ABSTRACT
OBJECTIVE:To observe analgesia,sedation effects and safety of flurbiprofen axetil combined with hydromorphone for postoperative patient-controlled intravenous analgesia (PCIA) after orthopedics surgery. METHODS:Totally 90 patients with combined spinal epidural anesthesia underwent lower limb surgery were selected from anesthesology department in the Affiliated Hospital of Chengde Medical College during May 2016-Jan. 2018. They were divided into SF group,H group and KH group according random number table,with 30 cases in each group. The postoperative PCIA pump drug liquid formula of SF group included Sufentanil citrate injection 2-3 μ g/kg+Tropisetron hydrochloride for injection 10 mg+0.9% Sodium chloride injection diluted to 100 mL;that of H group included Hydromorphone hydrochloride injection 0.12 mg/kg+Tropisetron hydrochloride for injection 10 mg+0.9% Sodium chloride injection diluted to 100 mL;that of KH group included Hydromorphone hydrochloride injection 0.12 mg/kg+Flurbiprofen axetil injection 50 mg+Tropisetron hydrochloride for injection 10 mg+0.9% Sodium chloride injection diluted to 100 mL. The operation time, intraoperative medication (epidural application frequency of additional ropivacaine,frequency of ephedrine and atropine),effective pressing times of analgesic pump and the analgesic effect of PCIA were observed in 3 groups. VAS score and Ramsay sedation score were observed 2,6,12,24,48 h after surgery. The hospital anxiety and depression scale (HAD) score,profile of mood states (POMS) score and the occurrence of ADR were observed before and after surgery. RESULTS:There was no statistical significance in operation time,epidural application frequency of additional ropivacaine or frequency of ephedrine and atropine among 3 groups (P＞0.05). The effective pressing times of analgesic pump in KH group were significantly lower than SF group and H group. The proportion of patients with excellent and good anesthesia effect in KH group was significantly higher than SF group and H group (P＜0.05);there was no statistical significance between SF group and H group(P＞0.05). VAS score of 3 groups 48 h after surgery were significantly lower than 6, 12,24 h after surgery;that of KH group was significantly lower than SF group and H group(P＜0.05);there was no statistical significance between SF group and H group(P＞0.05). There was no statistical significance in Ramsay score among 3 groups at different time points(P＞0.05). Before surgery,there was no statistical significance in HAD score or POMS score among 3 groups (P＞0.05). After surgery,HAD score and POMS score of KH group and H group were significantly lower than before surgery and SF group(P＜0.05);there was no statistical significance in KH group and H group,before and after surgery in SF group(P＞0.05). No vomiting,respiratory depression,pruritus and digestive tract bleeding were observed in 3 groups. The incidence of dizziness and nausea in H group and KH group were significantly lower than SF group (P＜0.05);there was no statistical significance between KH group and H group(P＞0.05). CONCLUSIONS:The flurbiprofen axetil combined with hydromorphone show good analgesic and sedative effect for PCIA after orthopedics operation,and can significantly improve emotion and mood of patients with good safety.
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Objective To observe the effect of early food intake for the patients undergoing orthopedic surgery under intravertebral anesthesia or general anesthesia.Methods A total of 52 cases of orthopedic surgeries under intravertebral anesthesia or general anesthesia from the orthopedic department in the First Hospital of Tsinghua University were randomly divided into an experiment group (n=30) and control group (n=22).The experiment group followed the orders of their doctor,allowed to eat food any time after the anesthesia wore off (without exhaustion beforehand) and the control group was asked to eat after 6～8h.The two groups were compared in terms of the first time for exhaustion,the feeding amount for the first time and the symptoms for the first time.Results The first time for exhaustion in the experiment group was earlier than that of the control group,showing significant difference between them (P＜0.05).The amount of food intake of the two groups was insignificantly different (P＞0.05).After the first feeding,the patients in the experiment group had no nausea/vomiting and abdominal distension,and the incidence of thirst and hunger was significantly lower in the experiment group than that in the control group (P＜0.05).The discharge time was significantly earlier than that in the control group (P＜0.05).Conclusion It is feasible for patients undergoing orthopedic surgery to eat food early.Patients are able to eat food once they are conscious and it is not necessary to wait until gastrointestinal function fully recovered.
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OBJECTIVE:To investigate the influence of dexmedetomidine combined with fentanyl on analgesic effects and hemodynamics of orthopedics patients after surgery.METHODS:A total of 80 patients undergoing orthopedics surgery were randomly divided into observation group (40 cases) and control group (40 cases).Observation group was given patient-controlled analgesia (PCA) of Dexmedetomidine hydrochloride injection+Fentanyl citrate injection,maintaining analgesia for 48 h.Control group was given PCA of Fentanyl citrate injection,maintaining analgesia for 48 h.The MAP,SpO2,HR,VAS and the occurrence of ADR were observed in 2 groups from the application of multi-function monitor to connecting to PCA (T0),12 h after connecting (T1) and 48 h after connecting (T2).RESULTS:At T0,there was no statistical significance in VAS score between 2 groups (P＞0.05).VAS scores of 2 groups at T1-2 were significantly higher than at T0.Those of 2 groups at T1 were significantly higher than at T2;but the observation group was significantly lower than the control group,with statistical significance (P＜0.05).There was no statistical significance in MAP,SpO2 or HR between 2 groups at different time points (P＞0.05).The incidence of respiratory depression,sharp pain,nausea and vomiting,hypotension in observation group were significantly lower than control group,with statistical significance (P＜0.05).CONCLUSIONS:Dexmedetomidine combined with fentanyl show significant analgesic effect after orthopedics surgery,and have no effect on hemodynamics with good safety.
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Entre os problemas cirúrgicos das aves, as fraturas são os de maior prevalência. Em virtude das variações no tamanho, peso, anatomia óssea peculiar, alta incidência de fraturas complicadas e das diferentes demandas funcionais entre espécies e indivíduos, não foi possível estabelecer ainda um método ideal de osteossíntese para os ossos longos das aves. Microplacas de titânio comumente utilizadas em cirurgias maxilofaciais de humanos foram empregadas recentemente na osteossíntese de aves, porém com poucos resultados disponíveis. O objetivo do presente estudo foi avaliar a utilização das microplacas de titânio no tratamento de fraturas experimentais de tibiotarso em pombos domésticos (Columba livia). Foram utilizadas 30 aves adultas, machos e fêmeas, com 7 meses de idade, pesando entre 400 a 500 gramas. Os animais foram separados em três grupos de dez, sendo que no grupo 1 foi utilizado uma microplaca de titânio com 6 furos e espaçador central; no grupo 2, com oito furos sem espaçador central; e, no grupo 3, com oito furos com espaçador central. Após avaliação clínica, as aves foram submetidas à osteotomia médio-diafisária no tibiotarso direito para colocação das diferentes configurações de microplaca de titânio, sendo fixadas com microparafusos de titânio com 7mm de comprimento. Os animais foram avaliados clínica e radiograficamente até os 90 dias de pós-operatório. Após esse período, foi realizada eutanásia em duas aves de cada grupo. Em todas elas, foi observada a consolidação óssea, sendo que, no grupo 1, o tempo médio e o desvio padrão foram 32,9±9,9; no grupo 2, 30,8±6,7 e, no grupo 3, 26,6±6,4 dias, não havendo diferença estatística entre os grupos. O envergamento do implante foi a complicação mais frequente. A configuração da microplaca resultou em diferença estatisticamente significativa em relação à deambulação e ao grau de envergamento nos diferentes grupos, sendo que, no grupo 3, houve maior precocidade no apoio do membro e menor grau de envergamento em relação aos outros grupos. Histologicamente, foi verificada a formação de calo ósseo em todos os animais e presença de tecido ósseo ao redor da microplaca e dos microparafusos. Apesar das complicações observadas, as microplacas de titânio são uma opção para osteossíntese de tibiotarso em aves de médio porte.
Among the surgical problems in birds, the fractures are the most prevalent. Due to variations in size, weight, peculiar bone anatomy, high incidence of complicated fractures and functional demands of different species and individuals, it is still not possible to establish an ideal method for osteosynthesis of long bones in birds. Titanium microplates commonly used in human maxillofacial surgery have been recently employed in osteosynthesis of birds, but with few results available. The aim of this study was to evaluate the use of titanium microplates in the treatment of tibiotarsus fractures in 30 pigeons (Columba livia) , adult males and females, with 7 months old, weighing from 400 to 500. The animals were divided into 3 groups with ten animals each. In group 1, a titanium microplate with 6 holes and a central spacer was used; in group 2, a titanium microplate with 8 holes without a spacer in the center was used; in group 3, a titanium microplate with 8 holes with central spacer was used. After clinical evaluation, the birds were submitted to mid-diaphyseal osteotomy in the right bone for placement of different configurations of the titanium plate, and fixed with titanium microscrews 7mm long. The animals were evaluated clinically and radiographically until 90 days postoperatively. After this period, euthanasia was performed in 2 animals from each group. In all animals was observed bone healing and in group 1 the mean and standard deviation were 32.9±9.9 days, in group 2, 30.8±6.7 days in group 3, 26.6±6.4 days. There was no statistical difference in healing time between groups. The bending of the implant was the most common complication. The configuration of the plate resulted in a statistically significant difference in relation to walking and to the degree of bending in the different groups. Moreover, in group 3 there was higher precocity in the member suppor and a lower degree of bending in relation to other groups. Histologically, it was verified formation of the callus in all animals and presence of bone tissue around the plate and microscrews. Despite the complications of titanium microplates, they are an option for tibiotarsus osteosynthesis in birds of medium size.