Objective To assess the efficacy and safety of lornoxicam, one non-steroidal anti-inflammatory drug (NSAID) in patient-controlled analgesia (PCA) in patients undergoing abdominal surgeries. Methods Thirty-nine patient...Objective To assess the efficacy and safety of lornoxicam, one non-steroidal anti-inflammatory drug (NSAID) in patient-controlled analgesia (PCA) in patients undergoing abdominal surgeries. Methods Thirty-nine patients scheduled for abdominal surgeries were randomly assigned to different PCA treatment groups using either lornoxicam or fentanyl postoperatively. Pain intensity difference (PID) and sum of pain intensity difference (SPID) were used to assess the analgesic efficacy of both drugs during a 24-hour period. Results The analgesic efficacy of lornoxicam is 1/66 of fentanyl, which was shown by SPID value of 3.250 and 3.058, respectively (P > 0.05). Lornoxicam caused fewer adverse events than fentanyl (33% vs. 68%, P < 0.05). Conclusion In clinic, we can use lornoxicam to treat postoperative pain effectively and with less adverse reactions com-pared with fentanyl.展开更多
Objective To evaluate the effects of ultrasound-guided transversus abdominis plane(TAP) block on postoperative analgesia and early recovery in patients undergoing retroperitoneoscopic urologic surgeries.Methods This w...Objective To evaluate the effects of ultrasound-guided transversus abdominis plane(TAP) block on postoperative analgesia and early recovery in patients undergoing retroperitoneoscopic urologic surgeries.Methods This was a randomized,controlled,double-blinded trial.Eligible patients scheduled for retroperitoneoscopic urologic surgeries were randomly assigned to two groups.Group TAP received ultrasound-guided TAP block with 0.5% ropivacaine 20 ml at 30 minutes before surgery,and Group C received TAP sham block with normal saline.All patients received retroperitoneoscopic urologic surgeries under general anesthesia.The primary outcome was the severity of pain after surgery.Secondary outcomes included opioids consumption,analgesics,postoperative nausea and vomiting,time to Foley catheter removal and to passage of flatus,length of post-anesthesia care unit stay and hospital stay.Results Eighty patients completed the study,forty cases in each group.Compared to the Group C,the Group TAP had lower visual analogue scale pain scores within two postoperative days(all P<0.05).They also had less consumption of intraoperative fentanyl(2.0±0.5 vs. 3.8±0.7 μg/kg,P<0.05),reduced incidence of postoperative rescue analgesic usage(12.5% vs. 45.0%,P<0.05),and lower incidence of postoperative nausea and vomiting within postoperative 48 hours(12.5% vs. 25.0%,P<0.05) when compared to the Group C.In addition,Group TAP had a shortened post-anesthesia care unit stay(25±8 vs. 49±12 minutes,P<0.05),and a greater proportion of patients discharged within postoperative three days(57.5% vs. 35.0%,P<0.05).Conclusion Preoperative ultrasound-guided TAP block is an effective technique to improve postoperative analgesia and early recovery in patients undergoing retroperitoneoscopic urologic surgeries.展开更多
BACKGROUND: Emergency physicians have been successful in implementing procedural sedation and analgesia(PSA) to treat emergency department(ED) patients who need to undergo painful procedures.However, 25% of the EDs in...BACKGROUND: Emergency physicians have been successful in implementing procedural sedation and analgesia(PSA) to treat emergency department(ED) patients who need to undergo painful procedures.However, 25% of the EDs in the Netherlands are not staffed by emergency physicians.The aim of this study was to investigate PSA availability and quality in EDs without emergency physicians.METHODS: We performed an exploratory cross-sectional study amongst ED nurses and physicians in all 13 EDs without emergency physicians in the Netherlands.Data were gathered using a standardized questionnaire.RESULTS: The response rate was 34.3%(148/432).Of the respondents, 84/148(56.8%) provided adult PSA and 30/148(20.3%) provided paediatric PSA.Main reasons for not providing PSA were insufficient numbers of trained staff to support PSA in the ED and insufficient training and exposure.The providers agreed significantly stronger when reflecting their PSA competencies in adults compared to paediatric patients.CONCLUSION: The key to improve pain management in the ED-setting may lay in investing in continuous training of ED health care professionals and/or acquiring professionals who are both qualified in PSA and available in the ED.展开更多
Radioimmunoassay was employed to dctermine the immunorcactivc met-enkephalin(ir-MEK)contents of several brain regions .The pain threshold(PT)andir-MEK content of striatum and hypothalamus increased markedly afterintra...Radioimmunoassay was employed to dctermine the immunorcactivc met-enkephalin(ir-MEK)contents of several brain regions .The pain threshold(PT)andir-MEK content of striatum and hypothalamus increased markedly afterintraoerebroventricular injection of substance P(SP)in the dosage of lμgg/10μl ,but nosignificant change of ir-MEK content in hippocampus was observed.When theperiaqueductal gray(PAG)was destroyed with electrolysis,the increase of PT andir-MEK content in the two brain regions after SP injection was obviouslysuppressed(P【0.05-0.01).The PT and ir-MEK content of hypothalamus andstriatum would also increase after intra-PAG injection of SP(0.4μg/4μl),electroacupuncture or intraperitoneal injection of morphine.The ir-MEK content ofhippocampus could also increase after intra-PAG injection of SP or intraperitoncal injec-tion of morphine.The combination of intra-PAG injection of SP andelectroacupuncture caused a more marked elevation of PT and ir-MEK content of the 3brain regions than either of the two used singly could(P【0.01 ).The combined effect ofintra-PAG injection of SP and intraperitoneal injection of morphine was similar to thatof either of the two used singly(P】0.05).These facts indicate that thc analgesic effect ofSP activated by PAG was mediated through the increase of cerebral met-cnkcphalin con-tent,and there was a synergic effect between SP and elcctroacupuncturc.展开更多
Objective.To c ompare the analgesic efficacy and adverse effects of patient-controlled analges iawith tramadol and with morphine for postoperative middle or severe pain .Methods.Fifty-nine patients,scheduled for elect...Objective.To c ompare the analgesic efficacy and adverse effects of patient-controlled analges iawith tramadol and with morphine for postoperative middle or severe pain .Methods.Fifty-nine patients,scheduled for elective hysterectomy or hystero myomectomy ,were ran-domly divided into Group Tand Group M.The2drugs were administered intravenously v ia a patient-controlled analgesia device till24h postoperatively.Efficacy wa s assessed by comparing total pain reliefand the sum of pain intensity differencevalues over24h.Results.Statistically significant equival ence of tramadol and morphine was shown by TOTPAR values(15.9±4.4and1 6.4±3.5,respectively)and SPID values(9.2±4.7and9.0±2.0, respectively).Tramadol caused fewer adverse events than morphin e(16.7%and26.7%of patients,respectively).Conclusion.The analgesic efficacy of PCA with tramadol and with morphine were equivalent in the treatme nt of postoperative pain,and tramadol can cause slighter gastrointestinal adve rse effects.展开更多
BACKGROUND:This prospective,randomized trial was undertaken to evaluate the utility of adding end-tidal capnometry(ETC)to pulse oximetry(PO)in patients undergoing procedural sedation and analgesia(PSA)in the emergency...BACKGROUND:This prospective,randomized trial was undertaken to evaluate the utility of adding end-tidal capnometry(ETC)to pulse oximetry(PO)in patients undergoing procedural sedation and analgesia(PSA)in the emergency department(ED).METHODS:The patients were randomized to monitoring with or without ETC in addition to the current standard of care.Primary endpoints included respiratory adverse events,with secondary endpoints of level of sedation,hypotension,other PSA-related adverse events and patient satisfaction.RESULTS:Of 986 patients,501 were randomized to usual care and 485 to additional ETC monitoring.In this series,48%of the patients were female,with a mean age of 46 years.Orthopedic manipulations(71%),cardioversion(12%)and abscess incision and drainage(12%)were the most common procedures,and propofol and fentanyl were the sedative/analgesic combination used for most patients.There was no difference in patients experiencing de-saturation(Sa O2<90%)between the two groups;however,patients in the ETC group were more likely to require airway repositioning(12.9%vs.9.3%,P=0.003).Hypotension(SBP<100 mm Hg or<85 mm Hg if baseline<100 mm Hg)was observed in 16(3.3%)patients in the ETC group and 7(1.4%)in the control group(P=0.048).CONCLUSIONS:The addition of ETC does not appear to change any clinically significant outcomes.We found an increased incidence of the use of airway repositioning maneuvers and hypotension in cases where ETC was used.We do not believe that ETC should be recommended as a standard of care for the monitoring of patients undergoing PSA.展开更多
Bupivacaine encapsulated poly(lactidecoglycolide)nanoparticles is a novel formulation of extended-release of bupivacaine in poly(lactidecoglycolide)matrix.We evaluated the efficacy and safety of bupivacaine nanopartic...Bupivacaine encapsulated poly(lactidecoglycolide)nanoparticles is a novel formulation of extended-release of bupivacaine in poly(lactidecoglycolide)matrix.We evaluated the efficacy and safety of bupivacaine nanoparticles in peripheral analgesia via behavior tests,electrophysiological recordings,pharmacokinetic analysis,and pathology staining by employing the models of uninjured rats and mice.Nanoparticles injection increased the pain thresholds of rats and mice for 21 days.展开更多
To compare the analgesic and side effects of post-operative analgesia between epidural administration ofneostigmine (NEO) and morphine (MOR) or their combination in patients undergoing abdominal surgery. Methods: One ...To compare the analgesic and side effects of post-operative analgesia between epidural administration ofneostigmine (NEO) and morphine (MOR) or their combination in patients undergoing abdominal surgery. Methods: One hundredand two selective patients undergoing surgery were randomly divided into five groups at the end of the surgical procedure. GroupN1 (n=11) and Group N2(n =15) were administered epidurally with NEO 1 mg and 2 mg respectively, Group M1 (n=18)and Group M2 (n=55) were administered epidurally with MOR 1 mg and 2 mg respectively, Group M1 + N1 (n=17) was administered epidurally with the combination of MOR 1 mg and NEO 1 mg. Results: Single dose epidural administration of NEO (1mg and 2 mg) or MOR (1 mg and 2 mg) showed dose-dependent analgesic effects. The analgesic duration in Group N1 (4.7 ± 2.7 h) was significantly shorter than other four groups (P<0. 01). Group M1, M2 and M1 + N1 showed better analgesic effectsthan group N1 and N2 (16.1±8.7h) , with similar analgesic durations in Group M1, M2 and M1 + N1. me percentages of excellent, good and poor effects were 0%, 54.5 % and 45.5 % respectively in Group N1. The percentages of excellent and good effects were 100% in Group M2 and M1 + N1, but 83.3% in Group N2. The time to first use analgesic medication was similar inGroup M1, M2 and M1 + N1, but longer compared with Croup N1 and N2. The incidences of nausea and vomiting closelyresem-bled one another in Croup N1, N2 and M1 + N1, which were less than those in Group M1 and M2. The incidence of urinary retention was 51.2%, 25.0% and 31.3% in Group M2, M1 and M1 + N1, respectively, but 0% in Group N1 and N2. In GroupN2 two patients opened the bowel movement and one patient developed bradycardia (58 beats/min) at 45 min after receiving NEO.Conclusion: Epidural administration of NEO produces dose-dependent prolonged analgesic effects (similar to MOR) and the combination of MOR and NEO could produce analgesia with fewer side effects than administration of equivalent analgesic doses of eachdrug separately. me epidural administration of NEO 2 mg could provide satisfactory postoperative analgesia.展开更多
文摘Objective To assess the efficacy and safety of lornoxicam, one non-steroidal anti-inflammatory drug (NSAID) in patient-controlled analgesia (PCA) in patients undergoing abdominal surgeries. Methods Thirty-nine patients scheduled for abdominal surgeries were randomly assigned to different PCA treatment groups using either lornoxicam or fentanyl postoperatively. Pain intensity difference (PID) and sum of pain intensity difference (SPID) were used to assess the analgesic efficacy of both drugs during a 24-hour period. Results The analgesic efficacy of lornoxicam is 1/66 of fentanyl, which was shown by SPID value of 3.250 and 3.058, respectively (P > 0.05). Lornoxicam caused fewer adverse events than fentanyl (33% vs. 68%, P < 0.05). Conclusion In clinic, we can use lornoxicam to treat postoperative pain effectively and with less adverse reactions com-pared with fentanyl.
文摘Objective To evaluate the effects of ultrasound-guided transversus abdominis plane(TAP) block on postoperative analgesia and early recovery in patients undergoing retroperitoneoscopic urologic surgeries.Methods This was a randomized,controlled,double-blinded trial.Eligible patients scheduled for retroperitoneoscopic urologic surgeries were randomly assigned to two groups.Group TAP received ultrasound-guided TAP block with 0.5% ropivacaine 20 ml at 30 minutes before surgery,and Group C received TAP sham block with normal saline.All patients received retroperitoneoscopic urologic surgeries under general anesthesia.The primary outcome was the severity of pain after surgery.Secondary outcomes included opioids consumption,analgesics,postoperative nausea and vomiting,time to Foley catheter removal and to passage of flatus,length of post-anesthesia care unit stay and hospital stay.Results Eighty patients completed the study,forty cases in each group.Compared to the Group C,the Group TAP had lower visual analogue scale pain scores within two postoperative days(all P<0.05).They also had less consumption of intraoperative fentanyl(2.0±0.5 vs. 3.8±0.7 μg/kg,P<0.05),reduced incidence of postoperative rescue analgesic usage(12.5% vs. 45.0%,P<0.05),and lower incidence of postoperative nausea and vomiting within postoperative 48 hours(12.5% vs. 25.0%,P<0.05) when compared to the Group C.In addition,Group TAP had a shortened post-anesthesia care unit stay(25±8 vs. 49±12 minutes,P<0.05),and a greater proportion of patients discharged within postoperative three days(57.5% vs. 35.0%,P<0.05).Conclusion Preoperative ultrasound-guided TAP block is an effective technique to improve postoperative analgesia and early recovery in patients undergoing retroperitoneoscopic urologic surgeries.
文摘BACKGROUND: Emergency physicians have been successful in implementing procedural sedation and analgesia(PSA) to treat emergency department(ED) patients who need to undergo painful procedures.However, 25% of the EDs in the Netherlands are not staffed by emergency physicians.The aim of this study was to investigate PSA availability and quality in EDs without emergency physicians.METHODS: We performed an exploratory cross-sectional study amongst ED nurses and physicians in all 13 EDs without emergency physicians in the Netherlands.Data were gathered using a standardized questionnaire.RESULTS: The response rate was 34.3%(148/432).Of the respondents, 84/148(56.8%) provided adult PSA and 30/148(20.3%) provided paediatric PSA.Main reasons for not providing PSA were insufficient numbers of trained staff to support PSA in the ED and insufficient training and exposure.The providers agreed significantly stronger when reflecting their PSA competencies in adults compared to paediatric patients.CONCLUSION: The key to improve pain management in the ED-setting may lay in investing in continuous training of ED health care professionals and/or acquiring professionals who are both qualified in PSA and available in the ED.
文摘Radioimmunoassay was employed to dctermine the immunorcactivc met-enkephalin(ir-MEK)contents of several brain regions .The pain threshold(PT)andir-MEK content of striatum and hypothalamus increased markedly afterintraoerebroventricular injection of substance P(SP)in the dosage of lμgg/10μl ,but nosignificant change of ir-MEK content in hippocampus was observed.When theperiaqueductal gray(PAG)was destroyed with electrolysis,the increase of PT andir-MEK content in the two brain regions after SP injection was obviouslysuppressed(P【0.05-0.01).The PT and ir-MEK content of hypothalamus andstriatum would also increase after intra-PAG injection of SP(0.4μg/4μl),electroacupuncture or intraperitoneal injection of morphine.The ir-MEK content ofhippocampus could also increase after intra-PAG injection of SP or intraperitoncal injec-tion of morphine.The combination of intra-PAG injection of SP andelectroacupuncture caused a more marked elevation of PT and ir-MEK content of the 3brain regions than either of the two used singly could(P【0.01 ).The combined effect ofintra-PAG injection of SP and intraperitoneal injection of morphine was similar to thatof either of the two used singly(P】0.05).These facts indicate that thc analgesic effect ofSP activated by PAG was mediated through the increase of cerebral met-cnkcphalin con-tent,and there was a synergic effect between SP and elcctroacupuncturc.
文摘Objective.To c ompare the analgesic efficacy and adverse effects of patient-controlled analges iawith tramadol and with morphine for postoperative middle or severe pain .Methods.Fifty-nine patients,scheduled for elective hysterectomy or hystero myomectomy ,were ran-domly divided into Group Tand Group M.The2drugs were administered intravenously v ia a patient-controlled analgesia device till24h postoperatively.Efficacy wa s assessed by comparing total pain reliefand the sum of pain intensity differencevalues over24h.Results.Statistically significant equival ence of tramadol and morphine was shown by TOTPAR values(15.9±4.4and1 6.4±3.5,respectively)and SPID values(9.2±4.7and9.0±2.0, respectively).Tramadol caused fewer adverse events than morphin e(16.7%and26.7%of patients,respectively).Conclusion.The analgesic efficacy of PCA with tramadol and with morphine were equivalent in the treatme nt of postoperative pain,and tramadol can cause slighter gastrointestinal adve rse effects.
基金supported by a grant from the Capital Health Research FundHalifax+1 种基金Nova ScotiaCanada
文摘BACKGROUND:This prospective,randomized trial was undertaken to evaluate the utility of adding end-tidal capnometry(ETC)to pulse oximetry(PO)in patients undergoing procedural sedation and analgesia(PSA)in the emergency department(ED).METHODS:The patients were randomized to monitoring with or without ETC in addition to the current standard of care.Primary endpoints included respiratory adverse events,with secondary endpoints of level of sedation,hypotension,other PSA-related adverse events and patient satisfaction.RESULTS:Of 986 patients,501 were randomized to usual care and 485 to additional ETC monitoring.In this series,48%of the patients were female,with a mean age of 46 years.Orthopedic manipulations(71%),cardioversion(12%)and abscess incision and drainage(12%)were the most common procedures,and propofol and fentanyl were the sedative/analgesic combination used for most patients.There was no difference in patients experiencing de-saturation(Sa O2<90%)between the two groups;however,patients in the ETC group were more likely to require airway repositioning(12.9%vs.9.3%,P=0.003).Hypotension(SBP<100 mm Hg or<85 mm Hg if baseline<100 mm Hg)was observed in 16(3.3%)patients in the ETC group and 7(1.4%)in the control group(P=0.048).CONCLUSIONS:The addition of ETC does not appear to change any clinically significant outcomes.We found an increased incidence of the use of airway repositioning maneuvers and hypotension in cases where ETC was used.We do not believe that ETC should be recommended as a standard of care for the monitoring of patients undergoing PSA.
文摘Bupivacaine encapsulated poly(lactidecoglycolide)nanoparticles is a novel formulation of extended-release of bupivacaine in poly(lactidecoglycolide)matrix.We evaluated the efficacy and safety of bupivacaine nanoparticles in peripheral analgesia via behavior tests,electrophysiological recordings,pharmacokinetic analysis,and pathology staining by employing the models of uninjured rats and mice.Nanoparticles injection increased the pain thresholds of rats and mice for 21 days.
文摘To compare the analgesic and side effects of post-operative analgesia between epidural administration ofneostigmine (NEO) and morphine (MOR) or their combination in patients undergoing abdominal surgery. Methods: One hundredand two selective patients undergoing surgery were randomly divided into five groups at the end of the surgical procedure. GroupN1 (n=11) and Group N2(n =15) were administered epidurally with NEO 1 mg and 2 mg respectively, Group M1 (n=18)and Group M2 (n=55) were administered epidurally with MOR 1 mg and 2 mg respectively, Group M1 + N1 (n=17) was administered epidurally with the combination of MOR 1 mg and NEO 1 mg. Results: Single dose epidural administration of NEO (1mg and 2 mg) or MOR (1 mg and 2 mg) showed dose-dependent analgesic effects. The analgesic duration in Group N1 (4.7 ± 2.7 h) was significantly shorter than other four groups (P<0. 01). Group M1, M2 and M1 + N1 showed better analgesic effectsthan group N1 and N2 (16.1±8.7h) , with similar analgesic durations in Group M1, M2 and M1 + N1. me percentages of excellent, good and poor effects were 0%, 54.5 % and 45.5 % respectively in Group N1. The percentages of excellent and good effects were 100% in Group M2 and M1 + N1, but 83.3% in Group N2. The time to first use analgesic medication was similar inGroup M1, M2 and M1 + N1, but longer compared with Croup N1 and N2. The incidences of nausea and vomiting closelyresem-bled one another in Croup N1, N2 and M1 + N1, which were less than those in Group M1 and M2. The incidence of urinary retention was 51.2%, 25.0% and 31.3% in Group M2, M1 and M1 + N1, respectively, but 0% in Group N1 and N2. In GroupN2 two patients opened the bowel movement and one patient developed bradycardia (58 beats/min) at 45 min after receiving NEO.Conclusion: Epidural administration of NEO produces dose-dependent prolonged analgesic effects (similar to MOR) and the combination of MOR and NEO could produce analgesia with fewer side effects than administration of equivalent analgesic doses of eachdrug separately. me epidural administration of NEO 2 mg could provide satisfactory postoperative analgesia.
