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Objective: To observe the clinical effect of combined spinal epidural anesthesia(CSEA)by using orbital needle in patient-controlled epidural analgesia(PCEA)post cesarean delivery.Methods: 94 puerperas who received cesarean were divided into observation group(47 cases)and control group(47 cases).The patients of two groups were narcotized by using CSEA combined with PCEA.And the observation group adopted a new type of lumbar vertebral combined puncture needle and the control group adopted the traditionally typical lumbar vertebral combined puncture needle.The score of visual analogue scale(VAS)and sedation score of Ramesay of two groups of postoperative 1h,4h,12h,24h and 48h were compared.And the number of times in 48h,the drug dosage and adverse reaction of using analgesia pump also were compared.Results: In postoperative 12 h,the VAS scores of the two groups showed an increasing trend.And the VAS scores of pain of two groups within postoperative 12-48 h decreased gradually.The differences of VAS scores of pain of two groups within postoperative 1-12h and 12-48h between observation group and control group were statistically significant(F=29.596,F=156.366,P＜0.05),respectively.And the VAS scores of pain post operative 4h and 12h of observation group [(2.01±0.51)and(3.49±0.74)]were significantly lower than that of control group [(2.32±0.47)and(3.85±0.69)](t=3.064,t=2.439,P＜0.05),respectively.Within postoperative 1-48h,there were no significant fluctuation in sedation score of Ramesay and the difference of sedation score between the two groups were no significant.And the number of times(11.35±3.04)and drug dosage(65.67± 7.98)mL of using analgesic pump of observation group were significantly lower than that of control group [(20.08±5.32)and(82.07 ± 9.05)mL],(t=9.768,t=9.318,P＜0.05),respectively.Besides,the incidences of postoperative nausea and skin pruritus of observation group(4.26％and 14.89％)were significantly lower than that of control group(17.02％and 34.04％)(x2=4.029,x2=4.663,P＜0.05),respectively.Conclusion: The analgesia effect of orbital needle external needle in implementing CSEA for cesarean delivery is better than that of traditional needle inner needle,and its adverse reactions are less and it is safety.
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Background: PCEA (patient controlled epidural analgesia) is a safe and effective technique for postoperative analgesia on routine surgical wards. Use of the epidural catheter as part of a combined epidural-general anesthetic technique results in less pain and faster patient recovery immediately after surgery than general anesthesia followed by systemic opioids does. Aim: In this prospective, randomized, double – blind study, we compared the analgesic effectiveness, hemodynamic changes and other side effects of epidural analgesia with drug combination – bupivacaine with fentanyl and ropivacaine with fentanyl in different concentrations. Material and methods: It was a prospective, randomized, double – blind study. Sixty patients of ASA I-II and age group 18-65 years divided in four groups 15 patients in each group (Group B1 bupivacaine 0.1%; Group B2 bupivacaine 0.05%; Group R1 ropivacaine 0.1%; Group R2 ropivacaine 0.05% with fentanyl 5micrograms/ml in each groups). After taking consent from patients epidural catheter was placed and study drugs were given to every patient. Visual analogue scale, heart rate, Jain R, Gupta P, Jain V. A comparison of ropivacaine with fentanyl to bupivacaine with fentanyl for post-operative patient controlled epidural analgesia in patients undergone lower abdominal cancer surgery. IAIM, 2016; 3(7): 137-149. Page 138 blood pressure, sedation score, modified bromage scale and other side effects were noted for the next 48 hours. Statistical analysis was done by using Medcalc 12.2.1.0 version statistical analysis software. Results: All four groups were comparable in terms of analgesia but group B1 patients had significant decrease in blood pressure at all time intervals. This group also had loss in motor power of lower extremity p value 0.020 than all other three groups. Conclusions: We concluded that ropivacaine 0.1% with fentanyl 5 µg/mL after major abdominal surgery provides optimal dynamic analgesia without significant adverse effects.
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Objective To investigate the analgesic effect and motor block of ropivacayin combined dezocine in lower abodiminal operation.Methods Sixty patients of ASA Ⅰ - Ⅱ were divided into three groups randomly(n =20 for each group).They were treated with dezocine 5 mg +0.125％ ropivacayin/100 ml( group DI ),dezocine 5 mg +0.175％ ropivacayin/100 ml( group D2),dezocine 5 mg +0.225％ ropivacayin/100 ml (group D3 ).The initial dose was 5 ml,and the maintenance dose was 2 ml/h,with lock-out time of 20 mins,and the duration of patient-controlled epidermal analgesia (PCEA) was 48 h.The analgesic effect was evaluted by VAS score at 2,4,12,24 and 48 h after surgery.Bromage score and the side effects such as motor ability,and vomiting after surgery were recorded.Results At 2,4,12 h after surgery,the VAS scores of group D2 and D3 were less than that of group D1 (2.54 ± 1.34,2.47 ± 1.05 and 3.62 ± 1.02 at 2 hrs,2.13 ± 1.30,2.15 ± 1.28 and 3.56 ± 1.10 at 4 hrs,1.03 ± 0.43,1.04 ± 0.51 and 1.92 ± 1.20 at 12 hrs,respectively) ( Ps ＜ 0.05 ).As for the Bromage score among the 3 groups,there were no sighificant diffrences between group D1 and D2,wheras they were significantly lower than that in group D3 ( 1.21 ± 0.21,1.28 ±0.22 and 1.53 ± 0.31 at 2 hrs,1.15 ± 0.15,1.44 ± 0.25 and 1.61 ± 0.12 at 4 hrs,0.92 ± 0.14,0.99 ± 0.13 and 1.71 ± 0.22 at 12 hrs,0.85 ± 0.11,0.88±0.14 and (1.66±0.15) at 24 hrs,0.42 ± 0.10,0.55 ± 0.09 and 1.19±0.11 at 48 hrs,respectively,Ps ＜0.05).There were 2,2 and 3 patients affected with nausea and vomiting among the 3 groups,and there were no other side effects ( P ＞ 0.05 ).Conclusion 0.175％ ropivacayin combined with dezocine 5 mg via PCEA in lower abodiminal operation shows better analgesic effect and benefical to the restoration of lower limbs movements.
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Objective To explore impact of nursing intervention on the adverse reaction of patient con-trol epidural analgesia (PCEA) after abdominal operation. Methods 258 patients underwent PCEA after ab-dominal operation were selected from 2006 to 2007. The clinical data of 126 patients without nursing interven-tion were analyzed as the control group admitted to our hospital from January to December, 2006 and compared with those of 132 patients receiving nursing intervention as the experimental group from January to December, 2007. The control group was managed by the anesthetists and nurses only conducted routine nursing instruction, while the experimental group was given systematic and normative nursing intervention besides routine nursing instructions, including psychological intervention, behavioral intervention, close observation, of discovery of ad-verse reaction in time and giving early disposal. The incidence of adverse reaction of PCEA of the two groups such as urinary retention, nausea and vomiting, abdominal distension, skin indentation, catheter shedding, skin itching, numbness of lower limbs, respiratory depression was observed. Results Compared with the control group,the incidence of adverse reactions of PCEA in the experimental group such as urinary retention,nansea and vomiting, abdominal distension,skin indentation,catheter shedding was significantly lower. Conclusions The implementation of nursing intervention can reduce the adverse reaction of PCEA after abdominal operation, alle-viate the suffering of patients, and promote functional recovery and the body rehabilitation.
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Objective Observe the influence of using PCEA on the recovery of postoperative patient with cesearn section.Methods Observe the analgesic effect in advance of PCEA analgesia with 110 cases,and analgesic effect of non-PCEA analgesia for selective cesarean section 67 patients.Results PCEA analgesic effectiveness for cesarean section postoperative 6 hours and 24 hours respectively are 98% and 94%,the difference is remarkable(P0.05).Conclusion PCEA uses for cesarean section postoperative analgesia,has a good analgesic effects and highly safety.
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@#ObjectiveTo compare the effects of patient-controlled epidural analgesia (PCEA) and patient-controlled intravenous analgesia (PCIA) on postoperative nausea and vomit (PONV) in gynecologic and obstetric patients. Methods56 gynecologic or obstetric patients (ASA Ⅰ～Ⅱ) scheduled for lower abdominal surgeries were randomly allocated to receive either 1 mg/ml morphine plus 0.1 mg/ml droperidol intravenously (group PCIA) or 0.1 mg/ml morphine plus 0.125% bupivacaine (group PCEA-Ⅰ) or 0.1 mg/ml morphine plus 0.1 mg/ml droperidol plus 0.125% bupivacaine (group PCEA-Ⅱ) epidurally. 4, 24, and 48 h after operation, pain scores with visual analogus scale (VAS), sedation scores with Ramesay and the incidences of nausea, vomiting, pruritus, respiratory depression were assessed. ResultsVAS scores in the two PCEA groups were much lower than that of PCIA (P<0.01). The incidences of nausea and vomiting in PCEA-Ⅱ group were significantly lower than those in PCIA group (P<0.05), incidences of other side-effects such as pruritus, respiratory depression etc. were similar between the three groups (P>0.05). ConclusionThe regimen morphine/droperidol/bupivacaine by PCEA shows superiorities in relieving pain and reducing postoperative nausea and vomiting in gynecologic and obstetric patients.
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@#ObjectiveTo compare the effects of patient-controlled epidural analgesia (PCEA) and patient-controlled intravenous analgesia (PCIA) on postoperative nausea and vomit (PONV) in gynecologic and obstetric patients. Methods56 gynecologic or obstetric patients (ASA Ⅰ～Ⅱ) scheduled for lower abdominal surgeries were randomly allocated to receive either 1 mg/ml morphine plus 0.1 mg/ml droperidol intravenously (group PCIA) or 0.1 mg/ml morphine plus 0.125% bupivacaine (group PCEA-Ⅰ) or 0.1 mg/ml morphine plus 0.1 mg/ml droperidol plus 0.125% bupivacaine (group PCEA-Ⅱ) epidurally. 4, 24, and 48 h after operation, pain scores with visual analogus scale (VAS), sedation scores with Ramesay and the incidences of nausea, vomiting, pruritus, respiratory depression were assessed. ResultsVAS scores in the two PCEA groups were much lower than that of PCIA (P<0.01). The incidences of nausea and vomiting in PCEA-Ⅱ group were significantly lower than those in PCIA group (P<0.05), incidences of other side-effects such as pruritus, respiratory depression etc. were similar between the three groups (P>0.05). ConclusionThe regimen morphine/droperidol/bupivacaine by PCEA shows superiorities in relieving pain and reducing postoperative nausea and vomiting in gynecologic and obstetric patients.
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@#ObjectiveTo compare the effect of patient-controlled epidural analgesia (PCEA) and patient-controlled intravenous analgesia (PCIA) on pulmonary function in post-thoracotomy patients.Methods33 ASA Ⅰ～Ⅱ patients undergoing selective esophagectomy were randomly divided into the PCEA group (n=16, treated with morphine plus bupivacaine) and PCIA group (n=17, treated with morphine plus droperidol) for 3 days postoperatively. Pulmonary function indices including respiratory rate (RR), tidal volume (Vt), vital capacity (Vc) and pulse oximetry (SpO2) were recorded before operation and on the first 2 days after operation. Pain scores with visual analogue scale (VAS) at rest, deep breathing and with cough, and adverse effects were also recorded.ResultsRR increased, Vt , Vc and SpO2 decreased markedly in both groups postoperatively compared with the base line (P<0.01), but there were no significant differences between two groups. VAS scores were much lower in PCEA group, especially, when the patient was at deep breathing or during coughing (P<0.001).ConclusionPCEA is superior to PCIA in pain relief, but contributes no more than PCIA in improving pulmonary function in post-thoracotomy patients.
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BACKGROUND: Patient-controlled epidural analgesia (PCEA), using a local anesthetic-opioid mixture, has been effectively applied after total knee replacement (TKR) surgery, which is associated with intense postoperative pain that requires postoperative analgesia for both rehabilitation and the pain itself. However, adverse opioid-related effects, such as nausea, vomiting and pruritus, are commonly encountered. It was our hypothesis that the adverse opioid-related effects could be reduced by the addition of naloxone, an opioid antagonist, to a mixture of fentanyl-ropivacaine PCEA. METHODS: In 120 patients undergoing elective TKR surgery, epidural or combined spinal-epidural (CSE) anesthesia was performed and PCEA applied. In the control group (n = 65), 0.16% ropivacaine and 3microgram/ml fentanyl (2.4microgram/ml for those older than 65 yrs) were administered. In the naloxone group (n = 55), naloxone (2microgram/ml) was coadministered with the above regimen. The incidence and severity of postoperative nausea and vomiting, and the frequency of pruritus, the visual analog score (VAS) and the PCEA volume used were assessed 6 and 24 hrs after surgery. RESULTS: The incidence of nausea and vomiting during the early postoperative period, and those of pruritus during the late postoperative period were significantly lower in the naloxone group. The VAS pain scores, the PCEA volume used and amount of rescue IV meperidine were similar in the two groups. CONCLUSIONS: A small dose of naloxone mixed with an opioid significantly reduces the incidence and severity of adverse opioid-related effects in PCEA, without reducing the analgesic effect
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Humans , Analgesia , Analgesia, Epidural , Anesthesia , Arthroplasty, Replacement, Knee , Fentanyl , Incidence , Meperidine , Naloxone , Nausea , Pain, Postoperative , Postoperative Nausea and Vomiting , Postoperative Period , Pruritus , Rehabilitation , VomitingABSTRACT
BACKGROUND: Early pain control after gastrectomy is essential to minimize complication. We have compared the analgesic efficacy and side effects of sufentanil versus morphine for postoperative epidural analgesia. And we investigated the optimal dosage of sufentanil. METHODS: Sixty of seventy-five patients underwent gastrectomy were randomly allocated into three groups to receive ropivacaine 0.15% + sufentanil 0.5microgram/hour (group S1), or ropivacaine 0.15% + sufentanil 1.0microgram/hour (group S2) or ropivacaine 0.15% + morphine 32microgram/hour (group M). Before surgery, an epidural catheter was inserted at T 7-9 level and sufentanil 20microgram in group S1 and S2 or morphine 2 mg in group M were injected via the epidural catheter. After completion of surgery, continuous epidural infusion was started using PCEA device. Basal infusion rate, lock out time, bolus dose were 4 ml/hour, 20 minutes and 4 ml, respectively. Resting VAS, coughing VAS and side effects were recorded : immediate after awakening, 6, 12, 24, 48 hours after surgery. Forced vital capacity was assessed before and at 6, 24, 48 hours after surgery. RESULTS: There were no significant differences in resting VAS, coughing VAS and FVC among three groups. The number of side effects, especially pruritus and sedation were significantly more in group M than group S1 and S2 (P <0.05). No difference was seen between group S1 and S2. CONCLUSION: Thoracic epidural application of sufentanil combined with ropivacaine provides effective analgesia after gastrectomy, which is comparable to the analgesia with ropivacaine plus morphine and it provides less side effects especially pruritus and sedation. In addition, the optimal dosage of sufentanil was 2microgram/hour.
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Humans , Analgesia , Analgesia, Epidural , Catheters , Cough , Gastrectomy , Morphine , Pruritus , Sufentanil , Vital CapacityABSTRACT
BACKGROUND: Ondansetron is a specific 5-hydroxytrypamine (HT3) receptor antagonist, sodium channel blocker and mu-opioid receptor agonist. Prophylactic intravenous administration of ondansetron has an antiemetic effect in general and epidural anesthesia. This study is designed to evaluate the antiemetic effect of intravenous ondansetron in patient-controlled epidural analgesia (PCEA) patients. METHODS: Sixty ASA physical status I-II patients undergoing elective cesarean section under epidural anesthesia using 0.75% ropivacaine and fentanyl 50microgram were received intravenous fentanyl 50microgram plus ondansetron 2 mg (group 2 mg: n = 20), 4 mg (group 4 mg: n = 20) or 8 mg (group 8 mg: n = 20) after delivery of baby. PCEA was started using 0.15% ropivacaine and 50microgram/ml butorphanol (total volume: 300 ml, 4 ml of bolus dose, and 10 min of lockout interval). The intraoperative and postoperative incidence and severity of nausea and vomiting were recorded using 4 point scale (0: none, 1: mild, 2: moderate, 3: severe) for postoperative 24 hours. RESULTS: There were no significantly lower incidence and severity of nausea and vomiting in group 8 mg (10%, 5%) than group 2 mg (25%, 10%), and group 4 mg (20%, 10%) during postoperative 24 hours. CONCLUSIONS: Prophylactic intravenous ondansetron 8 mg injection with PCEA drug has no superior antiemitic effect than 2 mg or 4 mg in cesarean section patients under PCEA without significant side effects.
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Female , Humans , Pregnancy , Administration, Intravenous , Analgesia, Epidural , Anesthesia, Epidural , Antiemetics , Butorphanol , Cesarean Section , Fentanyl , Incidence , Nausea , Ondansetron , Postoperative Nausea and Vomiting , Sodium Channels , VomitingABSTRACT
Objective To compare the analgesic efficacy and side effects of patient-controlled intravenous analgesia (PCIA) with Lornoxicam and patient-controlled epidural analgesia(PCEA) with morphine in patients undergoing Orthopaedics surgery. Methods 100 ASA Ⅰ-Ⅱ Patients scheduled for Orthopaedic surgery were divided randomly into two groups: Lornoxicam PCIA group( n =50) , Lornoxicam 48mg was diluted to 100ml with normal saline (0.9%NS). Morphine PCEA group( n =50), Morphine 9mg + bupivacaine 150mg were diluted to 100ml with normal saline (0.9%NS) .In both groups the patients were received PCA at a rate of 2ml/h with the bolus dose of 0.5ml and lockout interval of 15min. The loading dose was Lornoxicam 8mg plus Ondansetron 4mg in group PCIA and morphine 1mg and Ondansetron 4mg diluted to 10ml with normal saline (0.9%NS) in group PCEA 30 minutes before the end of operation. BP, RR, ECG, SpO_2 were monitored continuously after operation. Efficacy of analgesia was assessed by VAS scores. Side effects such as drowsiness, sweat, nausea, vomiting and skin pruritus were also observed. Results There was no significant difference in the mean VAS score between group PCIA and group PCEA at 4h, 8h, 16h ,20h, 24h, 32h and 48h. after operation. There was no significant difference in side effects between the two groups except the occurrence of sweat, nausea, vomiting and skin pruritus which was lower in group PCIA than in group PCEA ( P
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BACKGROUND: Opioids may be used in a dose-sparing capacity with local anesthetics to reduce the dose needed. This study examined the efficacy of different concentrations of ropivacaine combined with butorphanol 50 micro gram/ml to provide postoperative analgesia. METHODS: Sixty parturients were received epidural infusion with 0.075% ropivacaine (Group 1: n = 20), 0.1% ropivacaine (Group 2: n = 20) and 0.15% ropivacaine (Group 3: n = 20) in combination with butorphanol 50 micro gram/ml using patient-controlled epidural analgesia (PCEA) after cesarean section. PCEA was started with basal infusion of 4 ml of PCEA solution and 4 ml of bolus infusion at 10 min of lockout interval. Using a visual analogue scale (VAS) assessed the degree of pain and incidences of side effects were checked. RESULTS: Total infusion doses of ropivacaine were significantly higher in group 3, and butorphanol consumption were significantly lower in group 3 (P<0.05). The incidences of nausea, vomiting and sedation were significantly higher in group 1 (P<0.05). There were no significantly differences in VAS pain score and other side effects among the groups. CONCLUSIONS: This study suggests that 0.1% or 0.15% ropivacaine with butorphanol 50micro gram//ml for PCEA can provide the most effective analgesia with less side effects after cesarean section.
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Female , Pregnancy , Analgesia , Analgesia, Epidural , Analgesics, Opioid , Anesthetics, Local , Butorphanol , Cesarean Section , Incidence , Nausea , VomitingABSTRACT
Objective:To compare the analgesic and side effect of patient-controlled epidural analgesia with two different solutions of ropivacaine/fentanyl after hysterectomy.Methods:Forty ASA Ⅰ-Ⅱ patient undergoing elective hysterectomy under epidural anesthesia were randomly divided into two groups:0.15% ropivacaine- 2?g/ml fentany group (R 1, n =20) and 0.2% ropivacaine-2 ?g/ml fentanyl group (R 2, n =20).Patient- controlled epidural analgesia setting for the two solutions:the loadinding doses was 6ml,bolus dose was 5ml,lock-out interval time 20 min and maximal amount within 4 h was 40ml in both groups.The clinical effects were assessed by(1)VAS score of pain (0=no pain,10=severe pain),(2)modified Bromage score,(3)monitoring heart rate and blood pressure after preoperation and analgesia,(4)the time when the patient passed gas and(5)side effect (nausea,vomiting,motor block et al).Results:All two solutions produced equivalent analgesia.Motor block was significantly more common and more intense with the 0.2% ropivacaine-2?g fentanyl solution.Other side effects were equivalent between solutions and mild. Conclution:Our results suggest that 0.15% ropivacaine -2?g fentanyl solution for postoperative PCEA after lower abdominal surgery provides satisfactory analgesia and less motor block.