Objective
To evaluate the clinical effects of surgical treatment for 30 patients with discogenic low back pain.
Methods
A total of 30 patients with 36 intervertebral discs were treated with posterior approach lumbar discectomy and interbody fusion with internal fixation by strict criteria. All patients were followed up for one year. The low back pain before and one year after surgery was evaluated by Japanese Orthopaedic Association (JOA) score and Visual Analogue Scale (VAS) score.
Results
The patients’ JOA score increased from 14.6±2.3 (before operation) to 27.1±0.9 (one year after operation) (t=–26.936, P<0.001), while the patients’ VAS score decreased from 6.2±1.6 (before operation) to 1.4±0.9 (one year after operation) (t=16.335, P<0.001), and the differences were significant.
Conclusion
When the conservative treatment is invalid, the operation of posterior lumbar intervertebral fusion is an effective method for the patinets with discogenic low back pain.
ObjectiveTo explore the effect of rehabilitation training focusing on early exercise on the time of first getting out of bed after surgery, pain during early activities, postoperative infection rate and the length of hospital stay for renal transplant recipients.MethodsThe clinical data of patients undergoing allogeneic renal transplantation in West China Hospital of Sichuan University from June to August 2020 were analyzed retrospectively. According to the time of multidisciplinary postoperative management and the time of early rehabilitation intervention, the patients were divided into the conventional group (from June 2020 to the beginning of multidisciplinary postoperative management) and the rehabilitation group (after multidisciplinary postoperative management). The time to get out of bed for the first time after surgery, the Visual Analogue Score (VAS) during weight monitoring on the second day post operation, the number of days required to complete an independent walk of 100 meters, postoperative complications, the incidence of postoperative infection and the length of hospital stay were compared between the two groups.ResultsA total of 79 patients were included. There were 46 cases in the conventional group and 33 cases in the rehabilitation group. Among the included patients, 14 patients had postoperative infection, 1 patients in the conventional group developed thrombosis, no catheter shedding or bleeding after exercise occurred. The differences between the rehabilitation group and the conventional group in the time to get out of bed for the first time after surgery [(1.1±0.2) vs. (2.2±0.4) d; t=13.224, P<0.001], the VAS during weight monitoring on the day post operation (2.5±0.9 vs. 3.4±1.4; t=3.267, P<0.001), the number of days required to complete an independent walk of 100 meters [(2.2±0.4) vs. (4.0±0.8) d; t=11.312, P<0.001], and the incidence of postoperative infection (6.1% vs. 26.1%; χ2=5.285, P=0.022) were statistically significant. There was no significant difference in the length of stay between the rehabilitation group and the conventional group [(19.8±5.8) vs. (20.7±7.4) d; t=0.584, P=0.561].ConclusionEarly postoperative rehabilitation training reduces the time required for renal transplant recipients to get out of bed for the first time post operation and to walk 100 meters independently, reduce the pain response during early activities, and reduce the incidence of postoperative infection.
ObjectiveTo systematically evaluate the efficacy of different interventions in preventing rocuroniuminduced injection pain or withdrawal movements, so as to provide references for preventing adverse reactions induced by rocuronium injection in clinical practice.
MethodsWe electronically searched PubMed, EMbase, The Cochrane Library (Issue 3, 2014), CBM, and CNKI databases to collect randomized controlled trials (RCTs) about the prevention of rocuronium-induced injection pain or withdrawal movements from inception to March 2014. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.2.8 software.
ResultsA total of 43 RCTs involving 6 034 patients were include. The results of meta-analysis showed that compared with the placebo/blank group, lidocaine pretreatment with venous occlusion (RR=0.37, 95%CI 0.29 to 0.48, P<0.000 01), opioid drug pretreatment with venous occlusion (RR=0.77, 95%CI 0.68 to 0.87, P<0.000 1), lidocaine pretreatment with venous injection (RR=0.51, 95%CI 0.44 to 0.59, P<0.000 01), opioid drug pretreatment with venous injection (OR=0.03, 95%CI 0.02 to 0.05, P<0.000 01), ketamine pretreatment with venous injection (RR=0.36, 95%CI 0.23 to 0.54, P<0.000 01), mixing sodium bicarbonate (NaHCO3) with rocuronium (OR=0.02, 95%CI 0.01 to 0.04, P<0.000 01) and local heating (RR=0.74, 95%CI 0.63 to 0.88, P=0.000 6) were all effective in decreasing the incidence of rocuronium-induced injection pain or withdrawal movements.
ConclusionThe intravenous injection of opioid drugs was effective in preventing rocuronium-induced injection pain or withdrawal movements, while local heating needs further research. Due to the limited quantity and quality of the induced studies, the above conclusion still needs to be verified by more high quality studies.
摘要:目的: 探討深部痛點阻滯在治療頑固性癌痛患者中的作用。 方法 : 將156例頑固性癌痛患者,隨機分為深部痛點阻滯組及對照組,每組78例。深部痛點阻滯組根據疼痛部位,應用軟組織外科學理論找出相應壓痛點,給予痛點深部阻滯治療;對照組找出壓痛點但僅按三階梯用藥原則給予口服藥物治療。 結果 : 深部痛點阻滯組及對照組兩組患者經治療后疼痛控制均較理想(深部痛點阻滯組VAS13, 對照組VAS17),但是深部痛點阻滯組嗎啡用量明顯少于對照組(嗎啡日平用量深部痛點阻滯組為335mg, 對照組為15287 mg)。便秘的發生率深部痛點阻滯組為5384%,對照組為7692%。 結論 : 深部痛點阻滯能較好的控制頑固性癌痛,同時可明顯減少嗎啡的用量,副作用相對發生要少。Abstract: Objective: To investigate the effect of the deeppressed pain points injection on the refractory cancer pain and provide reference for relieving the cancer pain. Methods : One hundred and fiftysix patients with refractory cancer pain were diagnosed by the soft tissue surgery,finding the pain point by pressing deeply,the patients with deeppressed pain points were divided into deeppressed pain points injection group and control group randomly, The patients in deeppressed pain points injection group were treated with deeppressed pain points injection; the patients in control group were treated with drugs according with the WHO analgesic ladder. Results : The patients in deeppressed pain points injection group got the same pain relief as those in control group (VAS 13 in deeppressed pain points injection group, 17 in control group ),but the daily dose of morphine in deeppressed pain points injection group was less than that incontrol group (morphine 335mg/day in deeppressed pain points injection group,15287mg/day in control group ) significantly. There was 5384% patients with constipation in deeppressed pain points injection group, 7692% in control group. Conclusion : The refractory cancer pain can be controlled effectively by the deeppressed pain point injection and the daily dose of morphine to control the cancer pain is decreased significantly. The side effect in deeppressed pain points injection group was less than that in control group.
ObjectiveTo compare the safety, effectiveness, and stability of 3D Max lightweight patch and standard patch in laparoscopic transabdominal preperitoneal (TAPP) herniorrhaphy.
MethodsThe clinical data of 147 patients who underwent laparoscopic TAPP herniorrhaphy with 3D Max from May 2013 to May 2014 in this hospital were collected. Of all the patients, the lightweight patches were used in 75 patients (observation group), the standard patches were used in 72 patients (control group). The mean operative time, mean early postoperative ambulation time, mean bleeding volume, postoperative pain, postoperative foreign body sensation, complications, average hospital stay, and average costs were compared between these two groups. The postoperative pain point was determined by using visual analogue scale (VAS). The foreign body sensation of postoperative groin area was determined basing on the pain point.
ResultsThere were no significant differences in the terms of the mean operation time, the mean early postoperative ambulation time, the mean bleeding volume, the average costs, and the average hospital stay between the observation group and the control group (P > 0.05). On postoperative 2 d, the pain point of the observation group was slightly lower than that of the control group, but there was no statistically significant difference between these two groups (P=0.132); On postoperative 1 month and 6 months, the postoperative pain points of the observation group were significantly lower than those of the control group, the differences were statistically significant (P=0.031, P=0.018). There was no recurrence of hernia and complications in the two groups.
ConclusionsThe cost of 3D Max lightweight patch in laparoscopic TAPP herniorrhaphy application is slightly higher than that in standard patch, but it could alleviate postoperative pain, reduce postoperative foreign body sensation, and make patients feel more comfortable. It is safe, effective, and stable in clinical application of laparoscopic TAPP herniorrhaphy.
Aiming at the single treatment and the design separation between treatment and assessment in electrotherapy equipment, a kind of system including low-intermediate frequency treatment and efficacy evaluation was developed. With C8051F020 single-chip microcomputer as the core and the circuit design and software programming used, the system realized the random switch of therapeutic parameters, the collection, display and data storage of pressure pain threshold in the assessment. Experiment results showed that the stimulus waveform, current intensity, frequency, duty ratio of the system output were adjustable, accurate and reliable. The obtained pressure pain threshold had a higher accuracy (<0.3 N) and better stability, guiding the parameter choice in the precise electrical stimulation. It, therefore, provides a reliable technical support for the treatment and curative effect assessment.
Objective To compare the difference of anterior knee pain between mobile-bearing prosthesis and fixedbearing prosthesis after total knee arthroplasty (TKA). Methods Between January 2008 and October 2008, 72 patients withosteoarthritis were treated with primary TKA. All patients were randomly divided into fixed-bearing prosthesis group (n=37)and mobile-bearing prosthesis group (n=35). In fixed-bearing prosthesis group, there were 8 males and 29 females with an average age of 69.6 years (range, 57-76 years), weighing from 55 to 92 kg (mean, 66.7 kg); the locations were the left knee in 20 cases and the right knee in 17 cases; the body mass index (BMI) ranged from 17.6 to 37.3 (mean, 26.2); the disease duration was 3-22 years; the Knee Society Score (KSS) knee score, function score, patellar score, and pain score were 29.4 ± 15.3, 33.4 ± 16.8, 7.2 ± 2.5, and 2.5 ± 2.2, respectively; and the Insall-Salvati (I-S) index was 1.6 ± 0.3. In mobile-bearing prosthesis group, there were 9 males and 26 females with an average age of 68.2 years (range, 58-73 years), weighing from 50 to 86 kg (mean, 67.9 kg); the locations were the left knee in 30 cases and the right knee in 5 cases; the BMI ranged from 18.4 to 34.4 (mean, 25.6); the disease duration was 6-18 years; the KSS knee score, function score, patellar score, and pain score were 30.9 ± 14.7, 31.4 ± 14.4, 6.8 ± 3.1, and 2.0 ± 2.3, respectively; and the I-S index was 1.6 ± 0.2. There was no significant difference in general data between 2 groups (P gt; 0.05). Results All incisions healed by first intention; no deep vein thrombosis of lower l imbs or pulmonary embol ism occurred. All patients were followed up 12-16 months. In mobile-bearing prosthesis group, knee infection occurred in 1 case, dislocation of the knee in 1 case, and cl icking of the knee in 3 cases; in fixed-bearing prosthesis group, cl icking of the knee occurred in 1 case. There was no significant difference in KSS knee score, function score, patellar score, or pain score between 2 groups (P lt; 0.05) at last follow-up; and there was no significant difference in congruence angle, lateral patellofemoralangle, patellar tilt angle, lateral patellar displacement, patellar displacement, or I-S index between 2 groups at last follow-up (P gt; 0.05). Anterior knee pain occurred in 7 cases (18.9%) of the fixed-bearing prosthesis group and in 5 cases (14.3%) of the mobilebearing prosthesis group, showing no significant difference (χ2=0.227, P =0.634). There were significant differences in KSS knee score, function score, patellar score, and I-S index between patients with anterior knee pain and patients without anterior knee pain (P lt; 0.05). Conclusion Fixed-bearing prosthesis and mobile-bearing prosthesis have the same short-term effectiveness and the incidence of anterior knee pain.
By reviewing the current status of chronic pain and combining with the new definition of pain revised by the International Association for the Study of Pain in 2020, firstly a prevention-based approach, self-management of pain, and multidisciplinary collaboration based on the integration of bio-psycho-social-environmental factors is proposed. The medical mode will greatly improve the treatment effect of chronic pain and the quality of life of patients. Secondly, the importance of strengthening humanistic care and paying attention to health education, as well as improving medical staff’s awareness of chronic pain and the level of diagnosis and treatment are pointed out. Finally, it is clarified that innovative non-drug treatments and the establishment of digital pain management platforms are the future of chronic pain.
Objective To investigate the effectiveness of pretreatment with mixture of lidocaine and flurbiprofen axetil in reducing injection pain of propofol. Methods One hundred and sixty ASI I–II patients undergoing general anaesthesia were randomly allocated into four groups (40 cases in each group): the control group, the lidocaine (Lc) group, the flurbiprofen axetil (FA) group and the mixture of lidocaine and flurbiprofen axetil (hereafter termed as “mixture”) group. After the occlusion of venous drainage, patients were pretreated with 7 mL of 0.9% saline in the control group, 5 mL (50 mg) of flurbiprofen axetil and 2 mL of 0.9% saline in the FA group, 2 mL (40 mg) of 2% lidocaine and 5 mL of 0.9% saline in the Lc group, and 5 mL (50 mg) of flurbiprofen axetil and 2 mL (40 mg) of 2% lidocaine in the mixture group, respectively. The occlusion was released 2 min later and then 0.5 mg/kg propofol was injected into the vein within 5 s. During injecting propofol, the patients were asked by another anesthetist to assess and record their pain through using VSR. Results No significant differences in the demographic characteristics were found among the four groups. In comparison with the control group, the incidence rates of propofol injection pain were obviously lower in the mixture group, the FA group and the Lc group (Plt;0.05); there was a significant reduction in the incidence rate of pain in the mixture group compared with the other three groups. The median pain score was significantly lower in the mixture group and the Lc group than that in the control group. During the 24 hour follow-up after operation, neither the adverse events such as red-swelling in injection site, phlebitis or drug eruption, nor the gastrointestinal stimulating signs were found. Conclusion The mixture of flurbiprofen axetil and lidocaine is found to be more effective in reducing injection pain of propofol.
ObjectiveTo summarize the early postoperative pain management strategies for anterior cruciate ligament reconstruction (ACLR), and to select a reasonable and effective pain management plan to promote functional rehabilitation after ACLR. MethodsThe literature about the early postoperative pain management strategies of ACLR both domestically and internationally in recent years was extensiverly reviewed, and the effects of improving postoperative pain were reviewed. ResultsCurrently, physical therapy and oral medication have advantages such as economy and simplicity, but the effect of improving postoperative pain is not satisfactory, often requires a combination of intravenous injection or intravenous pump, which is also a common way to relieve pain. However, in order to meet the analgesic needs of patients, the amount of analgesic drugs used is often large, which increases the incidence of various adverse reactions. Local infiltration analgesia (LIA), including periarticular or intra-articular injection of drugs, can significantly improve the early postoperative pain of ACLR, and achieve similar postoperative effectiveness as nerve block. LIA can be used as an analgesic technique instead of nerve block, and avoid the corresponding weakness of innervated muscles caused by nerve block, which increases the risk of postoperative falls. Many studies have confirmed that LIA can alleviate postoperative early pain in ACLR, especially the analgesic effects of periarticular injection are more satisfactory. It can also avoid the risk of cartilage damage caused by intra-articular injection. However, the postoperative analgesic effect and timeliness still need to be improved. It is possible to consider combining multimodal mixed drug LIA (combined with intra-articular and periarticular) with other pain intervention methods to exert a synergistic effect, in order to avoid the side effects and risks brought by single drugs or single administration route. LIA is expected to become one of the most common methods for relieving postoperative early pain in ACLR. ConclusionEarly pain after arthroscopic ACLR still affects the further functional activities of patients, and all kinds of analgesic methods can achieve certain effectiveness, but there is no unified standard at present, and the advantages and disadvantages of various analgesic methods need further research.
