Objective: To explore the clinical effectiveness of combined use of intravenous pain pump with Parecoxib injection in alleviating pain in patients during the early postoperative period after thoracoscopic surgery. Met...Objective: To explore the clinical effectiveness of combined use of intravenous pain pump with Parecoxib injection in alleviating pain in patients during the early postoperative period after thoracoscopic surgery. Methods: Eighty patients who underwent thoracoscopic surgery in a tertiary hospital were selected as the study subjects and randomly divided into two groups, with 40 patients in each group. The control group received routine postoperative treatment with intravenous pain pump, while the experimental group received Parecoxib in addition to the standard postoperative pain pump treatment. Visual Analog Scale (VAS) pain scores were used to evaluate postoperative pain relief in both groups, along with adverse reactions, postoperative complications, and patient satisfaction with pain relief. Results: Patients who received Parecoxib injection in addition to the routine use of intravenous pain pump had VAS pain scores lower than 3 points at 6 h, 12 h, 24 h, and 36 h postoperatively compared to those in the control group. The incidence of postoperative lung collapse, pleural effusion, and pulmonary infections was also significantly lower in the experimental group. The differences between the two groups were statistically significant (P Conclusion: Early combined use of Parecoxib injection in the early postoperative period after thoracoscopic surgery has shown good clinical efficacy. It can reduce the level of pain in patients, promote effective coughing and expectoration, facilitate early mobilization of patients, improve patient compliance, reduce complications, shorten hospital stay, and expedite patient recovery. Therefore, it is worth promoting the widespread clinical application of Parecoxib injection in this setting.展开更多
As arthroscopic knee procedures have evolved, so has the management of post-operative pain. Traditional pain management included intravenous narcotics, which often resulted in nausea and increased sedation. In an effo...As arthroscopic knee procedures have evolved, so has the management of post-operative pain. Traditional pain management included intravenous narcotics, which often resulted in nausea and increased sedation. In an effort to reduce post-operative pain and minimize complications, the concept of multimodal analgesia evolved, including subcutaneous infiltration of local anesthetic, ketorolac and/or narcotic. We studied the effect upon post-operative pain of combining ropivacaine, ketorolac and morphine injected as a one-time dose compared to the same mixture plus an intraarticular pump administering ropivacaine for 24 hours. Our findings showed that a single subcutaneous and intraarticular injection of ketorolac, morphine and ropivacaine was as effective as this solution plus a 24-hour intraarticular ropivacaine pain pump for post-operative pain relief after outpatient arthroscopic knee surgery. No clinical or radiographic signs of chondrolysis were seen in the knee with the use of intraarticular ropivacaine at an average of 18 months post-operatively.展开更多
We present an interesting case report of a 49-year-old female who presented with symptoms of post-dural puncture headache following implantation of an intrathecal pain pump. Her history was complicated by previous mul...We present an interesting case report of a 49-year-old female who presented with symptoms of post-dural puncture headache following implantation of an intrathecal pain pump. Her history was complicated by previous multi-level spinal fusion with hardware. The patient was evaluated and felt to be a candidate for epidural blood patch, which she elected to proceed with. Under fluoroscopic guidance epidural blood patch was successfully performed. Immediately following the procedure the patient noted significant improvement in the headache and six hours following the procedure was headache free and remained so at follow up three weeks later.展开更多
AIM:To investigate the efficacy of amitriptyline with proton pump inhibitor(PPI)for the treatment of functional chest pain(FCP).METHODS:This was a randomized,open-label trial investigating the addition of low dose ami...AIM:To investigate the efficacy of amitriptyline with proton pump inhibitor(PPI)for the treatment of functional chest pain(FCP).METHODS:This was a randomized,open-label trial investigating the addition of low dose amitriptyline(10 mg at bedtime)to a conventional dose of rabeprazole(20 mg/d)(group A,n = 20)vs a double-dose of rabeprazole(20 mg twice daily)(group B,n = 20)for patients with FCP whose symptoms were refractory to PPI.The primary efficacy endpoints were assessed by global symptom score assessment and the total number of individuals with > 50% improvement in their symptom score.RESULTS:The between-group difference in global symptom scores was statistically significant during the last week of treatment(overall mean difference;3.75 ± 0.31 vs 4.35 ± 0.29,the between-group difference;P < 0.001).Furthermore,70.6% of patients in group A had their symptoms improve by > 50%,whereas only 26.3% of patients in group B had a similar treatment response(70.6% vs 26.3%,P = 0.008).Specifically,patients in group A had a significantly greater improvement in the domains of body pain and general health perception than did patients in group B(52.37 ± 17.00 vs 41.32 ± 12.34,P = 0.031 and 47.95 ± 18.58 vs 31.84 ± 16.84,P = 0.01,respectively).CONCLUSION:Adding amitriptyline to a PPI was more effective than a double-dose of PPI in patients with FCP refractory to a conventional dose of PPI.展开更多
As intrathecal pumps are now widely used for management of pain and spasticity, there are more women of child-bearing age who have intrathecal pumps already implanted at time of conception of their children. There is ...As intrathecal pumps are now widely used for management of pain and spasticity, there are more women of child-bearing age who have intrathecal pumps already implanted at time of conception of their children. There is little in the way of guidelines for how to manage these women, especially those with intrathecal pumps infusing analgesics, throughout pregnancy and after birth. We present a woman who presented at 19 weeks of gestation for consultation of long term pain management, with 3 years of postpartum follow up.展开更多
AIM: Providing analgesia via peripheral nerve catheters attached to an infusion pump is an effective pain management option in children.METHODS: Portable infusion pumps are being used with increased frequency in pedia...AIM: Providing analgesia via peripheral nerve catheters attached to an infusion pump is an effective pain management option in children.METHODS: Portable infusion pumps are being used with increased frequency in pediatric patients. Because these pumps are infusing potentially toxic doses of medications, the accuracy and consistency of these devices becomes very important in this patient population. This study is a comparison of the actual delivery volume of local anesthetic of three elastomeric infusion devices approved for patient use in the ambulatory setting. Three brands of disposable elastomeric infusion devices were used(Five On-Q, Five Baxter, and Five Ambu pumps). Each was filled with 200 m L of Ropivicaine 0.1% and connected to a single, end hole infusion catheter and set to infuse at 12 m L/h. The devices were run simultaneously. The fluid delivered was measured every hour with a graduated column over a tenhour period. The ambient temperature was also recorded.RESULTS: There were statistically significant differences in the output from each elastomeric device over the 10 h infusion period when compared to the nominal rate of 12 m L/h. The output from the Ambu and Baxter pumps was less than that set on the regulator, while the output from the On-Q pump was greater than that set on the regulator. The results remained statistically significant after adjusting the nominal rate to correct for differences in temperature. The Ambu infusion device was the most consistent, while the Baxter infusion device was the most accurate. This emphasizes the importance of health care providers understanding the infusion profile of the pump being used for continuous peripheral nerve block, as these alterations in flow could result in inadequate analgesia, early reservoir exhaustion, excessive muscle weakness or potential toxicity, especially when used in pediatric patients.CONCLUSION: This investigation demonstrates that three modern elastomeric infusion pumps have significantly different output than the nominal rate set on the regulator.展开更多
目的 :研究鞘内连续注射吗啡联合地塞米松治疗癌性骨痛(cancer-induced bone pain,CIBP)的疗效及其机制。方法:76例CIBP患者均接受椎管内镇痛药输注港皮下植入术,并随机分入吗啡组(A组38例,鞘内泵入吗啡)和吗啡联合地塞米松组(B组38例,...目的 :研究鞘内连续注射吗啡联合地塞米松治疗癌性骨痛(cancer-induced bone pain,CIBP)的疗效及其机制。方法:76例CIBP患者均接受椎管内镇痛药输注港皮下植入术,并随机分入吗啡组(A组38例,鞘内泵入吗啡)和吗啡联合地塞米松组(B组38例,鞘内泵入吗啡和地塞米松)。于治疗前以及治疗开始后第1、3、7天评定11点数字评分量表(11-Point Numeric Rating Scale,NRS-11)评分、每日爆发痛次数、生活质量和SF-36量表评分。治疗开始后第7天测定血浆内啡肽和胃动素以及脑脊液中前列腺素E2、P物质和降钙素基因相关肽的水平。结果:B组疼痛缓解效果明显,治疗开始后第1、3、7天的每日爆发痛次数均明显少于A组(P<0.05);2组治疗后的NRS-11评分均<2分,但2组之间NRS-11评分的差异无统计学意义;B组治疗开始后第3和7天的SF-36量表评分和生活质量均较A组有显著改善(P<0.05)。治疗开始后第7天,2组的血浆内啡肽水平差异无统计学意义(P>0.05),但B组的血浆胃动素水平高于A组(P<0.05);B组脑脊液中前列腺素E2、P物质和降钙素基因相关肽水平均低于A组(P<0.05)。结论:鞘内泵入吗啡联合地塞米松与鞘内泵入吗啡相比,可减少CIBP的爆发痛次数,改善患者的生活质量;并可升高血浆胃动素水平,降低脑脊液中前列腺素E2、P物质和降钙素基因相关肽的水平,减轻吗啡耐受,增强镇痛效果。展开更多
文摘Objective: To explore the clinical effectiveness of combined use of intravenous pain pump with Parecoxib injection in alleviating pain in patients during the early postoperative period after thoracoscopic surgery. Methods: Eighty patients who underwent thoracoscopic surgery in a tertiary hospital were selected as the study subjects and randomly divided into two groups, with 40 patients in each group. The control group received routine postoperative treatment with intravenous pain pump, while the experimental group received Parecoxib in addition to the standard postoperative pain pump treatment. Visual Analog Scale (VAS) pain scores were used to evaluate postoperative pain relief in both groups, along with adverse reactions, postoperative complications, and patient satisfaction with pain relief. Results: Patients who received Parecoxib injection in addition to the routine use of intravenous pain pump had VAS pain scores lower than 3 points at 6 h, 12 h, 24 h, and 36 h postoperatively compared to those in the control group. The incidence of postoperative lung collapse, pleural effusion, and pulmonary infections was also significantly lower in the experimental group. The differences between the two groups were statistically significant (P Conclusion: Early combined use of Parecoxib injection in the early postoperative period after thoracoscopic surgery has shown good clinical efficacy. It can reduce the level of pain in patients, promote effective coughing and expectoration, facilitate early mobilization of patients, improve patient compliance, reduce complications, shorten hospital stay, and expedite patient recovery. Therefore, it is worth promoting the widespread clinical application of Parecoxib injection in this setting.
文摘As arthroscopic knee procedures have evolved, so has the management of post-operative pain. Traditional pain management included intravenous narcotics, which often resulted in nausea and increased sedation. In an effort to reduce post-operative pain and minimize complications, the concept of multimodal analgesia evolved, including subcutaneous infiltration of local anesthetic, ketorolac and/or narcotic. We studied the effect upon post-operative pain of combining ropivacaine, ketorolac and morphine injected as a one-time dose compared to the same mixture plus an intraarticular pump administering ropivacaine for 24 hours. Our findings showed that a single subcutaneous and intraarticular injection of ketorolac, morphine and ropivacaine was as effective as this solution plus a 24-hour intraarticular ropivacaine pain pump for post-operative pain relief after outpatient arthroscopic knee surgery. No clinical or radiographic signs of chondrolysis were seen in the knee with the use of intraarticular ropivacaine at an average of 18 months post-operatively.
文摘We present an interesting case report of a 49-year-old female who presented with symptoms of post-dural puncture headache following implantation of an intrathecal pain pump. Her history was complicated by previous multi-level spinal fusion with hardware. The patient was evaluated and felt to be a candidate for epidural blood patch, which she elected to proceed with. Under fluoroscopic guidance epidural blood patch was successfully performed. Immediately following the procedure the patient noted significant improvement in the headache and six hours following the procedure was headache free and remained so at follow up three weeks later.
文摘AIM:To investigate the efficacy of amitriptyline with proton pump inhibitor(PPI)for the treatment of functional chest pain(FCP).METHODS:This was a randomized,open-label trial investigating the addition of low dose amitriptyline(10 mg at bedtime)to a conventional dose of rabeprazole(20 mg/d)(group A,n = 20)vs a double-dose of rabeprazole(20 mg twice daily)(group B,n = 20)for patients with FCP whose symptoms were refractory to PPI.The primary efficacy endpoints were assessed by global symptom score assessment and the total number of individuals with > 50% improvement in their symptom score.RESULTS:The between-group difference in global symptom scores was statistically significant during the last week of treatment(overall mean difference;3.75 ± 0.31 vs 4.35 ± 0.29,the between-group difference;P < 0.001).Furthermore,70.6% of patients in group A had their symptoms improve by > 50%,whereas only 26.3% of patients in group B had a similar treatment response(70.6% vs 26.3%,P = 0.008).Specifically,patients in group A had a significantly greater improvement in the domains of body pain and general health perception than did patients in group B(52.37 ± 17.00 vs 41.32 ± 12.34,P = 0.031 and 47.95 ± 18.58 vs 31.84 ± 16.84,P = 0.01,respectively).CONCLUSION:Adding amitriptyline to a PPI was more effective than a double-dose of PPI in patients with FCP refractory to a conventional dose of PPI.
文摘As intrathecal pumps are now widely used for management of pain and spasticity, there are more women of child-bearing age who have intrathecal pumps already implanted at time of conception of their children. There is little in the way of guidelines for how to manage these women, especially those with intrathecal pumps infusing analgesics, throughout pregnancy and after birth. We present a woman who presented at 19 weeks of gestation for consultation of long term pain management, with 3 years of postpartum follow up.
文摘AIM: Providing analgesia via peripheral nerve catheters attached to an infusion pump is an effective pain management option in children.METHODS: Portable infusion pumps are being used with increased frequency in pediatric patients. Because these pumps are infusing potentially toxic doses of medications, the accuracy and consistency of these devices becomes very important in this patient population. This study is a comparison of the actual delivery volume of local anesthetic of three elastomeric infusion devices approved for patient use in the ambulatory setting. Three brands of disposable elastomeric infusion devices were used(Five On-Q, Five Baxter, and Five Ambu pumps). Each was filled with 200 m L of Ropivicaine 0.1% and connected to a single, end hole infusion catheter and set to infuse at 12 m L/h. The devices were run simultaneously. The fluid delivered was measured every hour with a graduated column over a tenhour period. The ambient temperature was also recorded.RESULTS: There were statistically significant differences in the output from each elastomeric device over the 10 h infusion period when compared to the nominal rate of 12 m L/h. The output from the Ambu and Baxter pumps was less than that set on the regulator, while the output from the On-Q pump was greater than that set on the regulator. The results remained statistically significant after adjusting the nominal rate to correct for differences in temperature. The Ambu infusion device was the most consistent, while the Baxter infusion device was the most accurate. This emphasizes the importance of health care providers understanding the infusion profile of the pump being used for continuous peripheral nerve block, as these alterations in flow could result in inadequate analgesia, early reservoir exhaustion, excessive muscle weakness or potential toxicity, especially when used in pediatric patients.CONCLUSION: This investigation demonstrates that three modern elastomeric infusion pumps have significantly different output than the nominal rate set on the regulator.
