Objective To investigate the effect of intravenous analgesia with a wireless or traditional analgesia pump system in thoracoscopic lung resection.MethodsPatients who used the patient-controlled intravenous analgesia after thoracoscopic lung resection between June 2016 and June 2021 were enrolled in the study. They were allocated into a wireless pump group (a ZigBee-based wireless analgesia pump system collecting data automatically) and a traditional analgesia pump group. Perioperative analgesia management followed the routine standard operation protocol of Shanghai Chest Hospital. The patients’ numeric rating scale (NRS) for pain and postoperative nausea and vomiting (PONV) scores were collected for analysis from the Anesthesia Information Record System. The incidence of postoperative analgesia insufficiency (defined as NRS≥4 points) within 48 h, the incidence of PONV within 24 h, and the 48 h completion rate of analgesia pump infusion were compared. ResultsA total of 59431 patients were collected, including 24855 males and 34576 females, 17209 patients in the wireless pump group, and 42222 patients in the traditional analgesia pump group. The incidence of analgesia insufficiency within 48 h after operation (3.75% vs. 4.98%, P=0.007), the incidence of PONV within 24 h after operation (13.60% vs. 16.70%, P=0.030) in the wireless pump group were lower than those in the traditional analgesia pump group. The 48 h completion rate of analgesia pump infusion in the wireless pump group was higher than that in the traditional analgesia pump group (83.40% vs. 71.90%, P<0.001). The wireless pump group could monitor the pressing times and use of the analgesia pump, while the traditional analgesia pump group could not record the relevant data. ConclusionCompared with the traditional analgesia pump, the wireless analgesia management system may be convenient for timely, accurate and individualized management, and has good analgesic effect and low incidence of adverse reactions, and may be more suitable for perioperative analgesia management.
Objective To evaluate the effectiveness of intravenous patient-controlled analgesia versus epidural patient-controlled analgesia for postoperative analgesia, sedation, and the incidence of side effects. Methods We searched the specialized trials registered in the Cochrane anesthesia group, The Cochrane Library (CCTR), MEDLINE (1966 to Sept. 2008), EMbase (1966 to Sept. 2008), PubMed (1966 to Sept. 2008), and handsearched some Chinese anesthesia Journals and Clinical anesthesia journals. Randomized controlled trials (RCTs) and quasi-RCTs of intravenous versus epidural analgesia for post-operation were included. The quality of the trials was critically assessed. RevMan 4.2.8 software was used for meta-analyses. Results Thirteen RCTs involving 580 patients of intravenous versus epidural analgesia for post-operation were included. The results of meta-analyses showed that there were no significant differences in postoperative analgesia and sedation at the hour-points of 2nd, 4th, 8th, 12th, and 24th hours after operation. There were no significant differences in plasma fentanyl concentration in the two groups on the same analgesia effects. There were also no significant differences in side effects. Conclusion Both intravenous patient-controlled analgesia and epidural patient-controlled analgesia have the same clinical effects. Compared with epidural patient-controlled analgesia, intravenous patient-controlled analgesia has fewer side effects and is more convenient. At the same time, it can reduce more costs of hospitalization. But because of the low quality and small sample size of the included studies, more well-designed, large scale, randomized controlled trials are needed.
ObjectiveTo review the advances in perioperative pain management of pediatric and adolescent spinal deformity corrective surgery.MethodsRegular analgesics, drug administrations, and analgesic regimens were reviewed and summarized by consulting domestic and overseas related literatures about perioperative pain management of pediatric and adolescent spinal deformity corrective surgery in recent years.ResultsAs for perioperative analgesis regimens of pediatric and adolescent spinal deformity corrective surgery, regular analgesics include non-steroidal anti-inflammatory drugs, opioids, antiepileptic drugs, adrenergic agonists, and local anesthetic, etc. Besides drug administration by mouth, intravenous injection, and intramuscular injection, the administration also includes patient controlled analgesia, epidural injection, and intrathecal injection. Multimodal analgesia is the most important regimen currently.ConclusionHeretofore, a number of perioperative pain managements of pediatric and adolescent spinal deformity corrective surgery have been applied clinically, but the ideal regimen has not been developed. To design a safe and effective analgesic regimen needs further investigations.
ObjectiveTo investigate whether parecoxib sodium preemptive analgesia reduces inflammatory cytokines and stress hormones production in elderly patients after total hip replacement. MethodSixty patients with American Society of Anesthesiologists Classification Ⅰ-Ⅱ undergoing total hip replacement for femoral neck fracture or aseptic necrosis of the femoral head, aged between 60 and 90 years with a body weight more than 50 kg, were randomly divided into preemptive analgesia group (group P, n=30) and control group (group C, n=30). The patients in group P received parecoxib sodium 40 mg intravenously 30 min before skin incision, and another 20 mg 8 hours after the first administration. All the patients in the two groups received the administration of patient-controlled analgesia sufentanyl. We recorded blood levels of interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-α), cortisol (COR), adrenaline (AD) and noradrenaline (NAD) 30 min before skin incision, and 1 hour, 6 hours, 12 hours and 24 hours postoperatively. ResultsThe blood levels of IL-6, TNF-α, COR, AD and NAD in group P at 1 hour, 6 hours, 12 hours or 24 hours postoperatively were significantly lower than those in group C (P<0.05). ConclusionsParecoxib sodium preemptive analgesia reduces postoperative inflammatory cytokines and stress hormones production in elderly patients undergoing total hip replacement.
ObjectiveTo explore the effect of standardized multimodal analgesia (SMA) on opioid consumption after major upper abdominal surgery under enhanced recovery after surgery pathway. MethodsPatients who underwent major upper abdominal surgery in the West China Hospital of Sichuan University between August and November 2020 were included prospectively. The patients were divided into two groups: SMA group (n=175) and control group (n=632). The SMA was defined as preoperative and postoperative use of non-steroidal anti-inflammatory drugs, combined with regional anesthesia, local anesthetic wound infiltration or intrathecal opioid. The postoperative opioid consumption in oral morphine equivalents, the pain scores on movement and at rest, the postoperative rehabilitation were recorded and compared between the two groups. ResultsPatients in the SMA group had a lower opioid consumption during the first 72 h compared to patients in the control group (median: 51 mg vs. 85 mg, P<0.001). The pain scores on movement and at rest at 24, 48, 72 h after surgery in the SMA group were lower than those in the control group (P<0.05). Time to first flatus, time to first ambulation, postoperative hospital stay in the SMA group were significantly shorter than those in the control group (P<0.05), and the quality of life scores at 5 d after surgery increased significantly (P<0.05). The satisfaction with analgesia and the incidence of adverse effects on day 5 after surgery had no statistical significances between the two groups (P>0.05). After controlling for confounding factors, multiple linear regression analysis showed that SMA was associated with less opioid consumption on hour 72 after surgery (P<0.001). ConclusionSMA can reduce postoperative opioid consumption in patients undergoing major upper abdominal surgery.
Objective To evaluate the efficacy of intravertebral analgesia for external cephalic version. Methods We electronically searched The Cochrane Library (Issue 4, 2009), PubMed (1980 to 2009), Ovid MEDLINE (1950 to 2009), Ovid EBM Database (1991 to 2009), EMbase (1980 to 2009), CBM (1978 to 2009) and CNKI (1979 to 2009) to collect literature about intravertebral analgesia for external cephalic version. We screened randomized controlled trials (RCTs) according to the predefined inclusion and exclusion criteria, extracted data and evaluated the quality of the included studies, and then performed meta-analyses by using RevMan 5.0.13 software. Results Seven RCTs involving 620 women met the inclusion criteria. Five trials were of relatively high quality, and 1 of low quality and 2 not clear. The result of meta-analyses showed that intravertebral analgesia was superior in external cephalic version with a RR 1.53 and 95%CI 1.24 to 1.88. Conclusion Intravertebral analgesia can increase the successful rate of external cephalic version in the treatment of breech presentation compared with intravenous medicine for systematic use or no analgesia.
ObjectiveTo evaluate the preemptive analgesic efficiency of parecoxib on patients undergoing inguinal hernia repair. MethodsOne hundred and twenty patients scheduled for surgery between May and August 2013 were randomized into group A (n=60) and group B (n=60). Patients in group A received intravenous parecoxib sodium (40 mg) for 45 minutes before surgery while group B received equivalent normal saline. All patients underwent tension-free hernia repair under local anesthesia with simplex lidocaine. Visual analogy scores (VAS) after surgery and the maximum VAS were recorded. The number of patients requiring rescue analgesic (tramadol injection) or with adverse effects related to analgesia were observed and recorded. Postoperative hospital stay and patient satisfaction score with analgesic effect were compared between the two groups. Concentrations of plasma prostaglandin E2(PGE2) before surgery and 24 hours after surgery were measured in both groups. ResultsVAS scores were significantly lower in group A at 2, 4, 8 and 12 hours after surgery than group B, while no significant difference was seen after 24 hours of the surgery. The number of patients requiring tramadol (3/60) or with adverse effects (2/60) in group A were significantly lower than that in group B (11/60 and 8/60 respectively). Postoperative hospital stay was shorter while patient satisfaction score with analgesic effect was higher in group A than in group B. There were no significant differences in concentration of plasma PGE2 between the two groups before surgery and after 24 hours of the surgery (P>0.05). ConclusionPreemptive administration of parecoxib for hernia repair can result in significant analgesic effect with fewer adverse effects, higher patient satisfaction and faster recovery.
Objective To summarize the research progress of the analgesic effect of adductor canal block (ACB) applied to knee arthroplasty, in order to find the ACB mode that can obtain better effectiveness. MethodsThe research progress of the analgesic effect of ACB after knee arthroplasty was reviewed by widely consulting the related literature on ACB at home and abroad in recent years. Results In recent years, multimodal analgesia has become the mainstay of postoperative pain management after knee arthroplasty. Among these, ACB replaces the once “gold standard” femoral nerve block (FNB) by offering comparable and effective analgesia with better preservation of quadriceps function. It is generally safe and efficient to use 0.2% ropivacaine ACB with initial loading doses of 15-30 mL and continual loading doses of less than 8 mL/hour to give analgesia comparable to FNB with minimal impact on lower extremity muscular strength. However, the risk of patient falls must still be taken into consideration by medical staff. Adjuvants like dexmedetomidine and dexamethasone used in ACB can increase the analgesic duration and postoperative analgesic impact. As a perineural adjunct for ACB, 1 µg/kg dexmedetomidine may strike a balance between safety and analgesic efficacy. Conclusion ACB is a safe and effective analgesia method after knee arthroplasty. The adductor canal anatomy, the optimum blocking strategy and blocking site of ACB are all hotly debated and still require additional study due to the significant variety of the nerve structures in adductor canal.
Objective To systematically evaluate the effect of epidural analgesia on prognosis after intestinal surgery. Methods Such databases as PubMed, EBSCO, Springer, Ovid and CNKI were searched to identify randomized controlled trials (RCTs) about the effects of epidural analgesia on prognosis after intestinal surgery published from 1985 to 2010. The methodological quality of the included RCTs was assessed and the data was extracted according to the Cochrane Handbook, and then the meta-analyses were conducted by using RevMan 5.0 software. Results Ten RCTs involving 506 patients were included. The results of meta-analyses showed that compared with the patient controlled analgesia (PCA), the patient controlled epidural analgesia (PCEA) significantly reduced the waiting time for having first flatus, first defecation, and the length of hospital stay (MD= –1.07, 95%CI –1.63 to –0.50; MD= –0.63, 95%CI –1.19 to –0.08; MD= –1.36, 95%CI –2.28 to –0.44; respectively), lowered the frequency of vomiting on the first and second day after operation (OR=0.33, 95%CI 0.13 to 0.82; OR=0.3, 95%CI 0.13 to 0.84; respectively), and obviously declined the visual analog scale (VAS) scores of rest pain on the first, second and third day after operation (MD= –26.60, 95%CI –33.06 to –20.15; MD= –25.98, 95%CI –30.98 to –20.97; MD= –15.59, 95%CI –27.29 to –3.88; respectively), and the VAS scores of motion pain on the first, second and third day after operation (MD= –26.00, 95%CI –36.00 to –16.00; MD= –27.89, 95%CI –35.70 to –20.08; MD= –11.79, 95%CI –21.28 to –2.30; respectively). There were no significant differences between the two groups in the incidence of urinary tract infection, urinary retention, anastomotic leak and ileus. Conclusion PCEA significantly reduces the waiting time for having first flatus and first feces, the length of hospital stay, the VAS scores of pain, and the incidence of postoperative vomiting.
Objective To evaluate the analgesic effect of intra-articular ropivacaine with lidocaine. Methods A double-blind randomized controlled trial was conducted. Ninety patients receiving selective knee arthroscopy were randomized into three groups of 30 patients. At the end of the operation, before the release of the tourniquet, an intra-articular injection was administered to each patient through arthroscope, in accordance with their random allocation: 0.9% normal saline (normal saline group); 100 mg ropivacaine (ropivacaine alone group) and 100 mg ropivacaine and 100 mg 2% lidocaine (ropivacaine with lidocaine group). Pain intensity was assessed after the operation using the 100-mm visual-analog scale (VAS), and the amount of supplemental analgesics used within the following 24 hours were recorded. Results The VAS scores of 2 hours postoperatively at rest, and 1, 2, 4, and 8 hours postoperatively at motion, were significantly higher in the normal saline group than in ropivacaine alone group (Plt;0.05). The VAS scores 0.5, 1 and 2 hours postoperatively at rest, and at the awaking moment, 0.5, 1, 4, 8, and 24 hours postoperatively at motion, were significantly higher in the normal saline group than in ropivacaine with lidocaine group (Plt;0.05). Conclusion Intra-articular ropivacaine can reduce a patient’s pain after operation. The combination of lidocaine with intra-articular ropivacaine can reduce the patient’s pain severity immediately after the operation and achieve an early analgesic effect.