Objective To evaluate the efficacy of intravertebral analgesia for external cephalic version. Methods We electronically searched The Cochrane Library (Issue 4, 2009), PubMed (1980 to 2009), Ovid MEDLINE (1950 to 2009), Ovid EBM Database (1991 to 2009), EMbase (1980 to 2009), CBM (1978 to 2009) and CNKI (1979 to 2009) to collect literature about intravertebral analgesia for external cephalic version. We screened randomized controlled trials (RCTs) according to the predefined inclusion and exclusion criteria, extracted data and evaluated the quality of the included studies, and then performed meta-analyses by using RevMan 5.0.13 software. Results Seven RCTs involving 620 women met the inclusion criteria. Five trials were of relatively high quality, and 1 of low quality and 2 not clear. The result of meta-analyses showed that intravertebral analgesia was superior in external cephalic version with a RR 1.53 and 95%CI 1.24 to 1.88. Conclusion Intravertebral analgesia can increase the successful rate of external cephalic version in the treatment of breech presentation compared with intravenous medicine for systematic use or no analgesia.
Objective To assess the effects on labour, maternal, and neonatal outcomes of different techniques and drugs for analgesia during labour. Methods We searched The Cochrane Library (Issue 4, 2006) , MEDLINE (Jan. 1978 to Oct. 2006) and CBMdisc (Jan. 1980 to Oct. 2006) to collect the current best evidence of labor analgesia. Results We included eight Cochrane systematic reviews and six other meta-analyses. The evidence showed that epidural analgesia was associated with a longer second stage of labour, more frequent oxytocin augmentation, higher incidence of instrumental vaginal delivery and maternal fever. But it was unlikely to increase the risk of caesarean section. Conclusion Epidural analgesia is superior to other approaches.
Objective To compare the analgesia effect and clinical rehabilitation between continuous adductor canal block (ACB) and single shot ACB in total knee arthroplasty (TKA)． Methods Between October 2016 and February 2017, 60 patients with severe knee osteoarthritis undergoing primary unilateral TKA were prospectively recruited in the study. All the patients were randomly allocated into 2 groups and received ultrasound-guided continuous ACB (group A, n=30) or single shot ACB (group B, n=30), respectively. There was no significant difference in gender, age, body mass index, nationality, American Society of Anesthesiology (ASA) grading, and preoperative knee range of motion and quadriceps strength between 2 groups (P>0.05). After operation, the tourniquet time, postoperative drainage volume, hospitalization time, and adverse events in 2 groups were recorded. Visual analogue scale (VAS) scores at rest and during activity, the quadriceps strength, the knee range of motion, and the time of 90° knee flexion in 2 groups were also recorded and compared. Results There was no significant difference in tourniquet time, postoperative drainage volume, and incidence of adverse events between 2 groups (P>0.05). But the hospitalization time was significant shorter in group A than in group B (P<0.05). VAS scores at rest and during activity were lower in group A than in group B, with significant differences in VAS score at rest after 12 hours and in VAS score during activity after 8 hours between 2 groups (P<0.05). The quadriceps strength was higher in group A than in group B, with significant difference at 24, 48, and 72 hours (P<0.05). The knee range of motion was significantly better in group A than in group B at 24, 48, 72 hours and on discharge (P<0.05). The time of 90° knee flexion was significantly shorter in group A than in group B (t=–2.951, P=0.016). There were 4 patients in group A and 7 patients in group B requiring meperidine hydrochloride (50 mg/time) within 24 hours, and 3 patients in group A and 7 patients in group B at 24 to 48 hours, and 1 patient in group A and 3 patients in group B at 48 to 72 hours. Effusion in the catheter site occurred in 2 cases of group A, but no catheter extrusion occurred. Conclusion Continuous ACB is superior in analgesia both at rest and during activity and opioid consumption compared with single shot ACB after TKA. And the quadriceps strength could be reserved better in continuous ACB group, which can perform benefits in early rehabilitation.
ObjectiveTo prospective study the effectiveness and safety of multimodal analgesia (MA) in treatment of avascular necrosis of the femoral head with free vascularized fibular grafting (FVFG).MethodsSixty patients with avascular necrosis of the femoral head, who were scheduled to unilateral primary FVFG between February 2016 and December 2016 and met the selection criteria, were included in the study. All patients were allocated to two groups according to the method of random number table: MA group (n=30) and control group (n=30). There was no significant difference in gender, age, body mass index, side, duration and stage of avascular necrosis of the femoral head, preoperative visual analogue scale (VAS) scores under quiescent and active states, and range of motion (ROM) of hip flexion and abduction before operation (P>0.05). The patients in the MA group were treated with MA therapy, including oral administration of celecoxib before operation, local anesthetic wound infiltration during operation, and ice compression and oral administration of celecoxib after operation. The patients in control group were only treated with patient-controlled intravenous analgesia pump. The postoperative VAS scores under quiescent and active states, ROM of hip flexion and abduction, prescription of Tramadol and adverse reaction were recorded and compared.ResultsThe operations were completed successfully in both groups without obvious complications and adverse reaction. The Tramadol was used in 4 cases (13.3%) of MA group and in 11 cases (36.7%) of control group, but no significant difference was found between the two groups (χ2=4.356, P=0.072). The VAS scores under quiescent state at 6 and 24 hours postoperatively were significantly lower in MA group than in control group (P<0.05), while VAS scores under active state at 48 hours postoperatively and on the day of discharge were significantly lower in MA group than in control group (P<0.05). There was no significant difference in VAS score between two groups at other time points (P>0.05). The ROM of hip flexion in MA group was better than that in control group at 1 day postoperatively and the day of discharge (P<0.05), while no significant difference was found at 2 and 3 days postoperatively (P>0.05). The ROM of hip abduction in MA group was superior to the control group at 1, 2, and 3 days postoperatively and the day of discharge (P<0.05).ConclusionThe MA can effectively relieve the pain following FVFG and facilitate early functional exercises of the hip. The usage of opioids was also relatively fewer for MA protocol.
Objective To verify the feasibility and effectiveness of the modified fast-track surgery (FTS) in the perioperative period of open liver resection. Methods A prospective randomized controlled trial was carried out in 188 consecutive patients undergoing open liver resection between March and December 2014 in the Department of Liver Surgery of West China Hospital. The modified fast recovery procedure and standard rehabilitation procedure were compared in terms of length of hospital stay after operation, hospitalization cost, complications and readmission rate. Results A total of 188 consecutive patients were enrolled in the trial. The analysis included 87 patients in the modified fast recovery group and 89 in the standard rehabilitation group. Compared with the standard rehabilitation group, the modified fast recovery group had a shorter length of hospital stay [(5.70±1.47)vs. (7.26±1.96) days] and a lower cost [(42.7±6.7)vs. (47.3±12.5) thousand yuan], and the differences were statistically significant (P<0.05). There were 20 complication cases in the modified group and 39 in the standard group with significant difference (P=0.003). There was no significant difference in the rate of readmission between the two groups (P=1.000). Compared with the standard group, patients in the modified group had less pain 8 hours, the 1st and 2nd days after surgery, better postoperative activities of daily living, more initiative cough times and off-bed activity times, longer duration of movement, and earlier bowel recovery and exhausting, and all the above differences were significantly different (P<0.05). Stepwise regression analysis showed that postoperative complications and bowel recovery and exhausting time were independent related factors for postoperative hospital stay (P<0.001). Conclusions Multimodal analgesia-based fast recovery procedure is feasible and effective in the perioperative period of partial hepatectomy. It can shorten the time of hospitalization and reduce the cost of hospitalization.
ObjectiveTo evaluate the early effectiveness of local infiltration anesthesia (LIA) with compound betamethasone in total knee arthroplasty (TKA). MethodsThe clinical data of 102 patients with knee osteoarthritis who were treated by TKA and met the selection criteria between May 2022 and March 2023 were retrospectively analyzed. They were divided into control group and study group according to whether LIA preparation was added with compound betamethasone, with 51 cases in each group. There was no significant difference of baseline data, such as age, gender, body mass index, operative side, preoperative range of motion (ROM), Knee Society Score (KSS), white blood cell (WBC), and hematocrit between the two groups (P>0.05). The intraoperative total blood loss and hidden blood loss were recorded, and WBC was recorded on the 1st, 2nd, and 3rd days after operation. Pain was assessed by visual analogue scale (VAS) score on the 1st, 2nd, and 3rd days after operation and morphine intake milligrames equivalent within 48 hours after operation. Passive ROM, maximum extension and flexion angles of knee joint were measured on the 3rd day after operation; the early postoperative complications were recorded. ResultsThere was no significant difference in total blood loss and hidden blood loss between the two groups (P>0.05). The postoperative pain levels in both groups were relatively mild, and there was no significant difference in VAS scores in the first 3 days after operation and in morphine intake milligrams equivalent within 48 hours after operation between the two groups (P>0.05). The WBC in the first 3 days after operation was significantly improved in both groups (P<0.05). The WBC in the study group was significantly higher than that in the control group on the 1st and 2nd days after operation (P<0.05), but there was no significant difference between the two groups on the 3rd day after operation (P>0.05). On the 3rd day after operation, the maximum extension angle of knee joint in the study group was smaller than that in the control group, while the maximum flexion angle and passive ROM of knee joint in the study group were larger than those in the control group, and the differences were significant (P<0.05). There were 6 cases of fever and 17 cases of deep venous thrombosis in the control group, and 1 case and 14 cases in the study group, respectively. There was no poor wound healing and periprosthetic joint infection in the two groups, and there was no significant difference in the incidence of complications between the two groups (P>0.05). ConclusionThe application of compound betamethasone in LIA during TKA is a safe and optimal strategy to promote the early postoperative rehabilitation of patients.
Objective To systematically evaluate effectiveness, dosage and adverse reaction of sufentanil versus fentanyl for postoperative patient-controlled epidural analgesia (PCEA), so as to provide evidence for rational drug use in clinic. Methods Databases including The Cochrane Library, the special trials registered in the Cochrane anesthesia group, MEDLINE, EMbase, CBM, CNKI, VIP and WanFang Data were searched by the end of 2012, and the relevant periodicals were also manually searched to collect the randomized controlled trials (RCTs) on sufentanil versus fentanyl for postoperative patient-controlled epidural analgesia. According to the Cochrane Handbook 5.0, literature was screened, data were extracted, and quality of the included studies was critically assessed. Then meta-analysis was performed using RevMan 5.1 software. Results A total of 25 RCTs involving 1 944 patients were included. The results of meta-analyses showed that: a) as for visual analog scale (VAS), compared with the fentanyl group, the postoperative VAS at 2-hour, 4-hour, 8-hour, 12-hour, 24-hour and 48-hour was decreased in the sufentanil group; b) as for sedation scale, the fentanyl group, the postoperative sedation at 12-hour and 24-hour was lower in the sufentanil group when adopting 0 to 3 points scoring method, but there were no significant differences at other time points; c) as for drug dosage, compared with the fentanyl group, the postoperative drug consumption at 24-hour and 48-hour was less in the sufentanil group; d) as for adverse reaction, the incidence of postoperative nausea, vomiting, dizziness and somnolence in the sufentanil group was lower than those in the fentanyl group. But there was no significant difference in other adverse reactions such as skin itching, limbs numbness and motor disturbance between the two groups; and e) as for the demands of additional analgesic drugs, compared with the fentanyl group, the incidence of demanding additional analgesic drugs was lower in the sufentanil group. Conclusion Compared with fentanyl, sufentanil has better effects of analgesia and sedation for PCEA; Its dosage and incidence of adverse reactions are lower, so sufentanil is safer in clinic.
ObjectiveTo investigate the clinical effect of transversus abdominis plane (TAP) block as part of multimodal analgesia in enhanced recovery after surgery (ERAS) program for patients with hepatic hydatidosis. MethodsThis study was a randomized controlled trial (The registration number was ChiCTR2100053689). According to the established inclusion and exclusion criteria, the patients diagnosed with hepatic hydatidosis treated in the People’s Hospital of Aba Tibetan and Qiang Autonomous Prefecture from October 2019 to August 2021 were prospectively included. The odd and even by obverse and reverse of coin was adopted to assign into the study group and the control group, respectively. The patients in the study group were treated with ERAS + TAP block + patient controlled intravenous analgesia (PCIA) + tramadol and the patients in the control group were treated with ERAS + PCIA + tramadol. The intraoperative and postoperative statuses of the two groups were compared. ResultsA total of 64 patients were enrolled in this study, including 32 patients in the study group and 32 patients in the control group. There were no statistical differences in the baseline data such as the age, gender, preoperative complications, preoperative liver function, and liver hydatid type between the two groups (P>0.05). The operations of 64 patients were performed successfully, and there was no perioperative death. There were no statistical differences in the operation time, intraoperative bleeding, and operation mode between the two groups (P>0.05). Compared with the control group, the points of visual analogue scale of postoperative pain on day 1 and 2 were lower (P<0.05), the dosage of tramadol within 2 d after operation and hospitalization expenses were less (P<0.05), and the getting out of bed time, eating liquid diet time, postoperative exhaust time, and total hospital stay were shorter (P<0.05) in the study group. The total complication rate of the study group was lower than that of the control group [28.1% (9/32) vs. 78.1% (25/32), χ2=16.063, P<0.001]. The comprehensive complication index was positively correlated with the total hospital stay (r=0.941, P<0.001) and hospitalization expenses (r=0.958, P<0.001). ConclusionPreliminary results of this study suggest that multimodal analgesia included TAP block is effective in ERAS, and could shorten hospital stay and reduce hospitalization expenses.
Objective To assess the effectiveness and safety of local versus systemic application of opioids for labor analgesia. Methods We searched PubMed (1966 to January 2008), EMBASE (1980 to January 2008), The Cochrane Library (Issue 1, 2008), CBM (1978 to January 2008), CNKI (1979 to January 2008) for randomized controlled trials (RCTs) involving local versus systemic application of opioids for labor analgesia. Quality assessment and data extraction were conducted by two reviewers independently. Meta-analyses were conducted with The Cochrane Collaboration’s RevMan 4.2.10 software. Results A total of 12 trials involving 5909 participants met the inclusion criteria. Meta-analyses showed that local application of opioids was superior to systemic application in terms of maternal satisfaction with pain relief during labor (RR 1.63, 95% CI 1.27 to 2.09). No significant difference was found between the two groups in the incidence of low neonatal Apgar score at 5 minutes (RR 0.63, 95% CI 0.40 to 1.01). Conclusion Local application of opioids for labor analgesia appears to be more effective than systematic use in reducing pain during labor. But as for safety concerns, maternal and neonatal adverse effects are observed in both groups. Thus, more high-quality and large-scale RCTs are needed.
ObjectiveTo investigate the effect and safety of subgluteal approach continous sciatic nerve block with 0.2% ropivacaine for postoperative analgesia in calcaneal fracture patients. MethodsForty calcaneal fracture patients treated from May 2012 to January 2013 were randomly assigned to two groups:20 patients in continuous sciatic nerve block group (group CSB) and 20 patients in self-controlled intravenous analgesia group (group PCIA).Patients in group CSB were given subgluteal approach continuous sciatic nerve block,and PCA pump was connected to give 0.2% ropivacaine via continuous nerve block catheter continuously for analgesia.Patients in group PCIA were given PCA pump directly for self-controlled intravenous analgesia.The movement/rest VAS scores and Ramsay scores at 2,8,24,48 hours after surgery,the dose of other analgesia drugs after surgery,the satisfaction of patients and surgeons,and side effects were recorded. ResultsThe movement and rest visual analogue scale (VSA) scores and the dose of analgesia drugs in group CSB were significantly lower than group PCIA at all time points (P<0.05).The satisfaction of patients and surgeons in group CSB was higher than group PCIA (P<0.05). ConclusionCompared with self-controlled intravenous analgesia,subgluteal approach continuous sciatic nerve block with 0.2% ropivacaine can provide better and safer postoperative analgesia for calcaneal fracture patients.