Acute Pain

Neostigmine is a spinal analgesic that could be a useful adjunct. This study was conducted to evaluate the postoperative analgesic efficacy and the safety of two low doses of intrathecal (IT) neostigmine in patients undergoing knee arthroscopy under spinal bupivacaine anaesthesia. By using a double-blinded study design, 80 patients undergoing knee arthroscopy during spinal anaesthesia were divided into four groups: bupivacaine group (Group B) received 15 mg hyperbaric bupivacaine; bupivacaine + fentanyl group (Group BF) received 15 mg hyperbaric bupivacaine mixed with 25 μg fentanyl; bupivacaine + neostigmine group 1 (Group BN1) received 15 mg hyperbaric bupivacaine mixed with 25 μg neostigmine; bupivacaine + neostigmine group 2 (Group BN2) received 15 mg hyperbaric bupivacaine mixed with 35 μg neostigmine. The postoperative visual analog scale (VAS) and the incidence of adverse effects were recorded for 24 h after administration of study drugs. VAS scores were significantly lower in group BN2 compared with group B, group BF and group BN1 at 2, 4, 6, 12, and 24 h after operation (P < 0.05). The time to the first patients’ demand for morphine administration after surgery was significantly prolonged in group BN2 compared with group B or group BN1 (P < 0.05). There was no significant difference between four groups in incidence of nausea and vomiting. Our study showed that IT neostigmine (35 μg) enhanced bupivacaine spinal anaesthesia (15 mg) and produced prolonged postoperative analgesia for about 24 h without producing significant more adverse effects such as nausea and vomiting.

Azim Honarmand

Mohammad Reza Safavi

Mohammad Reza Habibzadeh

Postoperative analgesic and adverse effects of two low doses of intrathecal neostigmine and its influence on spinal bupivacaine anaesthesia after knee arthroscopy

术后两种低剂量硬膜外新斯的明的镇痛效果及不良反应及其对膝关节镜术后脊髓布比卡因麻醉的影响

This prospective observer-blinded clinical trial is designed to evaluate the effectiveness and the safety of 0.5% ropivacaine 30 ml (150 mg) administrated via subcutaneous infiltration at incision with or without combination of intraperitoneal spray for analgesia after laparoscopically assisted gastrointestinal surgery. Ninety ASA grade I–III patients were randomized into three groups: Group R1 (29 patients) in which patients received infiltration of 0.5% ropivacaine 30 ml at all incision sites before the suturing, Group R2 (31 patients) in which patients received 0.5% ropivacaine 20 ml at all incision sites and intraperitoneal spray of 0.5% ropivacaine 10 ml before the suturing and Group C (30 patients) in which patients received no ropivacaine as control. VAS scores at rest and during coughing were recorded immediately after emergence (H0), at 2 h (H2), 4 h (H4), 6 h (H6) and 24 h (H24) after operation. Serum cortisol concentration of cortisol was measured preoperatively (F0) and 2 h after operation (F2). Subcutaneous pethidine blouses given for additional pain treatment were counted for the first 24 h after operation and follow-up examination of incisions were performed at the 1st, 4th, 7th day after operation. Within 6 h postoperatively, the patients in Groups R1 and R2 reported significantly lower VAS scores at rest and during coughing than those in Group C (P < 0.05). Serum cortisol concentrations at 2 h (F2) after operation were significantly lower in Group R2 than in Group C. There was no difference among the three groups in administration of pethidine boluses within 6 h and 24 h after the surgery. In this trial, no neurological or cardiac complications were observed in any patient. Thirty millilitres of 0.5% ropivacaine can be used effectively and safely for pain control in the early hours after laparoscopically assisted gastrointestinal surgery and subcutaneous infiltration at incision sites combined with intraperitoneal spray can provide more complete analgesia. However, analgesia provided by ropivacaine via subcutaneous infiltration at incision sites with or without intraperitoneal spray would gradually become less effective 6 h after the operation, hence requiring additional pain treatment.

Jun Yan

Jue Jin

Min-hua Zheng

Bu-wei Yu

Can ropivacaine be effectively and safely used in analgesia after laparoscopically assisted gastrointestinal surgery?

罗哌卡因能否安全有效地用于腹腔镜辅助胃肠手术后的镇痛？

Renal artery embolization (angio-infarction) of a large renal cell carcinoma, prior to excision, is an acceptable surgical option. It may reduce the tumour's size and vascularity. However, postembolization syndrome, as characterized by flank pain, fever, nausea, and/or vomiting, is a potential complication of such an approach. The flank pain of this syndrome may be resistant to conventional opioid therapy. Here we report the successful use of a unilateral paravertabral block for the control of the unilateral flank pain of postembolization syndrome secondary to renal artery embolization.

Joseph Atallah

Jihad Abbas

Steven H. Selman

Simmone S. Cooper

Vivian Onyewuche

Patricia Weis

Thomas J. Papadimos

Brenda G. Fahy

Thoracic paravertebral block for treatment of postembolization syndrome

胸椎旁阻滞治疗栓塞后综合征

Thrombophlebitis is a common complication of a widely used formulation of injectable diclofenac that employs propylene glycol and benzyl alcohol (PG–BA) as solvents. Initial studies of Dyloject®, a novel injectable diclofenac solubilised with hydroxypropyl-β-cyclodextrin (HPβCD), suggested that this complication occurred less frequently and with lower severity with the newer formulation. We conducted a safety analysis of seven single-dose clinical trials that enrolled 531 patients receiving either a rapid intravenous (IV) bolus of Dyloject® or a 30 min IV infusion of PG–BA diclofenac. The incidence of thrombophlebitis observed as an adverse event following Dyloject® treatment was 1.2% (5 of 423) versus 6.5% (7 of 108) following PG–BA diclofenac (p < 0.01). In a subset of clinical studies that included an observer-rated thrombophlebitis assessment, the incidence of mild irritation was similar for both products (5.4% for Dyloject® and 4.9% for PG–BA diclofenac). Differences between the formulations were most evident in the higher incidence of moderate to severe thrombophlebitis after PG–BA diclofenac (2.4% incidence) compared to Dyloject® (0% incidence). HPβCD, the solubilising agent in Dyloject®, may be less irritating and result in less clinical thrombophlebitis than the cosolvents propylene glycol and benzyl alcohol used in PG–BA diclofenac.

Robert D. Colucci

Curtis Wright

Fred H. Mermelstein

Daniel G. Gawarecki

Daniel B. Carr

Dyloject®, a novel injectable diclofenac solubilised with cyclodextrin: Reduced incidence of thrombophlebitis compared to injectable diclofenac solubilised with polyethylene glycol and benzyl alcohol

Dyloject®，一种以环糊精溶解的新型注射用双氯芬酸：与以聚乙二醇和苯甲醇溶解的注射用双氯芬酸相比，血栓性静脉炎发生率降低

Successful acute pain management after breast surgery remains challenging, and if not achieved, may increase the likelihood of subsequent chronic pain. This article aimed to evaluate the evidence for varied techniques described for peri-operative pain management in breast surgery, and to review the literature on chronic pain after breast surgery and particularly 'post-mastectomy pain syndrome'. A Pubmed search was performed, with the key words "mastectomy" and "pain" for articles in the English language in the adult human population (age > 19 years), looking specifically for different analgesic techniques that have been evaluated. Thirty-three peer-reviewed publications with pain outcome data were included, ranging from 15 to 289 patients per study (total n = 2104). Twenty three were randomised controlled trials and the rest were prospective or retrospective audits and case series. Inconsistent trial methodology precluded a meta-analysis. Paravertebral local anaesthetic nerve blockade resulted in lower pain scores and fewer side effects than opioid-based regimens. Three risk factors emerged predicting chronic pain post-mastectomy: higher post-operative pain scores, age <65 years and inclusion of major reconstructive surgery. Paravertebral block should be considered for use in major breast surgery. Pain control should be optimised/a priority for both acute care and to potentially reduce chronic pain.

Serene H. Chang

Vivek Mehta

Richard M. Langford

Acute and chronic pain following breast surgery

乳腺癌术后急性及慢性疼痛

J.K. Randall

A. Goede

P. Morgan-Warren

S.B. Middleton

Randomised clinical trial of the influence of local subcutaneous infiltration versus subcutaneous and deep infiltration of local anaesthetic on pain after appendicectomy

随机临床试验：局部皮下浸润与皮下和深层浸润局部麻醉对阑尾切除术后疼痛的影响

Severe pain is a common presenting symptom for emergency patients. One major challenge in the management of severe pain is the objective measurement of pain. Due to the subjective nature of pain, it can be very difficult for clinicians to quantify pain intensity and measure the qualitative features of the pain experience. A number of measurement tools have been validated in the acute care setting, with some appropriate for use in the prehospital setting. This paper reviews the characteristics required of a prehospital acute pain measure and appraises the relative utility of a number of currently used pain measures. At present, the verbal numerical rating scale appears the most appropriate pain measure to administer in the prehospital setting for adult patients as it is practical and valid. Either the Oucher scale or the faces pain scale is suitable for prehospital care providers to assess pain in children.

P.A. Jennings

P. Cameron

S. Bernard

Measuring acute pain in the prehospital setting

院前环境中急性疼痛的测量

Objectives: The treatment of acute pain in the prehospital emergency setting remains a significant problem. We evaluated the incidence, site, and possible cause of acute pain in the prehospital period and also the current state of prehospital pain management by evaluating analgesic availability in emergency vehicles in Italy. Methods: First aid volunteers documented the presence, intensity, and site of acute pain by questionnaire for over 3 months. Emergency service operations completed a questionnaire on analgesic availability in ambulances and helicopters. Results: Pain symptoms were present in two-thirds of the patients (n = 383) and ranked as moderate to unbearable in 41.75%. Results of the analgesic availability survey indicate that 10.6% of the ambulance services carry no pain killers (including non-steroidal anti-inflammatory drugs [NSAIDs]and/or paracetamol) and 11.5% are without an opioid. The emergency helicopter survey showed a significant difference in analgesic availability compared with ambulances, with 97.6% having at least one opioid agent available (weak or strong). A wide geographical variation in the availability of analgesic agents in ambulance and helicopter services was seen. Conclusions: There is a high prevalence of pain among patients receiving prehospital emergency treatment in Italy and treatment for acute pain during emergency treatment of trauma patients is inadequate. All emergency vehicles, without distinction, should carry opioids and other analgesic drugs (NSAIDs and paracetamol) and there should be no geographic differences in the availability of pain medications. Â© Journal compilation Â© 2009 World Institute of Pain.

F. Marinangeli

C. Narducci

M.L. Ursini

A. Paladini

A. Pasqualucci

A. Gatti

G. Varrassi

Acute pain and availability of analgesia in the prehospital emergency setting in Italy: A problem to be solved

意大利院前急救环境中急性疼痛与镇痛药物的可获得性：亟待解决的问题

A. Buvanendran

K.S. Kroin

Multimodal analgesia for controlling acute postoperative pain

多模式镇痛用于控制术后急性疼痛

Background Moderate to severe pain after total knee arthroplasty often interferes with postoperative rehabilitation and delays discharge from hospital. The present study examined the effects of a four-day postoperative gabapentin (GBP) regimen versus placebo on opioid consumption, pain scores and knee flexion, as well as adverse effects, after total knee arthroplasty. Methods After obtaining research ethics board approval and informed consent, 40 patients were enrolled in a randomized, single-blind, placebo-controlled, open-label study. Patients were assigned to one of five groups - preoperative placebo/postoperative placebo (G1), preoperative GBP 600 mg/postoperative placebo (G2), preoperative GBP 600 mg/postoperative GBP 100 mg three times per day (G3), preoperative GBP 600 mg/ postoperative GBP 200 mg three times per day (G4) and preoperative GBP 600 mg/postoperative GBP 300 mg three times per day (G5). Postoperative GBP or placebo was continued for four days after surgery. Two hours before surgery, all patients received celecoxib 400 mg. Based on the above groupings, patients in G1 received placebo medication, whereas patients in G2, G3, G4 and G5 received gabapentin 600 mg 2 h preoperatively. All patients received femoral and sciatic nerve blocks, followed by spinal anesthesia. Beginning in the postanesthetic care unit, all patients received a regimen of celecoxib 200 mg every 12 h for four days and a patient-controlled morphine analgesia pump for 48 h. Results Thirty-six patients (G1, n=7; G2, n=7; G3, n=8; G4, n=7; G5, n=7) completed the study. Data were analyzed by one-way ANOVA followed by a contrast comparing patients who received postoperative GBP (G3, G4 and G5) (n=22) with patients who received placebo postoperatively (G1 and G2) (n=14). Patients who received GBP postoperatively used significantly less patient-controlled morphine analgesia at 24 h, 36 h and 48 h (P Conclusions These results support the use of GBP in the acute postoperative period. Further trials are needed to delineate the optimal dose, timing and duration of GBP use following surgery.

H. Clarke

S. Pereira

D. Kennedy

I. Gilron

J. Katz

J. Gollish

J. Kay

Gabapentin decreases morphine consumption and improves functional recovery following total knee arthroplasty

加巴喷丁减少吗啡消耗并改善全膝关节置换术后功能恢复

Publication Information	Publisher: Elsevier B.V.，Publishing cycle: ，Journal Type: journal，Open Access Journals: No
Basic data	Year of publication: 2002，Proportion of original research papers: ，Self Citation Rate:， Gold OA Rate:

Acute Pain

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