Objective To understand the incidence and severity of postoperative acute pain in patients undergoing day surgery, and to explore the influencing factors of moderate to severe pain after surgery, so as to provide a reference for pain management in day surgery. Methods Convenience sampling method was used to select patients undergoing day surgery under multi-modal pain management in West China Hospital of Sichuan University between April and August 2020, and the general conditions, surgical conditions, and postoperative pain of the patients were investigated. According to the degree of postoperative pain, patients were divided into mild pain group and moderate to severe pain group. Logistic regression analysis was used to explore the influencing factors of postoperative pain in the two groups. Results A total of 509 patients were finally included, of which 69 patients presented with moderate to severe pain. Logistic regression analysis showed that patient age [odds ratio (OR)=0.970, 95% confidence interval (CI) (0.946, 0.993), P=0.012], pain threshold [OR=1.348, 95%CI (1.048, 1.734), P=0.020] and postoperative drainage tube [OR=2.752, 95%CI (1.090, 6.938), P=0.017] were the influencing factors of moderate to severe pain after surgery. Conclusion Under multimodal pain management, the incidence of moderate to severe pain in day surgery patients is low, and medical staff should further strengthen pain management from the factors affecting pain to reduce the incidence of moderate to severe pain after surgery.
Objective To investigate the status quo of knowledge and attitude towards pain among medical staff in West China Hospital of Sichuan University. Methods The medical staff in Emergency Department of West China Hospital of Sichuan University were investigated by the Chinese version of Knowledge and Attitudes Survey Regarding Pain (2008) questionnaire, the contents of which related to pain assessment, pain related knowledge, analgesic related knowledge, and comprehensive application, etc. And the questionnaire scores were compared among medical workers with different background. Results A total of 156 questionnaires were sent out and 130 valid ones were taken back, with an effective recovery rate of 83.3%. There was no statistically significant difference in questionnaire scores among the medical workers with different education background or different professional titles (P>0.05). The questionnaire scores were significantly different among nurses with different seniority (F=3.785, P=0.035), and the mean score of the nurses with more than 10 years of seniority was the highest (22.78±7.11). The questionnaire scores were significantly different among nurses working in different areas (F=3.043, P=0.033), and the mean score of the nurses working in rescue room was the highest (24.53±7.84).The erroneous items were concentrated on item 5, 17, 19. In the answers to the open questions, 97.7% (127/130) thought that the existing pain knowledge could not satisfy the needs of clinical work; 100.0% (130/130) believed that it was necessary to study pain related knowledge; 80.0% (104/130) acquired pain related knowledge from clinical experience, 40.0% (52/130) from books, 15.4% (20/130) from the network; 90% ( 117/130) commonly used numeric rating scale to evaluate the patients’ pain degree, 20.0% (26/130) evaluated the patients’ pain degree through facial expressions. Conclusions The overall level of pain management knowledge and attitude in medical staff in Emergency Department is low. The continuing education on pain knowledge should be strengthened, the attitude towards pain treatment and the importance of pain management should be paid more attention, and the standardized training and supervision should be enhanced.
Objective To describe the situation of postoperative pain management in colorectal cancer patient in enhanced recovery after surgery (ERAS) mode, and explore its influenceing factors. Methods From March to December 2017, colorectal cancer patients in ERAS mode in Department of Gastrointestinal Surgery, West China Hospital of Sichuan University were selected. On the third day after surgery, a total of 74 patients with acute pain completed a questionnaire, which was composed of a demographic form, the Houston Pain Outcome Instrument (HPOI), Self-Rating Anxiety Scale, and Social Support Rating Scale. Mean±standard deviation and percentage were used to describe the total score of pain experience, t test, analysis of variance, Spearman correlation analysis were used for single-factor analysis, and multiple linear regression was used for multi-factor analysis. Results The mean total score of pain experience was 15.1±3.8. Single-factor analysis results showed that the affection of pain on daily life (rs=0.270, P=0.020), satisfaction of pain controlling education (rs=–0.283, P=0.015), subjective support (rs=–0.326, P=0.005), and social support utilization (rs=–0.253, P=0.029) were correlated with the total score of pain experience. Multi-factor analysis results showed that satisfaction of pain controlling education (P<0.001) and subjective support (P=0.005) were negative influencing factors of postoperative pain experience score, and severe anxiety (P=0.001) and pain expectation after surgery (P=0.016) were positive influencing factors of postoperative pain experience score. Conclusions Pain management situation is not so bad in these patients. High satisfaction of pain controlling education and high subjective social support are helpful to decrease pain. The medical staff should pay more attention to patients with severe anxiety, and help patients to establish reasonable pain expectation after surgery.
【Abstract】 Objective To explore the correlation between pain grading, stage of necrosis and bone marrow edema(BME) in nontraumatic osteonecrosis of femoral head (NONFH) so as to strengthen understandings about cl inical significance of BME in NONFH. Methods From October 2004 to October 2006, 97 patients (149 hips) with NONFH were treated. There were 68 males and 29 femals with an average age of 38.8 years (19-62 years). The disease course was from 20 days to 4 years. BME was identified grade 0 to grade 2 according to MRI. Based on grading scale of pain, pain grading were divided into no pain (grade 0), mild pain (grade 1) and moderate or severe pain (grade 2). According to Association Research Circulation Osseous staging system, NONFH were divided into I-IV stages. The incidence rate of BME in each pain grading and stages of necrosis was analyzed respectively. Contingency table analyses and rank sum tests were used to compare the difference of pain grading and stages of necrosis among these groups. Results The total incidence rate of BME was 73.15% (109/149), the incidence rateswere 84.38% in pain groups (108 /128) and 94.12% in the grade 2 (32/34). Pain grading correlated with BME rating (P lt; 0.001).The results of rank sum tests for several independent samples showed significant difference in BME among pain groups(P lt; 0.001). With the advance of pain scale, the mean rank of BME increased gradually(28.19 for grade 0, 78.94 for grade 1 and 96.12 for grade 2). BME was more commonly and clearly seen in stage Ⅱ（77.05%）and stage Ⅲ（82.81%）of NONFH. Stage I-III of NONFH correlated with BME rating (P lt; 0.001). The results of rank sum tests showed significant difference in BME rating among three stages (P lt; 0.001). With the advance of disease, the rank of BME rating increased gradually (39.07 for grade 0, 60.16 for grade 1 and 86.15 for grade 2 ). Conclusion BME is a sign that is accompanied with NONFH. The probabil ity and extent of BME correlated well with the pain and stage of NONFH．The condition of BME can be used as a index for the appraisal of advancement of disease and the judgment of treatment result.
Objective To investigate the amputation-related pain and quality of life (QoL) between the amputees with transfemoral amputation (TFA) and transtibial amputation (TTA) 10 years after the Wenchuan earthquake, and compare the effects of two different amputation level on the long-term functional rehabilitation of amputees. Methods A total of 305 amputees from Center of Comprehensive Service of Disabled of Deyang for the disabled 10 years after the Wenchuan earthquake were selected for cross-sectional study from February to June 2018. Through face-to-face interview, the basic information of amputees was collected and the evaluation of Prosthetic Evaluation Questionnaire (PEQ) was completed. The amputees were divided into TFA group and TTA group according to the amputation level. Results A total of 53 amputees were included, including 27 in the TFA group and 26 in the TTA group. The PEQ scores showed that the prevalences of phantom limb sensation (96.3% vs. 65.4%; χ2=6.372, P=0.012) and phantom limb pain (92.6% vs. 69.2%; P=0.039) in the TFA group were significantly higher than those in the TTA group. There was no significant difference with regard to the intensity of amputation-related pain between the victims with TFA and TTA (P>0.05). However, the TFA group were more bothered by phantom limb sensation than the TTA group (52.9±24.1 vs. 35.9±26.7; t=2.108, P=0.042), there was no significant difference in other indexes (P>0.05). There was no significant difference in QoL between the TFA and TTA groups (P>0.05). Conclusions The phantom limb sensation, phantom limb pain, residual limb pain, non-amputated limb pain and back pain are still prevalent among the victims with TFA and TTA 10 years after the Wenchuan earthquake. The higher amputation level is associated with increased prevalence of phantom limb sensation and phantom limb pain, as well as more bothersomeness of phantom limb sensation. The amputation level appeares to have no impact on the long-term QoL.
Sleep deprivation can cause hyperalgesia, and the mechanisms involve glutamic acid, dopamine, serotonin, metabotropic glutamate receptor subtype 5, adenosine A2A receptor, nicotinic acetylcholine receptor, opioid receptor, brain-derived neurotrophic factor, melatonin, etc. The mechanisms of hyperalgesia caused by sleep deprivation are complex. The current treatment methods are mainly to improve sleep and relieve pain. This paper reviews the mechanism and treatment progress of hyperalgesia induced by sleep deprivation, and aims to provide scientific evidence for the treatment of hyperalgesia caused by sleep deprivation.
ObjectiveTo explore the effect of goal directed analgesia on patients with noninvasive positive pressure ventilation (NPPV) in the intensive care unit (ICU).MethodsThis was a retrospective study. Two hundred sixty-four patients requiring non-invasive positive pressure ventilation were enrolled in the ICU of this hospital, including 118 patients in the empirical analgesia group and 146 in the goal directed analgesia group. The empirical analgesia group was treated with remifentanil to analgesia and propofol, midazolam or dexmedetomidine to sedation. The sedative depth maintained <1 measured by the score of the Richmond restless sedative scale (RASS). The same analgesic and sedative drug were first used in the goal directed analgesia group to maintain the Critical Care Pain Observation Tool score <2, and the RASS score <1 was maintained after the analgesia depth were achieved. Whether the patients occurred delirium was assessed by the Confusion Assessment Method for the ICU. The dosage of analgesic and sedative drugs, the dependability (based on the total ventilation time in the first 24 hours after ventilation), the incidence of delirium, the rate of invasive ventilation, the total time of NPPV and the length of stay of ICU were observed in the two groups.ResultsThere were no significant differences in age, sex, APACHEⅡ score, mean arterial pressure, heart rate, respiratory rate, SpO2, arterial blood gas and the reason of NPPV between the two groups. The dosage of analgesic and sedative drugs in the goal directed analgesia group were less than the empirical analgesia group, and the dependability was higher than that of the empirical analgesia group ［(12.6±5.8)h vs. (10.9±4.8)h, P<0.05), and the incidence of delirium and the rate of invasive ventilation were also lower than those of the empirical analgesia group (15.8% vs. 25.4%, P<0.05; 32.9% vs. 44.9%, P<0.05). The total time of NPPV in the goal directed analgesia group was shorter than that of the empirical analgesia group ［(28.6±8.8)h vs. (37.3±10.7)h, P<0.05), but there was no significant difference in the length of stay in ICU.ConclusionGoal directed analgesia can improve the dependability of NPPV patients, reduce the use of sedative drugs, and decrease the incidence of delirium and rate of invasive ventilation.
ObjectiveWe aimed to further investigate the feasibility of using small bore chest tubes or even without chest tube insertion after da Vinci robot-assisted thoracic surgery. MethodsWe retrospectively analyzed initial 70 patients between September 12, 2014 and March 30, 2015 as a control group at the department of thoracic surgery, the First Affiliated Hospital of Zhejiang University, and proposed four schemes. There are 31 males and 39 females with mean age of 57.1±9.8 (ranged from 30-80 years). We applied those four schemes for the last 30 patients as an experimental group. There are 12 males and 18 females with mean age of 58.8±8.1 (ranged 42-73 years). ResultsThe days in hospital after surgery ranged 2-25 days and there was no severe complication. After the surgery, the pain scores of the trial group are lower than that of the control group. And the schemes 1 and schemes 2 of trial group reduced significantly than the control group (P<0.05). There is no significant difference of the rate of the complication caused by poor drainage between the trial group and the control group (P>0.05). But the pain score after surgery is lower than that of the control group (P<0.05). ConclusionOptimizing thoracic drainage strategy after da Vinci robot-assisted thoracic surgery is safe, possible and helpful to relieve postoperative pain.
ObjectiveTo assess postoperative analgesia and early rehabilitation of continuous incision infiltration with ropivacaine in open gastrectomy. MethodsFrom June 2011 to October 2014, 50 patients underwent open gastrectomy were divided into two groups:standard analgesic therapy group (Abbreviation:standard group, n=25) and continuous incision infiltration with ropivacaine group (Abbreviation:ropivacaine group, n=25). All the patients were also given patient controlled intravenous analgesia (PCIA). Points of visual analog scale (VAS), Bruggrmann comfort scale (BCS), and nausea and vomiting were assessed at different time during the first 48 hours postoperatively. Total sufentanil dosage, the first postoperative ambulation time, bowel recovery time, postoperative hospital stay, and incision infection rate were compared between two groups. ResultsAt 4 h, 8 h, 16 h, 24 h, 48 h postoperatively, the points of VAS in the ropivacaine group were significantly lower than those in the standard group (P < 0.05), the points of BCS in the ropivacaine group were significantly higher than those in the standard group (P < 0.05). Compared with the standard group, the dosage of sufentanil was significantly less (P < 0.05), the bowel recovery time, the first postoperative ambulation time, and the postoperative hospital stay were significantly shorter (P < 0.05), the point of nausea and vomiting was significantly lower (P < 0.05) at 48 h postoperatively in the ropivacaine group. There was no difference of the incision infection rate between the two groups (P > 0.05). ConclusionContinuous incision infiltration with ropivacaine is effective and safe to relief postoperative pain and accelerate patient's recovery after open gastrectomy.
Objective To manage the preoperative, intraoperative and postoperative pain of percutaneous kyphoplasty (PKP) under the concept of enhanced recovery after surgery (ERAS) and explore the role of pain management under the ERAS concept in enhancing postoperative rehabilitation of PKP. Methods From January to December 2016, 136 patients with osteoporotic compression fractures treated with PKP of local anesthesia were selected, among which 71 patients in the ERAS group were treated between July and December 2016, who were treated with celecoxib capsule for analgesia before the operation and such local anesthetics as lidocaine and ropivacaine combined with intravenous injection of dexmedetomidine hydrochloride for multi-mode analgesia during the operation; after the operation, celecoxib capsules and tizanidine hydrochloride tablets were orally administered by the routine for analgesia; if the pain was increased, 40 mg parecoxib would be added for analgesia by intramuscular injection. While 65 patients in the conventional group were treated between January and June 2016, who were given intraoperative local anesthesia with lidocaine; if the patients suffered from severe pain after the operation, they would be given 40 mg parecoxib by intramuscular injection. The Visual Analogue Scale (VAS), mean arterial pressure (MAP), the complications after surgery, postoperative infections, bed rest time, length of hospital stay and patient satisfaction were compared between the two groups. Results There was no statistical difference in age, gender or fracture vertebral number between the two groups (P>0.05). The preoperative, intraoperative and postoperative VAS scores (4.0±1.5, 4.8±1.8, 1.6±1.1), MAP change [(22.0±4.7) mm Hg (1 mm Hg=0.133 kPa)], bed rest time [(1.5±0.7) days], and length of hospital stay [(3.8±0.8) days] in the ERAS group were significantly less than those in the conventional group [4.7±1.7, 5.7±1.5, 2.4±1.1, (31.3±6.1) mm Hg, (2.1±0.8) days, and (5.0±1.6) days, respectively] (P<0.05). The incidence of intraoperative complication of bone cement leakage (4.2%, 3/71) in the ERAS group was lower than that in the conventional group (13.8%, 9/65) (P<0.05); there was no statistical difference in postoperative pulmonary infection between the two groups (P>0.05). Patients’ satisfaction was significantly improved from 86.2% (the conventional group) to 95.8% (the ERAS group) (P<0.05). There was no incision infection, urinary tract infection or venous thrombosis in the two groups. Conclusion With the concept of ERAS, taking a management of pain can effectively alleviate the dis-comfortable pain feeling, improve the patients’ satisfaction, and enhance the recovery for the patients after PKP surgery.