1 microg.kg(-1) (group BF) or with midazolam 50 microg.kg(-1) (group BM) or bupivacaine alone (group B) after induction of anaesthesia. Haemodynamic parameters, degree of pain, additional analgesic requirements and side-effects were evaluated. RESULTS: The mean systolic arterial pressure at 10, 20, 30 min after caudal block was higher in group B compared with groups BF and BM. Mean intraoperative heart rate was lower in group BF than the other groups. Adequate analgesia was obtained in all patients (100%) in group BF, 23 patients (92%) in group BM and 21 patients (84%) in group B (P > 0.05). The time to recovery to an Aldrete score of 10 was significantly shorter in group B than group BM (P < 0.05). Although not significant, it was also shorter in group B than group BF. There was no difference in additional analgesic requirements between the groups in the first 24 h. Sedation score was higher in the midazolam group at 60 and 90 min postoperatively than the other groups. CONCLUSIONS: Caudal block with 0.75 ml.kg(-1) 0.25% bupivacaine and 50 microg.kg(-1) midazolam or 1 microg.kg(-1) fentanyl provides no further analgesic advantages to bupivacaine alone when administered immediately after induction of anaesthesia in children undergoing unilateral inguinal herniorrhaphy.     

芬太尼复合利多卡因布比卡因混合液用于颈丛阻滞的临床观察

目的 观察芬太尼复合利多卡因布比卡因混合液用于颈丛阻滞对心率、血压的影响。方法 择期甲状腺腺瘤行甲状腺次全切除术的病人40例,ASAⅠ～Ⅱ级,无内分泌疾患。按手术顺序分为A(观察组),B(对照组)。局麻药选用利多卡因和布比卡因混合液,A组加适量的芬太尼(芬太尼2μg/kg计算),B组不加芬太尼。穿刺采用颈4一针法,阻滞一侧颈深和双侧颈浅。观察心率、血压的变化,以及对症处理情况。结果 收缩压(SBP),A组波动范围小,而B组波动范围大,各时段组间比较,P<0.05,组内比较,P<0.05。心率,A组在阻滞后较平稳;B组阻滞后均明显上升。各时段组间比较,P<0.05,组内比较,P<0.05。阻滞后对症处理例数:A组4例,B组9例。结论 局麻药中复合芬太尼行颈丛阻滞用于甲状腺手术病人,能增强阻滞效果,解除病人的精神紧张,并有效地控制心率增快和血压升高,明显减轻颈丛阻滞后心血管的不良反应,低浓度的局麻药混合液能降低其副作用,从而提高了颈丛阻滞的安全性。