Objective:To evaluate the analgesic effect and safety of hydromorphone hydrochloride in PCIA combined with flurbiprofen axetil and pre-emptive analgesia in patients with TACE treatment for hepatocellular carcinoma.Met...Objective:To evaluate the analgesic effect and safety of hydromorphone hydrochloride in PCIA combined with flurbiprofen axetil and pre-emptive analgesia in patients with TACE treatment for hepatocellular carcinoma.Methods:Backward observation was made on 90 patients with advanced liver carcinoma who performed TACE treatment in the First Affiliated Hospital of Sun Yat-sen University from January 2022 to October 2023,dividing them into Group A(continuous pump injection of 6 mg hydromorphone+50mg flurbiprofen ester as background injection for 2 ml/h,additional single injection of 3 ml/10min,15 minutes before surgery)and Group B(intravenous injection of 50 mg flurbiprofen ester during the operation,additional injection of tramadol 100 mg intramuscular injection if necessary).Groups were compared and analyzed at different time points in surgery and post-operation time from pain level(NRS),side effects,inflammatory indexes(PCT,IL-6),satisfaction rate.Result:NRS scores at 5 time points,during operation,immediately post-surgery,12,24 hours post-operation,Group A were significantly lower than Group B(Group A during operation 3.0,immediate postoperation 3.0 to 24h 1.0;Group 4.0 to 24h 1.0,all P>0.05).The rate of adverse reactions were comparable between the two groups(all P>0.05).The amount of PCT(0.23 ng/ml vs 1.15 ng/ml)and IL-6(54.49 pg/ml vs 233.49 pg/ml)decreased post-surgery in Group A compared to Group B,but were not statistically significant difference(P=0.424/P=0.502),and more patients in Group A were relieved to grade score of pain relief 4 or above(86.7%vs.60%,P=0.001).Conclusions:Pre-emptive analgesia treatment using PCIA of hydromorphone hydrochloride combined with flurbiprofen axetil has better analgesic effect than routine analgesic therapy in postoperative care of mid to advanced hepatocellular carcinoma TACE,has good safety,and is worth of further promotion and verifying.展开更多
Objective To re-evaluate the systematic review of the safety and effectiveness of epidural analgesia(EA)for labor analgesia.Methods The Cochrane database,PubMed,EMBASE,EBSCO,Web of Science,ScienceDirect,China Biomedic...Objective To re-evaluate the systematic review of the safety and effectiveness of epidural analgesia(EA)for labor analgesia.Methods The Cochrane database,PubMed,EMBASE,EBSCO,Web of Science,ScienceDirect,China Biomedical Literature database,CNKI,Wanfang and VIP databases were searched,and the search time was limited to August 2020.Two researchers screened the literature and extracted data according to the inclusion criteria.AMSTAR was used to evaluate the methodological quality of the included studies.Pain intensity and pain relief satisfaction were used as the main indicators for re-evaluation of the effectiveness.Midwifery rate,cesarean section rate,back pain,fever,nausea and vomiting,umbilical artery pH value,and newborn Apgar score were used as the main indicators to re-evaluate the safety.Results and Conclusion A total of 9 meta-analyses were included.The safety and effectiveness of EA and opioid intravenous analgesia,acupuncture stimulation,inhalation analgesia,no analgesia,and continuous delivery were evaluated separately.The included systematic reviews showed that EA could increase the rate of device-assisted delivery,causing maternal fever,and prolonging the first and second stages of labor.But the incidence of back pain,nausea,and vomiting was lower.Therefore,analgesia had a good effect with better satisfactory degree.Current evidence shows that EA is safe and effective for labor analgesia,but the quality of the reports of current studies is not high.展开更多
BACKGROUND Gastric cancer(GC)is a prevalent tumor in the digestive system,with around one million new cases reported annually,ranking it as the third most common malignancy.Reducing pain is a key research focus.This s...BACKGROUND Gastric cancer(GC)is a prevalent tumor in the digestive system,with around one million new cases reported annually,ranking it as the third most common malignancy.Reducing pain is a key research focus.This study evaluates the effect of nalbuphine on the analgesic effect and the expression of pain factors in patients after radical resection.AIM To provide a reference for postoperative analgesia methods.METHODS One hundred eight patients with GC,admitted between January 2022 and June 2024,underwent radical gastrectomy.They received a controlled analgesia pump and a transverse abdominis muscle plane block,divided into two groups of 54 patients in each group.The control group received sufentanil,while the observation group received nalbuphine as an analgesic.Postoperative analgesic effects,pain factor expression,and adverse effects were compared.RESULTS The resting pain and activity pain scores in the observation group at 6,12,24 and 48 hours were significantly lower than those in the control group.Additionally,the number of presses and consumption of the observation group at 48 hours were lower than those of the control group;and the response rate of the observation group was higher than that of the control group(P<0.05).The prostaglandin E2,substance P,and serotonin levels 24 hours after the observation group were lower than those in the control group,and the incidence of adverse reactions was 5.56%lower than 22.22%in the control group(P<0.05).CONCLUSION The findings suggest that nalbuphine enhances postoperative multimodal analgesia in patients with radical GC,effectively improving postoperative analgesic effect,relieving postoperative resting and active pain,and reducing postoperative pain factor expression,demonstrating its potential for clinical application.展开更多
The significance of glial cells in the nervous system,particularly in the modulation of pain,has increasingly gained prominence,thereby shifting the traditional neurobiological research paradigm that predominantly foc...The significance of glial cells in the nervous system,particularly in the modulation of pain,has increasingly gained prominence,thereby shifting the traditional neurobiological research paradigm that predominantly focused on neurons.Acupuncture treatment have been shown to influence the functionality of glial cells,enabling them to serve as modulators that significantly contribute to the inhibition of neurogenic inflammation,the restoration of synaptic homeostasis,and the enhancement of the pain modulation system.Furthermore,various molecules and their associated signaling pathways facilitate the biological effects of glial cells in the context of acupuncture-induced analgesia.Notably,P2X receptors(P2X3,P2X4,and P2X7),the MAPK pathway(including p38MAPK and ERK),and the JAK/STAT pathway within glial cells are implicated in the modulation of neuroinflammation and pain regulation through acupuncture.These elucidated mechanisms underscore the potential of acupuncture to modulate neuroimmune signaling for pain alleviation and suggest the prospect of developing more targeted and effective treatments for chronic pain in the future.展开更多
Objective:To investigate the application effect of dexmedetomidine in anesthesia for thyroid cancer(TC)surgery.Methods:A total of 90 patients admitted to our hospital from January 2023 to December 2023 were selected a...Objective:To investigate the application effect of dexmedetomidine in anesthesia for thyroid cancer(TC)surgery.Methods:A total of 90 patients admitted to our hospital from January 2023 to December 2023 were selected as the study subjects.The patients were divided into an observation group(given continuous intravenous infusion of dexmedetomidine during surgery)and a control group(given continuous intravenous infusion of an equal volume of sodium chloride injection during surgery)by lottery method,and the anesthesia indicators of the two groups were compared.Results:The dosages of remifentanil and propofol in the observation group were lower than those in the control group(p<0.05);the incidence of complications in the observation group was lower than that in the control group(p<0.05);the Visual Analogue Scale(VAS)scores of the observation group at 4 h,12 h,24 h,and 48 h postoperatively,both at rest and during activity,were lower than those of the control group(p<0.05).Conclusion:During surgery for TC patients,continuous intravenous infusion of dexmedetomidine can reduce the dosage of anesthetic drugs and the incidence of anesthesia-related complications,alleviate postoperative pain,and is worthy of promotion and application.展开更多
BACKGROUND Chest physiotherapy and incentive spirometry,essential for pulmonary care,can exacerbate acute post-thoracotomy pain.Pain relief is,therefore,essential to facilitate early mobilization.This study evaluated ...BACKGROUND Chest physiotherapy and incentive spirometry,essential for pulmonary care,can exacerbate acute post-thoracotomy pain.Pain relief is,therefore,essential to facilitate early mobilization.This study evaluated the analgesic efficacy of unilateral continuous erector spinae block(ESB)compared to thoracic epidural analgesia(TEA)in terms of quality of pain relief and perioperative hemodynamic changes.AIM To compare the analgesic efficacy of continuous ultrasound-guided unilateral ESB and thoracic epidural in patients undergoing antero-lateral thoracotomy.METHODS This prospective,observational study was conducted at a tertiary care hospital of central India.Sixty-eight adult patients of either gender,posted for elective thoracic surgeries requiring one lung ventilation,were allocated to either TEA(n=34)or ESB(n=34)group,based on the attending anesthesiologist’s expertise.Continuous data were analyzed by independent t-tests,and categorical data byχ2 tests.RESULTS The proportion of patients requiring rescue opioids within 24 hours post-extubation was similar between the two group.Resting numerical rating scale scores(0 hour,6 hours,and 72 hours post-extubation)were significantly higher in the ESB group compared to the TEA group[1.70±1.03 vs 1.05±0.77(P=0.004);1.64±0.98 vs 1.2±0.88(P=0.05);3.2±1.07 vs 2.61±0.92(P=0.013)].Dynamic numerical rating scale scores and post-extubation mean arterial pressures were also higher in the ESB group.Additionally,block performance time was significantly longer in the ESB group(16.58±3.66 vs 13.84±2.88,P=0.001).CONCLUSION The two techniques provided similar opioid-sparing effects following antero-lateral thoracotomy,though TEA exhibited a superior analgesic efficacy at the expense of increased hemodynamic instability requiring vasopressor support.展开更多
BACKGROUND Patients who undergo cardiac surgery often face postoperative pain and potential cognitive issues.Multimodal analgesia may address these problems.We hypothesized that multimodal analgesia can reduce opioid ...BACKGROUND Patients who undergo cardiac surgery often face postoperative pain and potential cognitive issues.Multimodal analgesia may address these problems.We hypothesized that multimodal analgesia can reduce opioid use and improve cognitive recovery.AIM To investigate the effects of multimodal analgesia on postoperative opioid consumption and cognitive recovery in patients who underwent cardiac surgery.METHODS A prospective,randomized controlled trial at General Hospital from January 2020 to April 2023 recruited a total of 150 adult patients who underwent elective cardiac surgery.The patients were randomly divided into two groups.Group A had patient-controlled intravenous analgesia with sufentanil and flurbiprofen axil.Group B had flurbiprofen axil and paravertebral nerve block.Data were analyzed with appropriate statistical methods.RESULTS Group B had lower postoperative patient-controlled intravenous analgesia drug consumption(2.21 mL/hour vs 4.26 mL/hour,P<0.001),shorter extubation time(2.32 hours vs 3.81 hours,P<0.001),and intensive care unit stay(15.32 h vs 28.63 h,P<0.001).Visual Analogue Scale pain scores were lower in group B(P<0.001).Group B had fewer postoperative complications(no respiratory depression vs 37.9%in group A,P<0.05),a lower postoperative cognitive dysfunction incidence(16.0%vs 28.0%,P<0.05),and higher Barthel Index scores(P<0.05).CONCLUSION Multimodal analgesia with paravertebral nerve block and flurbiprofen axil reduces opioid use and improves cognitive outcomes in patients who underwent cardiac surgery.展开更多
Background Postoperative pain,if not effectively controlled,can trigger sympathetic activation and stress responses that increase the risk of cardiovascular complications.Oxycodone,a semisynthetic opioid acting on bot...Background Postoperative pain,if not effectively controlled,can trigger sympathetic activation and stress responses that increase the risk of cardiovascular complications.Oxycodone,a semisynthetic opioid acting on bothμ-andκ-receptors,may provide stable analgesia with less hemodynamic fluctuation compared with the pureμ-agonist sufentanil.This study aimed to compare the efficacy and cardiovascular safety of oxycodone-based versus sufent anil-based intravenous patient-controlled analgesia(IV-PCA)after laparoscopic abdominal surgery.Methods This single-center retrospective comparative study included patients who underwent laparoscopic abdominal surgery between March 2024 and March 2025.According to their postoperative PCA regimen,patients were divided into an oxycodone group and a sufentanil group.The primary endpoint was the incidence of cardiovascular adverse events(CVAE)within 48 h after surgery,including hypotension,bradycardia,and arrhythmia.Logistic regression was used to identify independent predictors of CVAE,and receiver operating characteristic(ROC)analysis assessed discriminative performance.Results A total of 356 patients were analyzed(oxycodone n=197;sufentanil n=159).The incidence of CVAE was significantly lower in the oxycodone group than in the sufentanil group(5.2%vs.12.1%,P=0.021).Oxycodone provided comparable analgesic intensity with fewer PCA bolus attempts(36±15 vs.52±17,P<0.001)and higher patient satisfaction scores(4.3±0.5 vs.4.1±0.5,P=0.002).Multivariate logistic regression identified sufentanil use(OR:2.53,95%CI:1.16-5.84,P=0.018)as independent predictors of CVAE.Conclusions Oxycodone-based IV-PCA provided effective postoperative analgesia with a lower incidence of cardiovascular adverse events compared with sufentanil-based PCA.The results suggested that oxycodone offered a favorable balance between analgesic efficacy and hemodynamic stability,making it a safer alternative for postoperative pain management in patients at cardiovascular risk.展开更多
To introduce the experience of professor JIA Chun-sheng in rapid analgesia and motor function rehabilitation by subcutaneous penetration needling of auricular acupuncture.Subcutaneous penetration needling of auricular...To introduce the experience of professor JIA Chun-sheng in rapid analgesia and motor function rehabilitation by subcutaneous penetration needling of auricular acupuncture.Subcutaneous penetration needling of auricular acupuncture plays a role in rapid analgesia and motor function rehabilitation in treatment of pain in limbs and trunk and/or limb dysfunction caused by migraine,cervical spondylosis,acute lumbar sprain,soft tissue injury,scapulohumeral periarthritis,lumbar disc herniation,sciatica,stroke or cerebral trauma,and it is worthy of being widely promoted and applied clinically.展开更多
Objective: To evaluate the effect of test dose fentanyl on predictingpostoperative analgesia and respiratory depression. Methods: Preoperatively the lowest pulseoximeter saturation (SpO_2) under room air breathing was...Objective: To evaluate the effect of test dose fentanyl on predictingpostoperative analgesia and respiratory depression. Methods: Preoperatively the lowest pulseoximeter saturation (SpO_2) under room air breathing was measured after 2 μg/kg of fentanyl givenintravenously in 35 patients who were scheduled with continuous intravenous morphine analgesia (12μg·kg^(-1)·h^(-1)) postoperatively. Results: The test dose fentanyl resulted in respiratorydepression in 19 of 35 cases, while 8 (42.1%) of the 19 cases developed respiratory depressionpostoperatively. However in the rest 16 patients, no patient (0) developed respiratory depression (P< 0.01). The fentanyl-induced lowest SpO_2 significantly correlated with the lowest SpO_2postoperatively (P < 0.01). The analgesia effect in terms of verbal analogue scale was correlatedneither with the fentanyl-induced lowest SpO_2 nor with the lowest SpO_2 postoperatively (P > 0.05).Conclusion: The patient who was sensitive to fentanyl-induced respiratory depression would take ahigh risk to develop postoperative respiratory depression with intravenous morphine analgesia andthe patient with respiratory depression does not always go with satisfactory analgesia.展开更多
The complex and diverse mechanisms of acupuncture analgesia are summarized from the following two aspects： the neural mechanisms （neurophysiology mechanism, neurochemistry mechanism and neuroanatomy mechanism） and ...The complex and diverse mechanisms of acupuncture analgesia are summarized from the following two aspects： the neural mechanisms （neurophysiology mechanism, neurochemistry mechanism and neuroanatomy mechanism） and the non-nerve mechanisms （connective tissue mechanism and local biochemical change mechanism）. Initial analysis are also carried out on the individual deficiencies of diverse mechanisms, the contradictions among different diverse mechanisms as well as the causing factors, and suggestions are proposed accordingly.展开更多
Objective To observe the analgesia effectiveness and safety of electroacupuncture at Neimadian （内麻点 Extra） after abdominal surgery. Methods One hundred and twenty patients with routine abdominal surgery were rand...Objective To observe the analgesia effectiveness and safety of electroacupuncture at Neimadian （内麻点 Extra） after abdominal surgery. Methods One hundred and twenty patients with routine abdominal surgery were randomly divided into an acupuncture group and a medication group, 60 cases in each group. The acupuncture group was treated with electroacupuncture at Neimadian （内麻点 Extra）, which was located on the medial side of lower leg, 7 cun above the medial malleolus and about 0.5 cun from post edge of tibia. The medication group was treated with patient-controlled intravenous analgesia （PCIA） with Sufentanil. After the treatment, the Visual Analogue Scale （VAS）, the security, the analgesic effect and plasma β-endorphin content in the two groups were compared.Results The postoperative VAS scores at 2, 4, 8, 16, 24 and 48 h in the acupuncture group were lower than those in the medication group （all P〈0.05）. The analgesic effects at 2, 4, 16 and 24 h after surgery in the acupuncture group were superior to those in the medication group （P〈0.05, P〈0.01）. The plasma β-endorphin contents at 0, 8, 16 and 48 h after surgery in both groups were increased, and the acupuncture group was superior to the medication group （all P〈0.05）. The security class after surgery in the acupuncture group was higher than that in the medication group （P〈0.05）. Two cases in acupuncture group stopped treatment due to overstress and fear of needling, 24 cases in medication group presented adverse reactions, among them, 3 cases stopped the treatment due to nausea, vomiting. Conclusion The analgesic effect and safety of electroacupuncture at Neimadian （内麻点 Extra） after abdominal surgery are superior to those of the PCIA with Sufentanil.展开更多
Literatures on acupuncture analgesia of the recent 30 years are analyzed through the target pain syndromes, points and tools selected for needling as well as the chosen direction, angle and depth of insertion. The rel...Literatures on acupuncture analgesia of the recent 30 years are analyzed through the target pain syndromes, points and tools selected for needling as well as the chosen direction, angle and depth of insertion. The relationship between effect of acupuncture analgesia and needling direction, angle as well as depth is initially optimized to enhance the analgesic effect. The result shows that the 3 factors are the key influences. However, studies on the above mentioned relation are still far from enough. Aiming at enhancing the effect of acupuncture analgesia and exploring the relative mechanism, it is held that multivariate analysis should be adopted to do systematic analysis on relationship between effect and mechanism of acupuncture analgesia and direction, angle and depth of the needle insertion.展开更多
The relative reports on the effects of electroacupuncture （EA） on the nervous system and neuro- transmitters, tolerance of EA and so on in recent years are reviewed so as to reveal the analgesic mechanism of EA and ...The relative reports on the effects of electroacupuncture （EA） on the nervous system and neuro- transmitters, tolerance of EA and so on in recent years are reviewed so as to reveal the analgesic mechanism of EA and provide reference for clinical researches and application of EA.展开更多
Cognition and pain share common neural substrates and interact reciprocally: chronic pain compromises cognitive performance, whereas cognitive processes modulate pain perception. In the present study, we established a...Cognition and pain share common neural substrates and interact reciprocally: chronic pain compromises cognitive performance, whereas cognitive processes modulate pain perception. In the present study, we established a non-drug-dependent rat model of context-based analgesia,where two different contexts(dark and bright) were matched with a high(52°C) or low(48°C) temperature in the hot-plate test during training. Before and after training,we set the temperature to the high level in both contexts.Rats showed longer paw licking latencies in trials with the context originally matched to a low temperature than those to a high temperature, indicating successful establishment of a context-based analgesic effect in rats. This effect was blocked by intraperitoneal injection of naloxone(an opioid receptor antagonist) before the probe. The context-based analgesic effect also disappeared after optogenetic activation or inhibition of the bilateral infralimbic or prelimbic sub-region of the prefrontal cortex. In brief, we established a context-based, non-drug dependent, placebo-like analgesia model in the rat. This model provides a new and useful tool for investigating the cognitive modulation of pain.展开更多
<span style="font-family:Verdana;"><strong>Introduction:</strong></span><span style="font-family:Verdana;">Regional anaesthesia combined with general anaesthesia reduc...<span style="font-family:Verdana;"><strong>Introduction:</strong></span><span style="font-family:Verdana;">Regional anaesthesia combined with general anaesthesia reduces </span><span style="font-family:;" "=""><span style="font-family:Verdana;">stress response to surgery, duration of ventilation, intensive care unit (ICU) </span><span style="font-family:Verdana;">stay and promotes early recovery. Studies on thoracic epidural, caudal analgesi</span><span style="font-family:Verdana;">a along wit</span><span style="font-family:Verdana;">h general anaesthesia (GA) in paediatric </span><span style="font-family:Verdana;">cardiac surgery are limited he</span><span style="font-family:Verdana;">nce we aimed to compare efficacy and safety of caudal, thoracic epid</span><span style="font-family:Verdana;">ural and intravenous analgesia in paediatric cardiac surgery. </span><b><span style="font-family:Verdana;">Methodology: </span></b><span style="font-family:Verdana;">This study was conducted in the Department of Anaesthesiology in a tertiary care teaching hospital in southern India from February 2019 to December 2019. 90 children were randomised into group A, group B, group C. Children in group A received caudal analgesia along with GA. Group B children received thoracic epidural along with GA. Group C patients received intravenous analgesia along with GA. Rescue analgesia 1 mcg/kg fentanyl given in all 3 groups if p</span><span style="font-family:Verdana;">ai</span><span style="font-family:Verdana;">n score is more than 4. Primary outcome assessed was post-o</span><span style="font-family:Verdana;">p pain sco</span><span style="font-family:Verdana;">res. Secondary outcome assessed was duration of ventilation, duration of intensive care unit stay. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> All patients were comparable in terms of age, sex, </span><span style="font-family:Verdana;">weight, mean RACHS score, baseline heart rate and blood pressure. Pain sco</span><span style="font-family:Verdana;">res </span><span style="font-family:Verdana;">were significantly lower in thoracic epidural group compared to other two grou</span><span style="font-family:Verdana;"> ps. Duration of ventilation was lower in thoracic epidural group (91.17</span></span><span style="font-family:;" "=""><span style="font-family:Verdana;">±</span><span style="font-family:Verdana;"> 43.85) minutes and caudal (199.6 </span><span style="font-family:Verdana;">±</span><span style="font-family:Verdana;"> 723.59) minutes compared to intravenous analgesia groups (436.37 </span><span style="font-family:Verdana;">±</span><span style="font-family:Verdana;"> 705.51) minutes. Duration of ICU stay was significantly low in thoracic epidural group (2.73 </span><span style="font-family:Verdana;">±</span><span style="font-family:Verdana;"> 0.69) days compared to caudal (3.7 </span><span style="font-family:Verdana;">±</span><span style="font-family:Verdana;"> 2.8) and intravenous analgesia groups (4.33 </span><span style="font-family:Verdana;">±</span><span><span style="font-family:Verdana;"> 0.920). We didn’t have </span><span><span style="font-family:Verdana;">any complications like hematoma, transient or permanent neurological sequelae in regional anesthesia groups. </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> Regional anaesthesia along with </span></span><span style="font-family:Verdana;">general anaesthesia was more effective in pain relief than intravenous analgesia with general anaesthesia in paediatric cardiac surgery.</span></span></span>展开更多
Childbirth experience is one of the most intense pain that majority of women will endure during their lifetime. Concerns about pain in labor remain a hot topic, and its popularity gets more common day by day as more w...Childbirth experience is one of the most intense pain that majority of women will endure during their lifetime. Concerns about pain in labor remain a hot topic, and its popularity gets more common day by day as more women become aware of their rights to achieve a better quality of care during labor. There are various non-pharmacologic (transcutaneous electrical nerve stimulation, hydrotherapy, intradermal water injections and acupuncture) and pharmacologic treatments (nitrous oxide, opioids and regional analgesia techniques: spinal, epidural and combined epidural analgesia) available today. Among these, epidural analgesia offers the most effective form of pain relief and is considered to be the gold standard of labor analgesia. Despite having labor analgesic services, most women still go through painful labor due to lack of knowledge regarding it, particularly in developing countries. The main source of information regarding pain reliefs is from friends and relatives, revealing the lack of information from caregiver’s side. So this study reflects that there is a wide gap in the communication between pregnant women and obstetricians. It supports the fact that obstetricians through the practice of routinely offering labor analgesia can significantly improve the maternal and perinatal outcomes of pregnancy. Provision of standardized epidural analgesia information at an appropriate time in their pregnancy may benefit them by the practice of mutual decision-making. Thus, it may prevent women from making a difficult choice of cesarean section to avoid the fear of painful labor.展开更多
In this editorial,we provide a critical review of the article by Tang et al published in the World J Clin Cases,focusing on the utilization of butorphanol for epidural analgesia during labor.Our discussion encompasses...In this editorial,we provide a critical review of the article by Tang et al published in the World J Clin Cases,focusing on the utilization of butorphanol for epidural analgesia during labor.Our discussion encompasses recent research developments in epidural labor analgesia,specifically highlighting the current status of clinical applications of butorphanol and associated treatment approaches.Epidural analgesia is widely acknowledged as the primary method for pain management during labor,offering effective and prolonged pain relief while allowing mothers to remain alert and actively participate in the delivery process.Among the various drugs utilized for epidural labor analgesia,butorphanol has received increasing attention due to its potential efficacy and distinctive pharmacological properties.As a synthetic opioid analgesic,butorphanol exhibits both agonistic and antagonistic activity on opioid receptors,striking a balance between analgesia and minimizing side effects.Nevertheless,the safety and efficacy of butorphanol in epidural labor analgesia remains controversial.While certain studies have reported positive outcomes with butorphanol,including effective pain relief and a reduced incidence of side effects,others have raised concerns about its safety and efficacy compared to traditional opioids or alternative analgesics.In addition,the optimal dosing strategy and regimen of butorphanol as an adjuvant in epidural labor analgesia still need to be verified.Through comprehensive synthesis and analysis of existing literature,we aim to evaluate the current evidence regarding the use of butorphanol for epidural labor analgesia,delineate areas of consensus and controversy,and propose future avenues for research and clinical practice in this domain.展开更多
This paper discusses the use of Acupuncture Analgesia for Labour and Deli-very with the application of auriculo-electro acupuncture and body acupuncture(Hegu L.I.4).Tonification was applied to the body acupoint Hegu(L...This paper discusses the use of Acupuncture Analgesia for Labour and Deli-very with the application of auriculo-electro acupuncture and body acupuncture(Hegu L.I.4).Tonification was applied to the body acupoint Hegu(L.I.4),Three case studies are presented.展开更多
In the mechanisms of acupuncture analgesia, an important aspect often overlooked is the antiinflammatory effect of acupuncture, which is mainly attained through the self-limiting inflammatory response-inflammatory ref...In the mechanisms of acupuncture analgesia, an important aspect often overlooked is the antiinflammatory effect of acupuncture, which is mainly attained through the self-limiting inflammatory response-inflammatory reflex and its regulation of hypothalamic-pituitary-adrenal(HPA) axis and autonomic nerve system(the vagus nerve and the sympathetic postganglionic fiber). The significance of antiinflammatory effect of acupuncture in analgesia is manifested twofold: The first, inflammatory nociceptive pain is a major type of chronic pain. The second, neurogenic inflammation is the mechanism by which certain acupoints or acu-reflex points(ARPs) are formed at the body surface and have short-cut connections to the pathological focus. Selecting ARPs and applying appropriate sensory stimulation or local microtrauma(affected by different needling means or stimulation parameters), combined with lowfrequency electrical stimulation or the vagus stimulation in the concha region, are helpful to strengthen the anti-inflammatory and analgesic effect of acupuncture.展开更多
基金The National Natural Science Foundation of China(Project No.:82172036)Undergraduate teaching quality and teaching reform cultivation project of the First Affiliated Hospital of Sun Yat-sen University in 2023(Project No.P12220011-230106)。
文摘Objective:To evaluate the analgesic effect and safety of hydromorphone hydrochloride in PCIA combined with flurbiprofen axetil and pre-emptive analgesia in patients with TACE treatment for hepatocellular carcinoma.Methods:Backward observation was made on 90 patients with advanced liver carcinoma who performed TACE treatment in the First Affiliated Hospital of Sun Yat-sen University from January 2022 to October 2023,dividing them into Group A(continuous pump injection of 6 mg hydromorphone+50mg flurbiprofen ester as background injection for 2 ml/h,additional single injection of 3 ml/10min,15 minutes before surgery)and Group B(intravenous injection of 50 mg flurbiprofen ester during the operation,additional injection of tramadol 100 mg intramuscular injection if necessary).Groups were compared and analyzed at different time points in surgery and post-operation time from pain level(NRS),side effects,inflammatory indexes(PCT,IL-6),satisfaction rate.Result:NRS scores at 5 time points,during operation,immediately post-surgery,12,24 hours post-operation,Group A were significantly lower than Group B(Group A during operation 3.0,immediate postoperation 3.0 to 24h 1.0;Group 4.0 to 24h 1.0,all P>0.05).The rate of adverse reactions were comparable between the two groups(all P>0.05).The amount of PCT(0.23 ng/ml vs 1.15 ng/ml)and IL-6(54.49 pg/ml vs 233.49 pg/ml)decreased post-surgery in Group A compared to Group B,but were not statistically significant difference(P=0.424/P=0.502),and more patients in Group A were relieved to grade score of pain relief 4 or above(86.7%vs.60%,P=0.001).Conclusions:Pre-emptive analgesia treatment using PCIA of hydromorphone hydrochloride combined with flurbiprofen axetil has better analgesic effect than routine analgesic therapy in postoperative care of mid to advanced hepatocellular carcinoma TACE,has good safety,and is worth of further promotion and verifying.
文摘Objective To re-evaluate the systematic review of the safety and effectiveness of epidural analgesia(EA)for labor analgesia.Methods The Cochrane database,PubMed,EMBASE,EBSCO,Web of Science,ScienceDirect,China Biomedical Literature database,CNKI,Wanfang and VIP databases were searched,and the search time was limited to August 2020.Two researchers screened the literature and extracted data according to the inclusion criteria.AMSTAR was used to evaluate the methodological quality of the included studies.Pain intensity and pain relief satisfaction were used as the main indicators for re-evaluation of the effectiveness.Midwifery rate,cesarean section rate,back pain,fever,nausea and vomiting,umbilical artery pH value,and newborn Apgar score were used as the main indicators to re-evaluate the safety.Results and Conclusion A total of 9 meta-analyses were included.The safety and effectiveness of EA and opioid intravenous analgesia,acupuncture stimulation,inhalation analgesia,no analgesia,and continuous delivery were evaluated separately.The included systematic reviews showed that EA could increase the rate of device-assisted delivery,causing maternal fever,and prolonging the first and second stages of labor.But the incidence of back pain,nausea,and vomiting was lower.Therefore,analgesia had a good effect with better satisfactory degree.Current evidence shows that EA is safe and effective for labor analgesia,but the quality of the reports of current studies is not high.
文摘BACKGROUND Gastric cancer(GC)is a prevalent tumor in the digestive system,with around one million new cases reported annually,ranking it as the third most common malignancy.Reducing pain is a key research focus.This study evaluates the effect of nalbuphine on the analgesic effect and the expression of pain factors in patients after radical resection.AIM To provide a reference for postoperative analgesia methods.METHODS One hundred eight patients with GC,admitted between January 2022 and June 2024,underwent radical gastrectomy.They received a controlled analgesia pump and a transverse abdominis muscle plane block,divided into two groups of 54 patients in each group.The control group received sufentanil,while the observation group received nalbuphine as an analgesic.Postoperative analgesic effects,pain factor expression,and adverse effects were compared.RESULTS The resting pain and activity pain scores in the observation group at 6,12,24 and 48 hours were significantly lower than those in the control group.Additionally,the number of presses and consumption of the observation group at 48 hours were lower than those of the control group;and the response rate of the observation group was higher than that of the control group(P<0.05).The prostaglandin E2,substance P,and serotonin levels 24 hours after the observation group were lower than those in the control group,and the incidence of adverse reactions was 5.56%lower than 22.22%in the control group(P<0.05).CONCLUSION The findings suggest that nalbuphine enhances postoperative multimodal analgesia in patients with radical GC,effectively improving postoperative analgesic effect,relieving postoperative resting and active pain,and reducing postoperative pain factor expression,demonstrating its potential for clinical application.
基金funded by Beijing National Science Foundation(No.7222289)the CACMS Innovation Fund(No.CI2021A03404)the Fundamental Research Funds for the Central Public Welfare Research Institutes(No.ZZ2023002).
文摘The significance of glial cells in the nervous system,particularly in the modulation of pain,has increasingly gained prominence,thereby shifting the traditional neurobiological research paradigm that predominantly focused on neurons.Acupuncture treatment have been shown to influence the functionality of glial cells,enabling them to serve as modulators that significantly contribute to the inhibition of neurogenic inflammation,the restoration of synaptic homeostasis,and the enhancement of the pain modulation system.Furthermore,various molecules and their associated signaling pathways facilitate the biological effects of glial cells in the context of acupuncture-induced analgesia.Notably,P2X receptors(P2X3,P2X4,and P2X7),the MAPK pathway(including p38MAPK and ERK),and the JAK/STAT pathway within glial cells are implicated in the modulation of neuroinflammation and pain regulation through acupuncture.These elucidated mechanisms underscore the potential of acupuncture to modulate neuroimmune signaling for pain alleviation and suggest the prospect of developing more targeted and effective treatments for chronic pain in the future.
文摘Objective:To investigate the application effect of dexmedetomidine in anesthesia for thyroid cancer(TC)surgery.Methods:A total of 90 patients admitted to our hospital from January 2023 to December 2023 were selected as the study subjects.The patients were divided into an observation group(given continuous intravenous infusion of dexmedetomidine during surgery)and a control group(given continuous intravenous infusion of an equal volume of sodium chloride injection during surgery)by lottery method,and the anesthesia indicators of the two groups were compared.Results:The dosages of remifentanil and propofol in the observation group were lower than those in the control group(p<0.05);the incidence of complications in the observation group was lower than that in the control group(p<0.05);the Visual Analogue Scale(VAS)scores of the observation group at 4 h,12 h,24 h,and 48 h postoperatively,both at rest and during activity,were lower than those of the control group(p<0.05).Conclusion:During surgery for TC patients,continuous intravenous infusion of dexmedetomidine can reduce the dosage of anesthetic drugs and the incidence of anesthesia-related complications,alleviate postoperative pain,and is worthy of promotion and application.
文摘BACKGROUND Chest physiotherapy and incentive spirometry,essential for pulmonary care,can exacerbate acute post-thoracotomy pain.Pain relief is,therefore,essential to facilitate early mobilization.This study evaluated the analgesic efficacy of unilateral continuous erector spinae block(ESB)compared to thoracic epidural analgesia(TEA)in terms of quality of pain relief and perioperative hemodynamic changes.AIM To compare the analgesic efficacy of continuous ultrasound-guided unilateral ESB and thoracic epidural in patients undergoing antero-lateral thoracotomy.METHODS This prospective,observational study was conducted at a tertiary care hospital of central India.Sixty-eight adult patients of either gender,posted for elective thoracic surgeries requiring one lung ventilation,were allocated to either TEA(n=34)or ESB(n=34)group,based on the attending anesthesiologist’s expertise.Continuous data were analyzed by independent t-tests,and categorical data byχ2 tests.RESULTS The proportion of patients requiring rescue opioids within 24 hours post-extubation was similar between the two group.Resting numerical rating scale scores(0 hour,6 hours,and 72 hours post-extubation)were significantly higher in the ESB group compared to the TEA group[1.70±1.03 vs 1.05±0.77(P=0.004);1.64±0.98 vs 1.2±0.88(P=0.05);3.2±1.07 vs 2.61±0.92(P=0.013)].Dynamic numerical rating scale scores and post-extubation mean arterial pressures were also higher in the ESB group.Additionally,block performance time was significantly longer in the ESB group(16.58±3.66 vs 13.84±2.88,P=0.001).CONCLUSION The two techniques provided similar opioid-sparing effects following antero-lateral thoracotomy,though TEA exhibited a superior analgesic efficacy at the expense of increased hemodynamic instability requiring vasopressor support.
文摘BACKGROUND Patients who undergo cardiac surgery often face postoperative pain and potential cognitive issues.Multimodal analgesia may address these problems.We hypothesized that multimodal analgesia can reduce opioid use and improve cognitive recovery.AIM To investigate the effects of multimodal analgesia on postoperative opioid consumption and cognitive recovery in patients who underwent cardiac surgery.METHODS A prospective,randomized controlled trial at General Hospital from January 2020 to April 2023 recruited a total of 150 adult patients who underwent elective cardiac surgery.The patients were randomly divided into two groups.Group A had patient-controlled intravenous analgesia with sufentanil and flurbiprofen axil.Group B had flurbiprofen axil and paravertebral nerve block.Data were analyzed with appropriate statistical methods.RESULTS Group B had lower postoperative patient-controlled intravenous analgesia drug consumption(2.21 mL/hour vs 4.26 mL/hour,P<0.001),shorter extubation time(2.32 hours vs 3.81 hours,P<0.001),and intensive care unit stay(15.32 h vs 28.63 h,P<0.001).Visual Analogue Scale pain scores were lower in group B(P<0.001).Group B had fewer postoperative complications(no respiratory depression vs 37.9%in group A,P<0.05),a lower postoperative cognitive dysfunction incidence(16.0%vs 28.0%,P<0.05),and higher Barthel Index scores(P<0.05).CONCLUSION Multimodal analgesia with paravertebral nerve block and flurbiprofen axil reduces opioid use and improves cognitive outcomes in patients who underwent cardiac surgery.
基金supported by the Health and Health Development Promotion Project-Anesthesia and Critical Care Research Project(No.KM-20240219-01)。
文摘Background Postoperative pain,if not effectively controlled,can trigger sympathetic activation and stress responses that increase the risk of cardiovascular complications.Oxycodone,a semisynthetic opioid acting on bothμ-andκ-receptors,may provide stable analgesia with less hemodynamic fluctuation compared with the pureμ-agonist sufentanil.This study aimed to compare the efficacy and cardiovascular safety of oxycodone-based versus sufent anil-based intravenous patient-controlled analgesia(IV-PCA)after laparoscopic abdominal surgery.Methods This single-center retrospective comparative study included patients who underwent laparoscopic abdominal surgery between March 2024 and March 2025.According to their postoperative PCA regimen,patients were divided into an oxycodone group and a sufentanil group.The primary endpoint was the incidence of cardiovascular adverse events(CVAE)within 48 h after surgery,including hypotension,bradycardia,and arrhythmia.Logistic regression was used to identify independent predictors of CVAE,and receiver operating characteristic(ROC)analysis assessed discriminative performance.Results A total of 356 patients were analyzed(oxycodone n=197;sufentanil n=159).The incidence of CVAE was significantly lower in the oxycodone group than in the sufentanil group(5.2%vs.12.1%,P=0.021).Oxycodone provided comparable analgesic intensity with fewer PCA bolus attempts(36±15 vs.52±17,P<0.001)and higher patient satisfaction scores(4.3±0.5 vs.4.1±0.5,P=0.002).Multivariate logistic regression identified sufentanil use(OR:2.53,95%CI:1.16-5.84,P=0.018)as independent predictors of CVAE.Conclusions Oxycodone-based IV-PCA provided effective postoperative analgesia with a lower incidence of cardiovascular adverse events compared with sufentanil-based PCA.The results suggested that oxycodone offered a favorable balance between analgesic efficacy and hemodynamic stability,making it a safer alternative for postoperative pain management in patients at cardiovascular risk.
文摘To introduce the experience of professor JIA Chun-sheng in rapid analgesia and motor function rehabilitation by subcutaneous penetration needling of auricular acupuncture.Subcutaneous penetration needling of auricular acupuncture plays a role in rapid analgesia and motor function rehabilitation in treatment of pain in limbs and trunk and/or limb dysfunction caused by migraine,cervical spondylosis,acute lumbar sprain,soft tissue injury,scapulohumeral periarthritis,lumbar disc herniation,sciatica,stroke or cerebral trauma,and it is worthy of being widely promoted and applied clinically.
文摘Objective: To evaluate the effect of test dose fentanyl on predictingpostoperative analgesia and respiratory depression. Methods: Preoperatively the lowest pulseoximeter saturation (SpO_2) under room air breathing was measured after 2 μg/kg of fentanyl givenintravenously in 35 patients who were scheduled with continuous intravenous morphine analgesia (12μg·kg^(-1)·h^(-1)) postoperatively. Results: The test dose fentanyl resulted in respiratorydepression in 19 of 35 cases, while 8 (42.1%) of the 19 cases developed respiratory depressionpostoperatively. However in the rest 16 patients, no patient (0) developed respiratory depression (P< 0.01). The fentanyl-induced lowest SpO_2 significantly correlated with the lowest SpO_2postoperatively (P < 0.01). The analgesia effect in terms of verbal analogue scale was correlatedneither with the fentanyl-induced lowest SpO_2 nor with the lowest SpO_2 postoperatively (P > 0.05).Conclusion: The patient who was sensitive to fentanyl-induced respiratory depression would take ahigh risk to develop postoperative respiratory depression with intravenous morphine analgesia andthe patient with respiratory depression does not always go with satisfactory analgesia.
文摘The complex and diverse mechanisms of acupuncture analgesia are summarized from the following two aspects： the neural mechanisms （neurophysiology mechanism, neurochemistry mechanism and neuroanatomy mechanism） and the non-nerve mechanisms （connective tissue mechanism and local biochemical change mechanism）. Initial analysis are also carried out on the individual deficiencies of diverse mechanisms, the contradictions among different diverse mechanisms as well as the causing factors, and suggestions are proposed accordingly.
文摘Objective To observe the analgesia effectiveness and safety of electroacupuncture at Neimadian （内麻点 Extra） after abdominal surgery. Methods One hundred and twenty patients with routine abdominal surgery were randomly divided into an acupuncture group and a medication group, 60 cases in each group. The acupuncture group was treated with electroacupuncture at Neimadian （内麻点 Extra）, which was located on the medial side of lower leg, 7 cun above the medial malleolus and about 0.5 cun from post edge of tibia. The medication group was treated with patient-controlled intravenous analgesia （PCIA） with Sufentanil. After the treatment, the Visual Analogue Scale （VAS）, the security, the analgesic effect and plasma β-endorphin content in the two groups were compared.Results The postoperative VAS scores at 2, 4, 8, 16, 24 and 48 h in the acupuncture group were lower than those in the medication group （all P〈0.05）. The analgesic effects at 2, 4, 16 and 24 h after surgery in the acupuncture group were superior to those in the medication group （P〈0.05, P〈0.01）. The plasma β-endorphin contents at 0, 8, 16 and 48 h after surgery in both groups were increased, and the acupuncture group was superior to the medication group （all P〈0.05）. The security class after surgery in the acupuncture group was higher than that in the medication group （P〈0.05）. Two cases in acupuncture group stopped treatment due to overstress and fear of needling, 24 cases in medication group presented adverse reactions, among them, 3 cases stopped the treatment due to nausea, vomiting. Conclusion The analgesic effect and safety of electroacupuncture at Neimadian （内麻点 Extra） after abdominal surgery are superior to those of the PCIA with Sufentanil.
文摘Literatures on acupuncture analgesia of the recent 30 years are analyzed through the target pain syndromes, points and tools selected for needling as well as the chosen direction, angle and depth of insertion. The relationship between effect of acupuncture analgesia and needling direction, angle as well as depth is initially optimized to enhance the analgesic effect. The result shows that the 3 factors are the key influences. However, studies on the above mentioned relation are still far from enough. Aiming at enhancing the effect of acupuncture analgesia and exploring the relative mechanism, it is held that multivariate analysis should be adopted to do systematic analysis on relationship between effect and mechanism of acupuncture analgesia and direction, angle and depth of the needle insertion.
文摘The relative reports on the effects of electroacupuncture （EA） on the nervous system and neuro- transmitters, tolerance of EA and so on in recent years are reviewed so as to reveal the analgesic mechanism of EA and provide reference for clinical researches and application of EA.
基金supported by grants from the National Natural Science Foundation of China (91732107, 31200835, 81571067, and 81521063)the National Basic Research Development Program (973 Program) of China (2014CB548200 and 2015CB554503)
文摘Cognition and pain share common neural substrates and interact reciprocally: chronic pain compromises cognitive performance, whereas cognitive processes modulate pain perception. In the present study, we established a non-drug-dependent rat model of context-based analgesia,where two different contexts(dark and bright) were matched with a high(52°C) or low(48°C) temperature in the hot-plate test during training. Before and after training,we set the temperature to the high level in both contexts.Rats showed longer paw licking latencies in trials with the context originally matched to a low temperature than those to a high temperature, indicating successful establishment of a context-based analgesic effect in rats. This effect was blocked by intraperitoneal injection of naloxone(an opioid receptor antagonist) before the probe. The context-based analgesic effect also disappeared after optogenetic activation or inhibition of the bilateral infralimbic or prelimbic sub-region of the prefrontal cortex. In brief, we established a context-based, non-drug dependent, placebo-like analgesia model in the rat. This model provides a new and useful tool for investigating the cognitive modulation of pain.
文摘<span style="font-family:Verdana;"><strong>Introduction:</strong></span><span style="font-family:Verdana;">Regional anaesthesia combined with general anaesthesia reduces </span><span style="font-family:;" "=""><span style="font-family:Verdana;">stress response to surgery, duration of ventilation, intensive care unit (ICU) </span><span style="font-family:Verdana;">stay and promotes early recovery. Studies on thoracic epidural, caudal analgesi</span><span style="font-family:Verdana;">a along wit</span><span style="font-family:Verdana;">h general anaesthesia (GA) in paediatric </span><span style="font-family:Verdana;">cardiac surgery are limited he</span><span style="font-family:Verdana;">nce we aimed to compare efficacy and safety of caudal, thoracic epid</span><span style="font-family:Verdana;">ural and intravenous analgesia in paediatric cardiac surgery. </span><b><span style="font-family:Verdana;">Methodology: </span></b><span style="font-family:Verdana;">This study was conducted in the Department of Anaesthesiology in a tertiary care teaching hospital in southern India from February 2019 to December 2019. 90 children were randomised into group A, group B, group C. Children in group A received caudal analgesia along with GA. Group B children received thoracic epidural along with GA. Group C patients received intravenous analgesia along with GA. Rescue analgesia 1 mcg/kg fentanyl given in all 3 groups if p</span><span style="font-family:Verdana;">ai</span><span style="font-family:Verdana;">n score is more than 4. Primary outcome assessed was post-o</span><span style="font-family:Verdana;">p pain sco</span><span style="font-family:Verdana;">res. Secondary outcome assessed was duration of ventilation, duration of intensive care unit stay. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> All patients were comparable in terms of age, sex, </span><span style="font-family:Verdana;">weight, mean RACHS score, baseline heart rate and blood pressure. Pain sco</span><span style="font-family:Verdana;">res </span><span style="font-family:Verdana;">were significantly lower in thoracic epidural group compared to other two grou</span><span style="font-family:Verdana;"> ps. Duration of ventilation was lower in thoracic epidural group (91.17</span></span><span style="font-family:;" "=""><span style="font-family:Verdana;">±</span><span style="font-family:Verdana;"> 43.85) minutes and caudal (199.6 </span><span style="font-family:Verdana;">±</span><span style="font-family:Verdana;"> 723.59) minutes compared to intravenous analgesia groups (436.37 </span><span style="font-family:Verdana;">±</span><span style="font-family:Verdana;"> 705.51) minutes. Duration of ICU stay was significantly low in thoracic epidural group (2.73 </span><span style="font-family:Verdana;">±</span><span style="font-family:Verdana;"> 0.69) days compared to caudal (3.7 </span><span style="font-family:Verdana;">±</span><span style="font-family:Verdana;"> 2.8) and intravenous analgesia groups (4.33 </span><span style="font-family:Verdana;">±</span><span><span style="font-family:Verdana;"> 0.920). We didn’t have </span><span><span style="font-family:Verdana;">any complications like hematoma, transient or permanent neurological sequelae in regional anesthesia groups. </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> Regional anaesthesia along with </span></span><span style="font-family:Verdana;">general anaesthesia was more effective in pain relief than intravenous analgesia with general anaesthesia in paediatric cardiac surgery.</span></span></span>
文摘Childbirth experience is one of the most intense pain that majority of women will endure during their lifetime. Concerns about pain in labor remain a hot topic, and its popularity gets more common day by day as more women become aware of their rights to achieve a better quality of care during labor. There are various non-pharmacologic (transcutaneous electrical nerve stimulation, hydrotherapy, intradermal water injections and acupuncture) and pharmacologic treatments (nitrous oxide, opioids and regional analgesia techniques: spinal, epidural and combined epidural analgesia) available today. Among these, epidural analgesia offers the most effective form of pain relief and is considered to be the gold standard of labor analgesia. Despite having labor analgesic services, most women still go through painful labor due to lack of knowledge regarding it, particularly in developing countries. The main source of information regarding pain reliefs is from friends and relatives, revealing the lack of information from caregiver’s side. So this study reflects that there is a wide gap in the communication between pregnant women and obstetricians. It supports the fact that obstetricians through the practice of routinely offering labor analgesia can significantly improve the maternal and perinatal outcomes of pregnancy. Provision of standardized epidural analgesia information at an appropriate time in their pregnancy may benefit them by the practice of mutual decision-making. Thus, it may prevent women from making a difficult choice of cesarean section to avoid the fear of painful labor.
文摘In this editorial,we provide a critical review of the article by Tang et al published in the World J Clin Cases,focusing on the utilization of butorphanol for epidural analgesia during labor.Our discussion encompasses recent research developments in epidural labor analgesia,specifically highlighting the current status of clinical applications of butorphanol and associated treatment approaches.Epidural analgesia is widely acknowledged as the primary method for pain management during labor,offering effective and prolonged pain relief while allowing mothers to remain alert and actively participate in the delivery process.Among the various drugs utilized for epidural labor analgesia,butorphanol has received increasing attention due to its potential efficacy and distinctive pharmacological properties.As a synthetic opioid analgesic,butorphanol exhibits both agonistic and antagonistic activity on opioid receptors,striking a balance between analgesia and minimizing side effects.Nevertheless,the safety and efficacy of butorphanol in epidural labor analgesia remains controversial.While certain studies have reported positive outcomes with butorphanol,including effective pain relief and a reduced incidence of side effects,others have raised concerns about its safety and efficacy compared to traditional opioids or alternative analgesics.In addition,the optimal dosing strategy and regimen of butorphanol as an adjuvant in epidural labor analgesia still need to be verified.Through comprehensive synthesis and analysis of existing literature,we aim to evaluate the current evidence regarding the use of butorphanol for epidural labor analgesia,delineate areas of consensus and controversy,and propose future avenues for research and clinical practice in this domain.
文摘This paper discusses the use of Acupuncture Analgesia for Labour and Deli-very with the application of auriculo-electro acupuncture and body acupuncture(Hegu L.I.4).Tonification was applied to the body acupoint Hegu(L.I.4),Three case studies are presented.
文摘In the mechanisms of acupuncture analgesia, an important aspect often overlooked is the antiinflammatory effect of acupuncture, which is mainly attained through the self-limiting inflammatory response-inflammatory reflex and its regulation of hypothalamic-pituitary-adrenal(HPA) axis and autonomic nerve system(the vagus nerve and the sympathetic postganglionic fiber). The significance of antiinflammatory effect of acupuncture in analgesia is manifested twofold: The first, inflammatory nociceptive pain is a major type of chronic pain. The second, neurogenic inflammation is the mechanism by which certain acupoints or acu-reflex points(ARPs) are formed at the body surface and have short-cut connections to the pathological focus. Selecting ARPs and applying appropriate sensory stimulation or local microtrauma(affected by different needling means or stimulation parameters), combined with lowfrequency electrical stimulation or the vagus stimulation in the concha region, are helpful to strengthen the anti-inflammatory and analgesic effect of acupuncture.
