摘要:目的: 探讨深部痛点阻滞在治疗顽固性癌痛患者中的作用。 方法 : 将156例顽固性癌痛患者,随机分为深部痛点阻滞组及对照组,每组78例。深部痛点阻滞组根据疼痛部位,应用软组织外科学理论找出相应压痛点,给予痛点深部阻滞治疗;对照组找出压痛点但仅按三阶梯用药原则给予口服药物治疗。 结果 : 深部痛点阻滞组及对照组两组患者经治疗后疼痛控制均较理想(深部痛点阻滞组VAS13, 对照组VAS17),但是深部痛点阻滞组吗啡用量明显少于对照组(吗啡日平用量深部痛点阻滞组为335mg, 对照组为15287 mg)。便秘的发生率深部痛点阻滞组为5384%,对照组为7692%。 结论 : 深部痛点阻滞能较好的控制顽固性癌痛,同时可明显减少吗啡的用量,副作用相对发生要少。Abstract: Objective: To investigate the effect of the deeppressed pain points injection on the refractory cancer pain and provide reference for relieving the cancer pain. Methods : One hundred and fiftysix patients with refractory cancer pain were diagnosed by the soft tissue surgery,finding the pain point by pressing deeply,the patients with deeppressed pain points were divided into deeppressed pain points injection group and control group randomly, The patients in deeppressed pain points injection group were treated with deeppressed pain points injection; the patients in control group were treated with drugs according with the WHO analgesic ladder. Results : The patients in deeppressed pain points injection group got the same pain relief as those in control group (VAS 13 in deeppressed pain points injection group, 17 in control group ),but the daily dose of morphine in deeppressed pain points injection group was less than that incontrol group (morphine 335mg/day in deeppressed pain points injection group,15287mg/day in control group ) significantly. There was 5384% patients with constipation in deeppressed pain points injection group, 7692% in control group. Conclusion : The refractory cancer pain can be controlled effectively by the deeppressed pain point injection and the daily dose of morphine to control the cancer pain is decreased significantly. The side effect in deeppressed pain points injection group was less than that in control group.
OBJECTIVE: To provide a better treatment method of lumbar stenosis and root pain resulting from simple hypertrophy of ligamentum flavum. METHODS: By studying the records of 143 lumbar pain cases, we found 5 cases caused by simple hypertrophy of ligamentum flavum. All the patients were old man with a long progressed history. There was little difference of clinical features between the disc herniation and hypertrophy of ligamentum flavum. All cases accepted resection of ligamentum flavum. RESULTS: All the symptoms were relieved postoperatively. The patients could walk. CONCLUSION: The degeneration of lumbar ligamentum flavum can cause lumbar stenosis and root pain. Resection of ligamentum flavum can relieve the symptom.
Objective To determine the independent influencing factors of intraoperative choking during painless gastrointestinal endoscopy (PGIE) after coronavirus disease 2019 (COVID-19). Methods The data of patients undergoing PGIE with COVID-19 in Northern Jiangsu People’s Hospital between December 2022 and April 2023 were retrospectively collected. Multiple logistic regression analysis was used to screen the influencing factors of intraoperative coughing events that occurred during the diagnosis and treatment process. Results A total of 948 patients were included, with 93 (9.8%) cases of choking. The results of the multiple logistic regression analysis showed that smoking and unresolved cough were independent risk factors for coughing (P<0.05), while colonoscopy and infection duration beyond 14 days between diagnosis and treatment were independent protective factors for coughing (P<0.05). ConclusionsWhen patients with COVID-19 undergoing PGIE, special attention should be paid to high-risk groups such as smoking and unresolved cough. It is necessary to strengthen intraoperative monitoring and implementation of prevention and control measures to reduce the incidence of coughing and improve the safety of diagnosis and treatment for patients.
Objective To systematically evaluate effectiveness and safety of nerve block therapy for neck pain. Methods Databases including CENTRAL, PubMed, Ovid, ISI, EBSCO, CBM and CNKI were searched from the date of their establishment to November 2011, and relevant references were also retrieved manually to collect both domestic and abroad randomized controlled trials (RCTs) about nerve block therapy for neck pain. According to the inclusion and exclusion criteria, two researchers independently screened literature, extracted data, and assessed the quality of the included studies. Then the meta-analysis was conducted using RevMan 5.0 software. Results A total of 10 studies involving 625 participants were included. The results of qualitative analysis showed that: a) The short-term effectiveness of the nerve block therapy group was markedly superior to the placebo group, the cognitive therapy group and the transcutaneous electric nerve stimulation (TENS) group; and b) The short-term effectiveness of the combined nerve block therapy was markedly superior to the single nerve block therapy. The results of meta-analysis demonstrated that: a) There was no significant difference between the greater occipital nerve (GON) block group and the C2/3 nerve block group in neither short-term (SMD=−0.13, 95%CI −0.58 to 0.32, P=0.58) nor medium-term effectiveness (SMD=−0.01, 95%CI −0.46 to 0.44, P=0.98); and b): There was no significant difference between the injection with steroids group and the injection without steroids group in both short-term (SMD=0.16, 95%CI −0.13 to 0.44, P=0.28) and long-term effectiveness (SMD=0.27, 95%CI −0.02 to 0.55, P=0.07). Conclusion Current evidence shows nerve block therapy for neck pain is safe and especially good in short-term effectiveness. The combined nerve block therapy is probably more effective, but the effectiveness is not obviously improved by injection with or without steroids, and by different block methods. Due to the limitation of quality, quantity and total sample size of the included studies, this conclusion still needs to be proved by conducting more high quality and large scale studies.
ObjectivesTo systematically review the efficacy of kinesio taping on post stroke shoulder pain.MethodsPubMed, EMbase, The Cochrane Library, Web of Science, PEDro, CNKI and WanFang Data databases were electronically searched to collect randomized controlled trials (RCTs) of kinesio taping on shoulder pain after stroke from inception to November, 2018. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 8 RCTs involving 525 patients were included. The results of meta-analysis showed that, compared with the control group, kinesio taping group for 4 weeks treatment significantly reduced shoulder pain (SMD=−0.81, 95%CI −0.58 to −0.04, P=0.04), increased range of motion of shoulder flexion (SMD=0.59, 95%CI 0.17 to 1.01, P=0.006) and abduction (SMD=0.67, 95%CI 0.24 to 1.09, P=0.002). It also improved Fugl-Meyer upper limb function (SMD=1.00, 95%CI 0.25 to 1.76, P=0.009).ConclusionsCurrent evidence shows that the kinesio taping for 4 weeks duration can effectively reduce shoulder pain after stroke. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify above conclusions.
Objective To determine the efficacy of radioisotopes to control metastasic pain in patients with tumor bone metastases and complications due to bone metastases (hypercalcaemia, bone fracture and spinal cord compression). The effectiveness of radioisotopes in relation to patient survival and adverse effects were also assessed. Methods MEDLINE (1966 to April 2005),EMBASE (1966 to April 2005), The Cochrane Library (Issue 1, 2005) and CBMdisc (1979 to April 2005) were searched for randomized controlled trials (RCTs). Data were extracted by two reviewers using a designed extraction form. The quality of included RCTs was critically assessed. RevMan 4.2 software was used for data analysis. Results Four RCTs were included. The results of meta-analysis showed that small dose of radioisotopes couldn’t control metastatic pain in short term(2 months) with relative risk (RR) 1.13, 95%confidence interval (CI) 0.34 to 3.76, but large dose can significantly control metastatic pain in medium term(6 month) with RR 1.90, 95％CI 1.23 to 2.92; no evidence was available to assess long term(≥12 months) effects. No study provided data on quality of life, mortality, bone metastatic complications (hypercalcaemia, bone fracture) and analgesic use etc. Leukocytopenia and thrombocytopenia were secondary effects associated with the administration of radioisotopes. The incidences of leukocytopenia and thrombocytopenia were significantly greater in patients treated by radioisotopes with RR 8.28, 95％CI 2.24 to 30.67, and RR 3.70, 95％CI 1.59 to 9.04, respectively. Conclusions There is some evidence indicating that large dose of radioisotopes can relieve metastatic bone pain over one to six months, but adverse effects, particularly leukocytopenia and thrombocytopenia, have also been experienced.
ObjectiveTo investigate the effect of preoperative gum chewing on the postoperative rehabilitation of patients undergoing gynecologic laparoscopic surgery.MethodsA total of 160 patients undergoing elective gynecologic laparoscopic surgery between January and May 2013 were selected to participate in the study. Each patient was randomly assigned to one of the two groups: the trial group (n=80) or the control group (n=80). Thirty to sixty minutes before the surgery, the patients in the trial group chewed one piece of sugarless gum for at least 30 minutes, and then removed the gum before being taken to the operating room; while the patients in the control group chewed nothing. The time to first passage of flatus and the time to first defecation after surgery, length of hospital stay, the degrees of pain at 2-, 4-, 6-, 8-, 24-, 48-hour after surgery, the incidences of postoperative nausea, vomiting, and abdominal distension, postoperative analgesic and antiemetic drug requirement were recorded.ResultsThe mean time to first passage of flatus was significantly earlier in the trial group than that in the control group [(16.49±7.64) vs. (20.25±7.94) hours, P=0.003]. The mean time to first defecation was significantly earlier in the trial group than that in the control group [(48.16±15.25) vs. (55.80±18.97) hours, P=0.006]. The degree of pain at 2-hour after surgery was significantly lighter in the trial group than that in the control group (P<0.05). Fewer participants in the trial group than in the control group experienced postoperative nausea (43.75% vs. 61.25%, P=0.027). There were no significant differences in the length of hospital stay, the degrees of pain at 4-, 6-, 8-, 24- and 48-hour after surgery, incidences of postoperative vomiting and abdominal distension, postoperative analgesic, or antiemetic drug requirement between the two groups (P>0.05).ConclusionsGum chewing before surgery can promote the recovery of gastrointestinal function, reduce postoperative short-term pain, and promote postoperative rehabilitation in patients undergoing gynecologic laparoscopic surgery. Gum chewing before surgery can be used clinically as an easy, inexpensive, safe, and effective procedure.
ObjectiveTo compare the effect of pretreatment with butorphanol or tramadol for prevention of propofol-induced injection pain by intravenous injection or drip, in order to explore a safe and effective method. MethodsWe chose 150 patients of ASAⅠ-Ⅱundergoing elective surgery between October 2012 and March 2013 in Sichuan Orthopedic Hospital as the study subjects. They were randomly divided into five groups with 30 patients in each group:butorphanol injection and drip group (group BI and group BD), tramadol injection and drip group (group TI and group TD), control group (group C). Five minutes before anesthesia induction, patients in group BI, TI and C were respectively injected with butorphanol 2 mg, tramadol 100 mg, and saline; patients in group BD and TD were respectively injected with butorphanol 2 mg and tramadol 100 mg before receiving propofol (2.5 mg/kg) for 2 minutes. Assessment of pain during injection was done by using a four-point scale. ResultsThe pre-injection pain incidence in group BI and TI was significantly higher than that in group BD, TD and C(P < 0.05), and it was significantly higher in group BI than group TI (P < 0.05). The incidence of propofol injection pain in group BI, BD, TI and TD were significantly lower than that in group C (P < 0.05), and it was the lowest in group BD (P < 0.05) followed by group BI (P < 0.05). The total rate of pain in group BD was only 6.67%, significantly lower than other groups (P < 0.05). ConclusionsThe pretreatment with butorphanol and tramadol by intravenous injection or drip can reduce the incidence of propofol injection pain. Pretreatment with butorphanol at 2 mg by intravenous drip is more effective, but should be closely observed to avoid adverse events.
ObjectiveTo investigate the current status of outpatient pain management in patients with pulmonary disease after surgery by WeChat and to provide a basis for postoperative pain management.MethodsA total of 449 patients who underwent thoracic surgery in our hospital from December 2017 to May 2018 were enrolled, including 156 males and 293 females with an average age of 22-83 (55.54±11.17) years. Brief Pain Inventory was adopted for pain assessment in 24-48 hours after discharge and 24 hours after removal of from the wound.ResultsTotally 98.22% of the patients reported that they suffered from pain in 24-48 h after discharge, most pain position was still at drainage port (45.21%), the overall pain score was 2.75 (2.00, 3.25) points, and 82.85% of patients adopted physical methods to relieve pain. After removal of stitches at the drainage port, 79.29% of the patients suffered from pain, the pain site was mainly at the drainage port (47.88%), and the overall pain score was 1.75 (1.25, 2.25) points, and 73.94% of patients adopted physical methods to relieve pain. The score of the overall influence degree of pain on patients was 2.29 (1.86, 2.86) points and 1.86 (1.29, 2.43) points, while pain had the greatest influence on sleep and mood. The scores were 4.00 (3.00, 5.00) points, 3.00 (2.00, 4.00) points and 2.00 (1.00, 4.00) points, 3.00 (2.00, 4.00) points, respectively.ConclusionUnder the concept of enhanced recovery after surgery, the overall pain level of patients with pulmonary disease after discharge is mild pain, but the application rate of drug analgesia in patients is low. The overall effect of pain on postoperative patients with lung cancer is low, but it has a great impact on sleep and mood. Medical staff should strengthen the pain education for patients in order to improve their pain self-management ability.
【Abstract】 Objective The effects and the complications of anhydrous alcohol intra-abdominal coeliac plexus block were studied for treating unresectable pancreatic cancer pain. Methods From Jan.2001 to Sep.2005, 61 patients with severe pancreatic cancer pain and accompanied gastrointestinal tract obstruction were treated by anhydrous alcohol intra-abdominal coeliac plexus block and palliative surgical therapy. Pain-relief, KPS and complications in 3 months after operation were observed. Results The cancer pain in all patients was controlled in one week after the block (P＜0.05). KPS was improved (P＜0.05). Three months after operation, 45(86.5%) patients were without pain or with only light pain. There were no severe complications. Conclusion Anhydrous alcohol intra-abdominal coeliac plexus block is a method with safe and good effective and less complications for the treatment of pancreatic carcinomatous pain.