Objective To compare the early analgesic effects and the impact on knee joint function recovery after unicompartmental knee arthroplasty (UKA) between single adductor canal block (SACB) and continuous adductor canal block (CACB) combined with local infiltration anesthesia (LIA) using a prospective study. Methods The patients with knee osteoarthritis admitted between April 2022 and December 2023 were enrolled as a subject. Among them, 60 patients met the selection criteria and were enrolled in the study. They were randomly assigned to the SACB group or CACB group in a ratio of 1:1 using a random number table method. There was no significant difference between the two groups (P>0.05) in terms of age, gender, height, body mass, body mass index, affected side, and preoperative resting visual analogue scale (VAS) score and active VAS score, Oxford knee score (OKS), and American Hospital of Special Surgery (HSS) score. All patients received multimodal analgesia management using LIA combined with SACB or CACB. The operation time, pain related indicators (resting and activity VAS scores, number and timing of breakthrough pain, opioid consumption), joint function related indicators (quadriceps muscle strength, knee range of motion, OKS score, and HSS score), as well as postoperative block complications and adverse events were recorded and compared between the two groups. Results There was no significant difference in the operation time between the two groups (P<0.05). All patients in the two groups were followed up with a follow-up time of (9.70±4.93) months in the SACB group and (12.23±5.05) months in the CACB group, and the difference was not significant (P>0.05). The CACB group had a significant lower resting VAS score at 24 hours after operation compared to the SACB group (P<0.05). There was no significant difference in resting and active VAS scores between the two groups at other time points (P>0.05). The CACB group had a significantly lower incidence of breakthrough pain compared to the SACB group [9 cases (30.00%) vs. 17 cases (56.67%); P<0.05). However, there was no significant difference in the timing of breakthrough pain occurrence and opioid consumption between the two groups (P>0.05). Four cases in the SACB group and 7 cases in the CACB group experienced adverse events, with no significant difference in the incidence of adverse events between the two groups (P>0.05). The CACB group had significantly better knee joint mobility than the SACB group at 1 and 2 days after operation (P<0.05). There was no significant difference between the two groups in knee joint mobility on 0 day after operation and quadriceps muscle strength and OKS and HSS scores at different time points (P>0.05). Conclusion In UKA, the analgesic effects and knee joint function recovery are similar when compared between LIA combined with SACB and LIA combined with CACB. However, SACB is simpler to perform and can avoid adverse events such as catheter displacement and dislocation. Therefore, SACB may be a better choice.
Sedation and analgesia is an essential part of the emergency work. Presently, for adults, clinical assessment and application of sedation and analgesia has been gradually perfect, but in the face of pediatric patients, clinicians would always concern drug-related adverse reactions as well as a variety of uncontrollable factors, leading to reducing and even ignoring the sedation and analgesia in children. This review focuses on the current research status and relevant evidence of pediatric sedation depth and risk assessment, pain assessment, as well as the principles, application methods, advantages and disadvantages of various commonly used clinical drugs, and the aim is to provide evidence for higher quality sedation and analgesia for children.
ObjectiveTo evaluate the feasibility and efficiency of patient-controlled analgesia and sedation (PCAS) with propofol and remifentanil for colonoscopy in elderly patients. MethodsSixty elderly patients preparing for painless colonoscopy between May and September 2015 were randomly allocated into PCAS group and total intravenous anesthesia (TIVA) group with 30 patients in each. In the PCAS group, the mixture of remifentanil and propofol at 0.6 mL/(kg·h) was pumped continuously after an initial bolus of 0.05 mL/kg mixture. The examination began three minutes after the infusion was finished. Patients could press the self-control button. Each bolus delivered 1 mL and the lockout time was 1 minute. In the TIVA group, patients received fentanyl at 1 μg/kg and midazolam at 0.02 mg/kg intravenously, and accepted intravenous propofol at 0.8-1.0 mg/kg two minutes later. The examination began when the patients lost consciousness. ResultsA significant decline of mean arterial blood pressure was detected within each group after anesthesia (P < 0.05). The decrease of mean blood pressure in the TIVA group was more significant than that in the PCAS group (P < 0.05). The heart rate, pulse oxygen saturation and respiratory rate decreased significantly after anesthesia in both the two groups (P < 0.05), while end-tidal CO2 increased after anesthesia without any significant difference between the two groups (P > 0.05). The induction time, time to insert the colonoscope to ileocecus, and total examination time were not significantly different between the two groups (P > 0.05). As for the time from the end of examination to OAA/S score of 5 and to Aldrete score of 9, the PCAS group was significantly shorter than the TIVA group (P < 0.05). ConclusionPCAS with remifentanil and propofol can provide sufficient analgesia, better hemodynamic stability, lighter sedation, and faster recovery compared with TIVA.
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.
【摘要】 目的 比较单次股神经阻滞和关节腔内单次注射罗哌卡因对膝关节镜检术后镇痛效果，为临床应用提供试验依据。 方法 2009年1月-2010年7月，选择美国麻醉医师协会（ASA）Ⅰ～Ⅱ级、年龄18~65岁、拟行择期单侧下肢膝关节镜手术患者180例，随机分为股神经阻滞组和关节腔内用药组，每组90例，分别于术前1 h行股神经阻滞（0.15%罗哌卡因20 mL）和手术结束时在膝关节腔内注入0.6%罗哌卡因20 mL。于术后4、8、24 h采用视觉模拟评分法（visual analog scale，VAS）行静止和运动时疼痛评分，记录术后患者满意度、不良反应发生率，术后使用镇痛药物情况。 结果 关节腔内用药组术后镇痛药物使用率（41.11%）明显高于股神经阻滞组（20.00%）（Plt;0.005）。两组患者术后24 h静止时及术后8、24 h运动时的VAS评分关节腔内用药组均明显高于股神经阻滞组（Plt;0.001），其余各时点差异无统计学意义（Pgt;0.05）。 结论 股神经阻滞可提供更加有效的术后镇痛效果，并且用药量小，安全系数高，值得临床推广。【Abstract】 Objective To compare the effect of single-injection femoral nerve block and local anesthetic intraarticular injection for analgesia after knee arthroscopy, in order to provide the experimental base for clinical application. Methods From January 2009 to July 2010, 180 American Society of Anesthesiologists (ASA) physical status I-II patients, aged from 18 to 65 years old, and scheduled for elective single knee arthroscopy were randomly divided into two groups: femoral nerve block group and local anesthetic intraarticular injection group with 90 patients in each group. For the patients in the former group, 20 mL of 0.15% ropivacaine was injected 1 hour before operation. For the latter group, 20 mL of 0.6% ropivacaine was injected into the articular cavity after operation. Pain intension scores at rest and in motion were measured 4, 8, and 24 hours after operation by visual analog scale (VAS). The degree of patients’ satisfaction, adverse reaction incidence rate and information of taking pain-killers were also recorded. Results The rate of using pain-killers in the intraarticular injection group (41.11%) was dramatically higher than the femoral nerve block group (20.00%) (Plt;0.005). The VAS scores of patients in the intraarticular injection group at rest 24 hours after operation and in motion 8 hours and 24 hours after operation were significantly higher than the femoral nerve block group (Plt;0.001), while there was no significant difference at other points between the two groups. Conclusions Femoral nerve block is more efficient for analgesia after knee arthroscopy compared with local anesthetic intraarticular injection. It is a safe procedure requiring only a relatively small dose of medicine, and is worth being popularized.
目的 观察右美托咪啶复合舒芬太尼用于经腹子宫全切术后患者自控静脉镇痛（PCIA）的效果。 方法 2011年3月－2012年6月选择经腹子宫全切术患者90例，年龄39～68岁，体重48～72 kg，美国麻醉医师协会分级Ⅰ～Ⅱ级。采用随机数字表法，将患者随机分为3组，每组各30例。于手术结束即刻行PCIA。对照组（C组）采用舒芬太尼150 μg+昂丹司琼12 mg；S1组采用右美托咪定200 μg+舒芬太尼100 μg+昂丹司琼12 mg；S2组采用右美托咪定200 μg+舒芬太尼150 μg+昂丹司琼12 mg。3组均用生理盐水稀释至100 mL，负荷剂量均为舒芬太尼0.1 μg/kg，静脉镇痛泵背景输注速度2 mL/h，自控给药剂量0.5 mL，锁定时间15 min。记录术后6、12、24和48 h Ramsay镇静评分和视觉模拟评分（VAS），记录不良反应发生情况和患者对术后镇痛的满意度。 结果 3组患者均能获得较好的镇痛效果。其中C组VAS评分较低，但恶心、呕吐、皮肤瘙痒发生率升高；与C组相比，Sl组和S2组Ramsay镇静评分升高，恶心、呕吐、皮肤瘙痒发生率降低，患者满意度升高。S1组患者满意度最高；S2组VAS评分最低。3组均未发生心动过缓、低血压、过度镇静和呼吸抑制。 结论 右美托咪啶可增加经腹子宫全切术患者术后舒芬太尼自控静脉镇痛的效果，提高患者满意度，降低不良反应。