Objective
To compare the analgesia effect and clinical rehabilitation between continuous adductor canal block (ACB) and single shot ACB in total knee arthroplasty (TKA)．
Methods
Between October 2016 and February 2017, 60 patients with severe knee osteoarthritis undergoing primary unilateral TKA were prospectively recruited in the study. All the patients were randomly allocated into 2 groups and received ultrasound-guided continuous ACB (group A, n=30) or single shot ACB (group B, n=30), respectively. There was no significant difference in gender, age, body mass index, nationality, American Society of Anesthesiology (ASA) grading, and preoperative knee range of motion and quadriceps strength between 2 groups (P>0.05). After operation, the tourniquet time, postoperative drainage volume, hospitalization time, and adverse events in 2 groups were recorded. Visual analogue scale (VAS) scores at rest and during activity, the quadriceps strength, the knee range of motion, and the time of 90° knee flexion in 2 groups were also recorded and compared.
Results
There was no significant difference in tourniquet time, postoperative drainage volume, and incidence of adverse events between 2 groups (P>0.05). But the hospitalization time was significant shorter in group A than in group B (P<0.05). VAS scores at rest and during activity were lower in group A than in group B, with significant differences in VAS score at rest after 12 hours and in VAS score during activity after 8 hours between 2 groups (P<0.05). The quadriceps strength was higher in group A than in group B, with significant difference at 24, 48, and 72 hours (P<0.05). The knee range of motion was significantly better in group A than in group B at 24, 48, 72 hours and on discharge (P<0.05). The time of 90° knee flexion was significantly shorter in group A than in group B (t=–2.951, P=0.016). There were 4 patients in group A and 7 patients in group B requiring meperidine hydrochloride (50 mg/time) within 24 hours, and 3 patients in group A and 7 patients in group B at 24 to 48 hours, and 1 patient in group A and 3 patients in group B at 48 to 72 hours. Effusion in the catheter site occurred in 2 cases of group A, but no catheter extrusion occurred.
Conclusion
Continuous ACB is superior in analgesia both at rest and during activity and opioid consumption compared with single shot ACB after TKA. And the quadriceps strength could be reserved better in continuous ACB group, which can perform benefits in early rehabilitation.
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.
【摘要】 目的 觀察小劑量氯胺酮在健忘鎮痛麻醉輔助局部麻醉（局麻）剖宮產中的應用。方法 選擇1200例剖宮產的孕婦,隨機分為單純局麻組(L組)、氟芬強化局麻組(F組)和健忘鎮痛麻醉組(J組),每組400例。L組單純局麻;F組局麻術中輔以氟哌利多500 mg,芬太尼015 mg;J組在F組基礎上輔以氯胺酮,觀察各組患者麻醉誘導至胎兒娩出時間;新生兒1、5 min Apgar評分;手術中血壓相對于基礎值的波動情況;手術中及手術后出血情況及麻醉滿意度。 結果 J組與L組和F組比較,胎兒娩出時間無顯著差別;Apgar評分提高;手術中孕婦血壓波動不明顯;手術中及手術后出血量無明顯增加,麻醉滿意度明顯提高。 結論 由小劑量氯胺酮輔助實施的健忘鎮痛麻醉在局麻剖宮產中優于單純局麻和氟芬強化局麻,在剖宮產中尤其急診剖宮產中值得推廣。【Abstract】 Objective To observe the application of lowdose ketamine during the local anesthesia in cesarean section assisted by analgestic and amnestic anesthesia. Methods A total of 1200 cases who need cesarean section were randomly divided into 3 groups (400 cases in each group): simple local anesthesia group (group L), droperidolfentanyl strengthen local anesthesia group (group F) and analgestic and amnestic anesthesia group (group J). Group L was only local anesthesia. Group F was local anesthesia supplemented by droperidol 500 mg, fentanyl 015 mg. Group J was supplemented with ketamine on the basis of group F. Then the time from anesthesia to the fetus delivery, Neonatal Apgar score of one and five minutes, the blood pressure fluctuations, amount of bleeding in or after surgery and the satisfaction of anesthesia were all observed. Results Compared with group L and F, the delivery time was no significant difference, Apgar score increased, blood pressure fluctuations in pregnant women was not obviously varied, amount of bleeding in or after surgery had no significantly increase, and the satisfaction of anesthesia improved markedly all in group J. Conclusions The analgestic and amnestic anesthesia assisted by lowdose ketamine, in cesarean section, is better than local anesthesia and strengthen local anesthesia by droperidolfentanyl, which is worthy to be popularized, especially in emergency caesarean section.
ObjectiveTo systematically review the clinical efficacy and safety of glucocorticoids, acetaminophen and antimicrobial drugs in the treatment of intrapartum fever in labor analgesia. MethodsThe PubMed, Embase, Cochrane Library, Web of Science, CBM, VIP, and CNKI databases were electronically searched to collect randomized controlled trials (RCTs) of glucocorticoids, acetaminophen, and antimicrobial drugs for intrapartum fever in labor analgesia from inception to June 30, 2023. Two reviewers independently screened the literature, extracted data, and evaluated the risk of bias of the included literature. Meta-analysis was then performed by using RevMan 5.4 software. ResultsA total of 10 RCTs involving 1 337 women were included. Meta-analysis showed that the use of glucocorticoids reduced the incidence of intrapartum fever in women with labor analgesia compared with the control group (OR=0.52, 95%CI 0.33 to 0.82, P<0.01). But there was no statistically significant difference between acetaminophen or antimicrobial drugs and the control group. ConclusionCurrent evidence shows that the use of glucocorticoids can reduce the incidence of intrapartum fever in labor analgesia, but the use of acetaminophen and antimicrobial drugs cannot reduce the incidence of intrapartum fever. Due to the limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.
Objective To evaluate the efficacy and safety of COX inhibitor flurbiprofen axetil in relieving propofol injection pain and preemptive analgesia after general anesthesia. Methods Databases such as PubMed, CBM, Springer, Ovid, CNKI and ISI were searched to identify randomized controlled trials (RCTs) about flurbiprofen axetil in relieving propofol injection pain and preemptive analgesia after general anesthesia published from 2000 to 2010. The methodological quality of the included RCTs was assessed and the data were extracted according to the Cochrane Handbook 5.0.1. Meta-analysis was performed by using RevMan 4.2.10 software. Results A total of 15 RCTs involving 1 425 patients were included. The results of meta-analyses showed that: a) Relieving propofol injection pain: Compared with the placebo group, flurbiprofen axetil could prevent the propofol injection pain (RR=3.13, 95%CI 1.08 to 9.11, P=0.04), and relieve the moderate and severe pain in injecting propofol (RR=0.57, 95%CI 0.40 to 0.81, P=0.002; RR=0.14, 95%CI 0.05 to 0.34, Plt;0.000 1, respectively), but there were no significant differences in relieving mild pain between the two groups; b) Preemptive analgesia: the visual analog scale (VAS) of post-operation at 2-hour (WMD= –2.25, 95%CI –4.20 to –0.29, P=0.02), 4-hour (WMD= –1.99, 95%CI –3.19 to –0.79, P=0.001), 8-hour (WMD= –1.39, 95%CI –1.86 to –0.93, Plt;0.000 01) and 12-hour (WMD= –2.70, 95%CI –4.73 to –0.68, P=0.009) was decreased when flurbiprofen axetil was injected before the operation, but there were no significant differences in VAS of post-operation at 48-hour between the two groups. When flurbiprofen axetil was injected at the end of the operation, VAS of post-operation at 12-hour (WMD= –0.94, 95%CI –1.73 to –0.16, P=0.02) was decreased, but there were no significant differences in VAS of post-operation at 24-hour between the two groups; flurbiprofen axetil could lessen the need for opioid analgesics (RR=0.47, 95%CI 0.27 to 0.82, P=0.008); and c) Safety: there were no significant differences in postoperative nausea, vomit and somnolence between the two groups. Conclusion Flurbiprofen axetil can significantly prevent or relieve the propofol injection pain; flurbiprofen axetil injected before operation can relieve post-operative pain at 2-, 4-, 8- and 12-hour; flurbiprofen axetil injected at the end of the operation can relieve post-operative pain at 12-hour. Yet more RCTs are required to discuss its effects on nausea, vomit and somnolence.
Objective
To verify the feasibility and effectiveness of the modified fast-track surgery (FTS) in the perioperative period of open liver resection.
Methods
A prospective randomized controlled trial was carried out in 188 consecutive patients undergoing open liver resection between March and December 2014 in the Department of Liver Surgery of West China Hospital. The modified fast recovery procedure and standard rehabilitation procedure were compared in terms of length of hospital stay after operation, hospitalization cost, complications and readmission rate.
Results
A total of 188 consecutive patients were enrolled in the trial. The analysis included 87 patients in the modified fast recovery group and 89 in the standard rehabilitation group. Compared with the standard rehabilitation group, the modified fast recovery group had a shorter length of hospital stay [(5.70±1.47)vs. (7.26±1.96) days] and a lower cost [(42.7±6.7)vs. (47.3±12.5) thousand yuan], and the differences were statistically significant (P<0.05). There were 20 complication cases in the modified group and 39 in the standard group with significant difference (P=0.003). There was no significant difference in the rate of readmission between the two groups (P=1.000). Compared with the standard group, patients in the modified group had less pain 8 hours, the 1st and 2nd days after surgery, better postoperative activities of daily living, more initiative cough times and off-bed activity times, longer duration of movement, and earlier bowel recovery and exhausting, and all the above differences were significantly different (P<0.05). Stepwise regression analysis showed that postoperative complications and bowel recovery and exhausting time were independent related factors for postoperative hospital stay (P<0.001).
Conclusions
Multimodal analgesia-based fast recovery procedure is feasible and effective in the perioperative period of partial hepatectomy. It can shorten the time of hospitalization and reduce the cost of hospitalization.
[Abstract]The number of lung transplantation is gradually increasing worldwide, which brings new challenges to the multi-disciplinary team of lung transplantation. The prognosis of lung transplant recipients is seriously affected by the pathophysiological state of specific lung diseases and perioperative risk factors. It is of great significance for these patients to optimize perioperative management according to these factors. Recently, several expert consensus have been published regarding anesthesia management of lung transplantation. Based on the current evidence and clinical practice of West China Hospital, this review summarizes the key points of anesthesia management for lung transplant recipients to guide anesthesiologists' clinical practice.
Objective
To analyze the outcome of fast track surgery after intercostal nerve block (INB) during thoracoscopic resection of lung bullae.
Methods
We recuited 76 patients who accepted thoracoscopic resection of lung bullae from February 2013 to March 2015. They were randomly divided into two groups: an intercostal nerve block and intravenous patient-controlled analgesia (INB+IPCA) group, in which 38 patients (30 males, 8 females, with a mean age of 23.63±4.10 years) received INB intraoperatively and IPCA postoperatively, and a postoperative intravenous patient-controlled analgesia (IPCA) group, in which 38 patients (33 males, 5 females, with a mean age of 24.93±6.34 years) only received IPCA postoperatively. Their general clinical data and the postoperative pain visual analogue scale (VAS) were recorded. Analgesia-associated side effects, rate of the pulmonary infection were observed. Expenses associated with analgesia during hospital were calculated.
Results
The score of VAS, the incidence of nausea and vomiting, fatigue and other side effects, pulmonary atelectasis and the infection rate in the INB+IPCA group were significantly lower than those in the IPCA group. Postoperative use of analgesic drugs was significantly less than that in the IPCA group. Medical expenses did not significantly increase.
Conclusion
INB+IPCA is beneficial for fast track surgery after thoracoscopic resection of lung bullae.
ObjectiveTo compare postoperative patient-controlled epidural analgesia (PCEA) and intravenous patient-controlled analgesia (PCIA) on maternal low back pain after caesarean section.
MethodsSixty cases of American Society of Anesthesiology gradeⅠ-Ⅱ single-birth full-term elective caesarean delivery primiparae chosen between July to September 2012 were divided into 3 groups randomly, 20 in each group. Group A accepted sufentanil 1 μg/mL and ropivacaine 1 mg/mL PCEA; group B had sufentanil 1.5 μg/mL PCEA; group C was given sufentanil 1.5 μg/mL and ondansetron 0.16 mg/mL PCIA. Background dose was 2 mL/h, patient-controlled analgesia dose was 2 mL, and locking time was 20 min. Visual analogue pain score was used to assess the effect of postoperative analgesia, and we recorded analgesia pump usage, adverse reactions, and at the same time investigated the onset of maternal low back pain.
ResultsNo obvious postoperative pain was found, and the analgesic effect was good in all the three groups, and the differences were not statistically significant (P>0.05). All three groups of women had a certain proportion of low back pain, and the differences were not statistically significant (P>0.05). After operation, group A had 5 cases of leg numbness, group B had 1, and group C had none. Leg numbness occurred significantly more in group A than in group B and C (P<0.05). Group B had one case of nausea and vomiting, while none occurred in group A and C (P>0.05).
ConclusionWith the same effect of postoperative analgesia, compared with PCIA, PCEA does not increase postoperative low back pain incidence after caesarean section.
ObjectiveTo evaluate the impact of local infiltration analgesia on postoperative pain after hip arthroplasty.
MethodsRelevant randomized controlled trials comparing the analgesia effect and adverse effects between local infiltration analgesia group and non-local infiltration analgesia group (control group) were identified from Cochrane Library, Embase, PubMed, China National Knowledge Infrastructure, VIP database and Wanfang database from their establishment until May 2016. A systematic review was performed to compare the pain scores and adverse events between those two groups. Effective data were pooled for Meta-analysis with software RevMan 5.2.0.
ResultsTwelve eligible trials were identified in this study. The pain scores of the two groups of patients during rest time after surgery were significantly different[WMD=-19.06, 95%CI (-21.51, -16.62), P<0.000 01]; the pain scores were also significantly different during activity time[WMD=-11.45, 95%CI (-15.56, -7.34), P<0.000 01]. There was significant difference in postoperative nausea and vomiting between the two groups[RR=0.59, 95%CI (0.42, 0.84), P=0.003]. The pain degree and incidence of nausea and vomiting in the local infiltration analgesia group were lower than the control group, but there was no significant difference between the two groups in terms of urinary retention, itch and hypotension (P>0.05).
ConclusionLocal infiltration analgesia is effective in reducing postoperative pain without any additional adverse reactions.
