Objective To overview the systematic reviews/meta-analyses of efficacy of FNB used as a postoperative analgesic technique among patients undergoing TKR. Methods We electronically searched databases including The Cochrane Library, PubMed, EMbase, CNKI, WanFang Data and VIP from inception to July, 2016. Two reviewers independently screened literature and extracted data. AMSTAR tool was used to assess the methodological quality of included studies. The primary outcome was pain scores and the consumption of opoid medicine to evaluate the effectiveness of FNB. Results A total of 16 systematic reviews/meta-analyses were included, involving the FNBvs. LIA, PMDI, EA, PCA and ACB, respectively. The results of quality assessment indicated medium scores with 3 to 9 scores. The overviews’ results showed that: at rest, FNB was not superior to LIA at 6h after TKR; it was superior to PMDI at 12h after TKR; it was also superior to PCA and LIA, but not superior to ACB at 24h after TKR. On movement, FNB was superior to PCA and LIA at 24h after TKR; it was also superior to PCA at 48h after TKR. As to the consumption of opoid medicine, the consumption in FNB group was more than LIA group at 12h after TKR. In addition, the consumption in FNB group was less than PCA and LIA at 24h after TKR, and it was also less than PCA and ACB at 48h. The satisfaction of patients who received FNB was better than ACB, EA and PCA. Conclusion The current overview shows that FNB is more effective than PCA and LIA, the patients’ satisfaction is better. Due to the limitations of the quantity and quality of included studies, the above conclusions are needed to be verified by more studies.
【摘要】 目的 观察密集型银质针松解术结合臂丛神经阻滞麻醉治疗老年肩周炎的疗效。 方法 2007年4月-2008年6月，将120例老年肩周炎患者（gt;60岁）随机分为治疗组、对照组各60例；治疗组采用密集型银质针松解术结合臂丛神经阻滞麻醉治疗，对照组则用单纯密集型银质针松解术治疗。 结果 治疗组痊愈43例、显效15例、好转2例；对照组痊愈41例、显效16例、好转3例。总有效率均为100%。两组疗效差异无统计学意义（Pgt;0.05），治疗组心率血压变化值及疼痛评分均低于对照组，差异有统计学意义（Plt;0.05）。 结论 密集型银质针松解术结合臂丛神经阻滞为治疗老年肩周炎的安全、有效方法。【Abstract】 Objective To investigate the effect of dense silver needle acupuncture therapy combined with brachial plexus nerve block for old patients with shoulder periarthritis. Methods A total of 120 patients with shoulder periarthritis diagnosed in our hospital between April 2007 and June 2008 were randomly divided into treatment group and control group with 60 in each group. Patients in the treatment group were treated with dense silver needle acupuncture therapy combined with brachial plexus nerve block, while patients in the control group were only treated with dense silver needle acupuncture therapy. Results In the treatment group, 43 patients were cured, the treatment produced effect in 15 patients, and improvement could be found in two patients. For the control group, those three numbers were respectively 41, 16 and 3. The effectice rate was 100% in both groups. The difference of effect between the two groups was not statistically significant (Pgt;0.05), while the variation of blood pressure and heart rate and the visual analogue scales in the treatment group were significant lower than these in the control gvroup (Plt;0.05) Conclusion The dense silver needle acupuncture therapy combined with brachial plexus nerve block is safe and effective in treating old patients with shoulder periarthritis.
Objective To compare the anesthetic effects of traditional digital block with single-injection digital block in digital injury patients for subcutaneous digital blocks. Methods Patients with one or two digits injured were randomized to the traditional digital block group and single-injection digital block group. All of the blocks were conducted by one investigator. The patients and outcome assessor were blinded to the treatment allocation. Both of the per-protocol-population (PP) analysis and the intention-to-treatment (ITT) analysis were performed to compare the two block techniques in terms of the pain during infiltration, the onset time of anesthesia and the failure rate of anesthesia. Results A total of 93 patients (109 digits) were included with 51 (61 digits) in the traditional block group and 42 (48 digits) in the single-injection block group.Two patients (3 digits) dropped out. Both of the PP analysis and ITT analysis showed that no significant difference between the two groups were detected in terms of the pain during infiltration, the onset time of anesthesia and the failure rate of anesthesia (P﹥0.05). Conclusions The subcutaneous single-injection digital block is as effective as the traditional digital block, but is much easier to perform. This technique is indicated for the digital anesthesia of palmar aspect distal to the proximal digital crease and dorsal aspect of the distal and middle phalanxes.
Splanchnicectomy is a minimally invasive and effective method of treating chronic upper abdominal pain in cancer. It offers good, short-term pain relief, reduces morphine consumption, and improves patients' satisfaction. In the wake of developments in minimally invasive technology, the method has brought a number of new breakthroughs. We reviewed the effect of the success of splanchnicectomy.
Objective To compare the pain relief and rehabilitation effect of intercostal nerve block and conventional postoperative analgesia in patients undergoing thoracoscopic surgery. Methods China National Repository, Wanfang Database, VIP, China Biomedical Literature Database, Web of Science, Clinicaltrials.gov, Cochrane Library, EMbase and PubMed were searched from establishment of each database to 10 Febraray, 2022. Relevant randomized controlled trials (RCTs) of intercostal nerve block in thoracoscopic surgery were collected, and meta-analysis was conducted after data extraction and quality evaluation of the studies meeting the inclusion criteria. Results A total of 21 RCTs and one semi-randomized study were identified, including 1 542 patients. Performance bias was the main bias risk. Intercostal nerve block had a significant effect on postoperative analgesia in patients undergoing thoracoscopic surgery. The visual analogue scale (VAS) score at 12 h after surgery (MD=–1.45, 95%CI –1.88 to –1.02, P<0.000 01), VAS score at 24 h after surgery (MD=–1.28, 95%CI –1.67 to –0.89, P<0.000 01), and VAS score at 48 h after surgery significantly decreased (MD=–0.90, 95%CI –1.22 to –0.58, P<0.000 01). In exercise or cough state, VAS score at 24 h after surgery (MD=–2.40, 95%CI –2.66 to –2.14, P<0.000 01) and at 48 h after surgery decreased significantly (MD=–1.89, 95%CI –2.09 to –1.69, P<0.000 01). In the intercostal nerve block group, the number of compression of the intravenous analgesic automatic pump on the second day after surgery significantly reduced (SMD=–0.78, 95%CI –1.29 to –0.27, P=0.003). In addition to the analgesic pump, the amount of additional opioids significantly reduced (SMD=–2.05, 95%CI –3.65 to –0.45, P=0.01). Postoperative patient-controlled intravenous analgesia was reduced (SMD=–3.23, 95%CI –6.44 to –0.01, P=0.05). Patient satisfaction was significantly improved (RR=1.31, 95%CI 1.17 to 1.46, P<0.01). Chest tube indwelling time was significantly shortened (SMD=–0.64, 95%CI –0.84 to –0.45, P<0.001). The incidence of analgesia-related adverse reactions was significantly reduced (RR=0.43, 95%CI 0.33 to 0.56, P<0.000 01). Postoperative complications were significantly reduced (RR=0.28, 95%CI 0.18 to 0.44, P<0.000 01). Two studies showed that the length of hospital stay was significantly shortened in the intercostal nerve block group, which was statistically different (P≤0.05), and there was no statistical difference in one report. Conclusion The relief of acute postoperative pain and pain in the movement state is more prominent after intercostal nerve block. Intercostal nerve block is relatively safe and conforms to the concept of enhanced recovery after surgery, which can be extensively utilized in clinical practice.
ObjectiveTo systematically evaluate the analgesic efficacy of local infiltration analgesia versus femoral nerve block for total knee arthroplasty. MethodsDatabases including PubMed, EMbase, The Cochrane Library (Issue 4, 2016), WanFang Data, CBM, and CNKI were searched to collect randomized controlled trials (RCTs) about the analgesic efficacy of local infiltration analgesia versus femoral nerve block for total knee arthroplasty from inception to April 2016. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. The meta-analysis was conducted using RevMan 5.3 software. ResultsA total of 13 RCTs involving 1 001 patients were included. The results of meta-analysis showed that: There were no significant differences in pain scores at rest (SMD=0.02, 95%CI -0.23 to 0.27, P=0.86), morphine consumption on movement (MD=-1.85, 95%CI -4.67 to 0.97, P=0.20), incidence of post-operative nausea and vomiting (RD=0.02, 95%CI -0.03 to 0.08, P=0.41) and incidence of post-operative knee infection (RD=0.01, 95%CI -0.02 to 0.03, P=0.60) between the two groups, but he local infiltration analgesia group had lower length of stay than the femoral nerve block group with statistical difference (SMD=-0.24, 95%CI -0.41 to -0.07, P=0.005). ConclusionLocal infiltration analgesia provides similar postoperative analgesia after total knee arthroplasty to femoral nerve block. However, due to the limited quantity of the included studies, the above conclusion still need to be verified by more high quality studies.
目的:观察在经尿道膀胱肿瘤电切术中采用闭孔神经阻滞减少闭孔反射的情况及远期疗效。方法:选取2005年1月～2006年5月期间我科收治的60例确诊膀胱肿瘤患者,严格按照手术适应症随机分为两组:对照组30例单纯硬膜外麻下行经尿道肿瘤电切术,治疗组30例在硬膜外麻醉基础上进行闭孔神经阻滞,观察两组闭孔反射发生率并进行术后随访,观察肿瘤的复发情况。结果:对照组闭孔反射发生率明显高于治疗组(Plt;0.05),经过随访治疗组30例患者3例出现了膀胱肿瘤复发,复发率为10.0%,对照组复发率为13.3%(4/30),两组复发率无明显差异(Pgt;0.05)。结论:在经尿道膀胱肿瘤电切术中采取闭孔神经阻滞能明显减少闭孔反射的发生,明显提高手术的效果,但是改善膀胱肿瘤近期和远期疗效还有待进一步探讨。
ObjectiveTo compare postoperative analgesic efficacy and motor function recovery between ultrasound guided adductor canal block (ACB) and Femoral nerve block (FNB) in patients after total knee arthroplasty (TKA). MethodsFrom March to April 2014, 40 patients chosen to receive TKA under general anesthesia were randomly allocated to FNB group and ACB group with 20 in each group. Opioids consumption during and after operation, pain score in rest and movement, the force of quadriceps femoris, activity of knee and complications after surgery were recorded. ResultsNo differences were found in opioids consumption during and after operation, pain score in rest and movement after operation. Patients of ACB group were superior to those of FNB group in motor function recovery. At hour 2, 4, 8, 12, 24, and 48 after operation, the force of quadriceps femoris was higher in patients of ACB group than those of FNB group (P<0.05). Activity of knee was higher in patients of ACB group than those of FNB group postoperatively. ConclusionACB and FNB have equal postoperative analgesic effect for TKA patients. But ACB has less influence on the force of quadriceps femoris than FNB. Therefore, patients of ACB group are superior to those of FNB group in motor function recovery, showing better activity of knee and early time of first straight leg raising.
ObjectiveTo investigate the efficacy of sequential treatment with adductor canal nerve block (ACNB) and cyclooxygenase 2 (COX-2) selective inhibitor (parecoxib and celecoxib) after primary total knee arthroplasty (TKA). MethodsBetween January 2015 and December 2015, 90 osteoarthritis patients who met the inclusion criteria were treated, and randomly divided into 3 groups:ACNB+COX-2 group (group A, n=30), COX-2 group (group B, n=30), and control group (group C, n=30). There was no significant difference in gender, age, body mass index, side, and osteoarthritis duration between groups (P > 0.05), and the data were comparable. ACNB was used in group A at the end of TKA. Intravenous injection of parecoxib (40 mg per 12 hours) was administrated at the first three postoperative days, and followed by oral celecoxib (200 mg per 12 hours) until 6 weeks after operation in groups A and B; while placebo was given at the same time point in group C. Oral tramadol or intravenous morphine, as remedial measures, were introduced when patients had a visual analogue scale (VAS) score more than 4. The following indicators were compared between groups:the operative time, drainage volume at 24 hours after operation, length of hospital stay, and incidence of side effect; VAS pain scores, morphine consumption, range of motion (ROM) of the knee joint, and inflammatory cytokines levels at pre-operation and at 1 day, 2 days, 3 days, 1 week, 2 weeks, 4 weeks, and 6 weeks after operation; morphine consumption within first 24 hours and at 24 hours to 6 weeks after operation; the American Hospital for Special Surgery (HSS) score at 1, 2, 4, and 6 weeks after operation; and the serum coagulation parameters at pre-operation, and at 1, 3, and 14 days after operation. ResultsThe length of hospital stay was significantly shorter and the incidence of postoperative nausea and vomiting was significantly lower in groups A and B than group C (P < 0.05). The VAS scores at rest (VASR) of groups A and B were significantly lower than that of group C at 1, 2, and 3 days after operation (P < 0.05); difference in the VAS scores at walking (VASW) was significant between groups at 1 day after operation (P < 0.05), and group A had the lowest VASW; and the VASW of groups A and B were significantly lower than that of group C at 2 and 3 days and at 1, 2, 4, and 6 weeks after operation (P < 0.05). The difference in morphine consumption was significant between groups within the first 24 hours after operation (P < 0.05), and group A exhibited the lowest consumption; and the morphine consumption in groups A and B was significantly lower than that in group C at 24 hours to 6 weeks after operation (P < 0.05). Significant difference was found in HSS scores between groups at 1, 2, 4, and 6 weeks after operation, and group A showed the highest score (P < 0.05). At 1 and 2 days after operation, group A showed the highest ROM (P < 0.05), and ROM of groups A and B was significantly higher that of group C at 3 days, 1 week, 2 weeks, 4 weeks, and 6 weeks after operation (P < 0.05). Groups A and B were significantly lower than group C in the serum erythrocyte sedimentation rate at 2 days, 3 days, 1 week, 2 weeks, 4 weeks, and 6 weeks, in C-reactive protein levels at 1, 2, and 3 days, in interleukin 6 (IL-6) and TNF-α levels at 1 day to 6 weeks, and in IL-8 level at 2 and 3 days (P < 0.05). The drainage volume within the first 24 hours and the serum coagulation parameters within the 2 weeks after operation showed no significant difference between groups (P > 0.05). ConclusionSequential treatment with ACNB and COX-2 selective inhibitor is a safe and effective approach for postoperative pain management after primary TKA, and it can alleviate postoperative pain, promote the joint function recovery, and reduce the risk of adverse reactions.