Application of ice bag cold dressing area after total extraperitonal herniorrhaphy / 中国基层医药

Objective To evaluate the effects of total extraperitonal herniorrhaphy on pain and effusion in patients with surgical area.Methods The clinical data of 58 cases of inguinal hernia admitted to the First Hospital of Shanxi Medical University from January 2017 to January 2018 were retrospectively analyzed.Complete extraperitoneal inguinal oblique hernia repair was performed under laparoscopy under general anesthesia .The patients were divided into two groups by the single or double of admission date number.The observation group(A group,32 cases) received post－operative intraoperative pressure homemade ice bags ,the control group ( B group,26 patients) was placed in normal temperature saline bag after operation.The degree of pain in patients was evaluated by numerical scoring method. The time of exit,discharge,accumulation rate and recurrence rate of hernia were analyzed.Results The differences in pain score,pain score during floor movement ,and regional efflux rate between A group and B group were statistically significant[(2.11 ±0.97)points vs.(2.45 ±1.21) points,(2.63 ±1.89) points vs.(2.76 ±1.95) points,0 case vs.2 cases,t ＝2.745,4.189;χ2 ＝1.15,all P＜0.05].The time of discharge from hospital and discharge after surgery in A group and B group were (19.16 ±9.22) h vs.(19.76 ±10.52) h,(34.85 ±7.43) h vs.(37.56 ± 8.91) h, the difference was not statistically significant ( t ＝1.790, 0.834, all P ＞0.05 ).Conclusion After laparoscopic repair of total extraperitonal herniorrhaphy ,the area ice pack can achieve the purpose of relieving pain in the surgical area and reducing the accumulation of fluid in the surgical area .

Test-retest Reliability and Inter-rater Reliability of Numerical Rating Scale for Abnormal Sensation Points of Patients with Spinal Cord Injury / 中国康复理论与实践

Objective:To investigate the test-retest reliability and inter-rater reliability of Numerical Rating Scale (NRS) for abnormal sensation points of patients with spinal cord injury (SCI). Methods:From October, 2016 to December, 2018, 69 patients with SCI were enrolled. Their impaired sensory points were measured with NRS. The score of sensory points was tested by examiner A firstly, and examiner B did the same work next day. Then, the examiner A retested the same patients after three weeks. Results:The Pearson correlation coefficients and intraclass correlation coefficient (ICC) of the test-retest reliability and inter-rater reliability for sensory score of both sides were all above 0.88 and 0.93 respectively (P < 0.001). The Pearson correlation coefficients and ICC of the sensory score of the different injury levels were all above 0.88 and 0.93 respectively (P < 0.001). Conclusion:NRS has high test-retest reliability and inter-rater reliability for the assessment at abnormal sensation points of patients with SCI.

Application of ice bag cold dressing area after total extraperitonal herniorrhaphy / 中国基层医药

Objective@#To evaluate the effects of total extraperitonal herniorrhaphy on pain and effusion in patients with surgical area.@*Methods@#The clinical data of 58 cases of inguinal hernia admitted to the First Hospital of Shanxi Medical University from January 2017 to January 2018 were retrospectively analyzed.Complete extraperitoneal inguinal oblique hernia repair was performed under laparoscopy under general anesthesia.The patients were divided into two groups by the single or double of admission date number.The observation group(A group, 32 cases) received post-operative intraoperative pressure homemade ice bags, the control group(B group, 26 patients) was placed in normal temperature saline bag after operation.The degree of pain in patients was evaluated by numerical scoring method.The time of exit, discharge, accumulation rate and recurrence rate of hernia were analyzed.@*Results@#The differences in pain score, pain score during floor movement, and regional efflux rate between A group and B group were statistically significant[(2.11±0.97)points vs.(2.45±1.21)points, (2.63±1.89)points vs.(2.76±1.95)points, 0 case vs.2 cases, t=2.745, 4.189; χ2=1.15, all P<0.05]. The time of discharge from hospital and discharge after surgery in A group and B group were (19.16±9.22)h vs.(19.76±10.52)h, (34.85±7.43)h vs.(37.56±8.91)h, the difference was not statistically significant(t=1.790, 0.834, all P>0.05).@*Conclusion@#After laparoscopic repair of total extraperitonal herniorrhaphy, the area ice pack can achieve the purpose of relieving pain in the surgical area and reducing the accumulation of fluid in the surgical area.

Comparison of Propacetamol plus Fentanyl and Fentanyl alone with Patient Controlled Analgesia after Total Knee Arthroplasty

OBJECTIVE: Opioid analgesics, for postoperative pain management, are an indispensable group of medication; however, they also have a variety of adverse drug reactions (ADR). Multimodal methods, combining non-opioid analgesics with opioid analgesics, have been investigated to increase the effects of analgesics and reduce ADR with opioid-sparing effects. The purpose of this study was to compare the effects of patient-controlled analgesia (PCA) with fentanyl alone, and PCA with fentanyl and intravenous (i.v.) propacetamol to determine the effects of pain control, cumulative opioid usage, and opioid ADR. METHODS: The subjects were patients who underwent total knee arthroplasty at the Seoul Veterans hospital from January 1, 2015 to December 31, 2016. The study period was from postoperative day 0 (POD0) to day 3 (POD3), and the retrospective study was conducted using electronic medical records. RESULTS: Pain severity was significantly low at POD1 (p = 0.017), POD2 (p = 0.003), and POD3 (p = 0.002) in the multimodal group. The fentanyl only group frequently reported both moderate and severe pain at a statistically significant level. This was consistent with the analysis of the pro re nata (PRN) intramuscular analgesia usage at the time of numerical rating scale (NRS) 4 and above. The opioid-sparing effect confirmed that the average opioid dose equivalent to i.v. morphine dose was 9.4 mg more than that used for the multimodal group in the fentanyl only group. The ADRs and length of stay between the two groups were not statistically different. CONCLUSION: The results of this study suggest that the combination therapy of fentanyl and i.v. propacetamol is superior to fentanyl monotherapy.

Effectiveness evaluation on percutaneous vertebroplasty combined with 125 I radioactive particle implantation in treatment of vertebral metastasis / 吉林大学学报(医学版)

Objective: To evaluate the clinical effect of pereutaneous vertbroplasty (PVP) combined with implantation of iodine-125 (125 I)radioactive particle in the treatment of vertebral metastasis,and to provide basis for the treatment of vertebral metastasis.Methods:A total of 69 patients with vertebral metastasis were divided into test group (n=32)and control group (n=37);the patients in test group were treated with PVP comined with implantation 125 I radioactive particle and the patients in control group were treated with PVP only.The heights of anterior and posterior vertebral bodies of the patients before and after treatment were detected by X-ray.The numerical rating scale (NRS)scores,pain relief rate and the incidence of surgical complications of the patients were recorded before operation and 1 d,1 week,1 month,3 months,and 6 months after operation.Results:The operation was successfully performed in all the patients without local bleeding;there were no movement dysfunction and nerve compression phenomenon.There was no leakage of bone cement.All the 125 I radioactive particles located well and there was no particle obscission.The heights of vertebral bodies of the patients in two groups after operation were increased compared with before operation (P <0.05).The NRS scores of the patients in two groups s at 1 d,1 week,1 month,3 months,6 months after operation were significantly decreased compared with before operation (P <0.05);compared with control group,the NRS scores of the patients in test group at 1 d,1 week, 1 month,3 months,6 months after operation were decreased (P <0.05).The incidence of pulmonary embolism or radiation myelitis complications was about 4.3% in 69 patients.Compared with control group,the difference in the incidence of complications of the patients in test group was not significant (P < 0.05 ).Conclusion:PVP combined with 125 I radioactive particle implantation is a safe and effective method in the treatment of vertebral metastasis,which can relieve the pain of the patients obviously compared with PVP.

Effects of Individual Prehabilitation on Functional Outcome Six Weeks after Total Knee Arthroplasty / 中国康复理论与实践

Objective To observe the effects of individual prehabilitation on the functional outcome six weeks after total knee arthroplas-ty (TKA). Methods The patients undergoing TKA from March, 2013 to August, 2015 were randomly divided into prehabilitation group (n=30) and control group (n=29). The prehabilitation group received individual rehabilitation since enrolled in the study. The control group re-ceived no prehabilitation. All the patients received regular pre-surgical education, surgery and post-surgical rehabilitation. Both groups were evaluated with Numerical Rating Scale (NRS) of pain, active range of motion (AROM), Manual Muscle Test (MMT), fall index, TimedUp and Go(TUG), and Hospital for Special Surgery-Knee Scale (HSS-KS). Results The scores of NRS reduced six weeks after TKA (t>2.342, P2.827, P0.05), and it increased in the control group six weeks after TKA (t>3.555, P0.05);the AROM of knee extension increased before TKA in the control group (Z=-2.257, P=0.024), and no increasement was found in the prehabilitation group (Z=0, P=1.000), and it decreased six weeks after TKA in both groups (Z>2.247, P2.387, P0.05). The muscle strength of trunk extensor and the upside of rectus abdominis showed no statistical difference between two groups six weeks after TKA (t0.05), the muscle strength of the downside of rectus abdominis and external oblique was more in the prehabilitation group than in the control group (t=2.585, P=0.013). There was no significant difference in the fall index be-fore TKA (t0.05), and it was lower in the prehabilitation group than in the control group six weeks after TKA (t=-2.837, P=0.007). The time of TUG shortened before TKA in the prehabilitation group (t=3.554, P=0.002), and it prolonged in the control group (t=-4.507, P2.092, P<0.05). Conclusion Individual prehabilitation could reduce pain, and improve the trunk muscles, the ability of walking and the function of the knee before and six weeks after TKA.

Comparative effectiveness of Pregabalin given by fixed dose method and flexible dose method on treating central post-stroke pain / 临床神经病学杂志

Objective To compare the effectiveness of Pregabalin given by fixed dose method and flexible dose method on treating central post-stroke pain.Methods Patients with central post-stroke pain were consecutively enrolled and randomized into fixed group and flexible group.The patients in fixed group were given pregabalin 300 mg per day for 8 weeks.The patients in flexible group were given pregabalin as follows:150 mg per day for 2 weeks, 300 mg per day for 2 weeks and 450 mg per day for 4 weeks.The primary outcome was numerical rating scale ( NRS) . The secondary outcomes included adverse effects, hospital anxiety and depression scales ( HADS ) and Athens insomnia scale ( AIS) .Results A total of 132 participants were enrolled with 65 in fixed group and 67 in flexible group from Jul 2009 to Dec 2014.Two patients in fixed group gave up the treatment while 7 patients gave up in flexible group though no significant difference was observed.Finally, 63 patients in fixed group and 60 patients in flexible group were included into analysis.There was no significant difference on gender, age, medical history between two groups. Compared with baseline, the NRS、HADS-A、HADS-D and AIS score were significantly decreased ( all P<0.05 ) .However, there was no significant difference of these scores between the two groups. Conclusion Two regimens of pregabalin showed the similar efficiency and safety to treat CPSP, however, fixed dose seemed to be more acceptable.

Significance of pupillary diameter variation in assessment of postoperative pain / 临床麻醉学杂志

Objective To observe the reactivity of pupillary diameter variation responding to numerical rating scale on postoperative pain to explore the accuracy of pupillary diameter variation for pain assessment.Methods Eighty patients after selected surgery (male 43 cases,female 37 cases,aged 24-79 years,ASA gradeⅠorⅡ)were included for the trial.After endotracheal extubation and on arri-val in the post-anaesthesia care unit (PACU),the levels of pain on numerical rating scale (NRS)were rated and recorded subsequently.If NRS was within 0-3,no analgesic was administered and 50 μg fentanyl was administrated after 5 min if NRS rated in 4-10.The pupillary diameter (PD),systolic blood pressure (SBP)and heart rate (HR)were recorded every minute during 20 minute after first NRS evaluation,the corresponding maximum variation of above index were calculated simultaneously in 10 minutes with NRS 0-3,after 5 minutes with NRS 0-3 to 4-10,after 5 minutes with NRS 4-10 to 0-3,in 10 minutes with NRS 4-10 which were marked respectively with ΔPD,ΔSBP and ΔHR.With the variation of NRS as a criterion,the reactivity of ΔHR,ΔSBP and ΔPD responding to NRS varia-tion were assessed by analysing the receiver operating characteristic curve (ROC),the area under the receiver operating characteristic curve (AUC)was calculated.Results The patients' ROC value ofΔHR,ΔSBP and ΔPD responding to NRS variation were AUCΔPD 0.904 (95% CI 0.822-0.987 ), AUCΔSBP 0.65 1(95%CI 0.5 10-0.781)and AUCΔHR 0.588(95%CI 0.444-0.733)respectively.Value of AUCΔPD was larger than that of AUCΔSBP and AUCΔHR respectively (P < 0.05 ).Importantly, operating characteristic curve (ROC)analysis showed that the diagnostic cutoff value of ΔPD was 41.3% with a sensitivity of 80.0% and a specificity of 93.5% and the diagnostic cutoff value of ΔSBP was 10.3% with a sensitivity of 62.4% and a specificity of 71.5%.Conclusion This study demon-strated that the accuracy of ΔPD was higher than ΔSBP and ΔHR responding to pain/analgesia evalu-ation.ΔPD was a valuable index for assessment of postoperative pain.

A substantial investigation of discrepancy between patient complaints and assessment by medical personnel in chemotherapy-induced nausea

Purpose： In this study, we aimed to investigate the discrepancy between interview by medical personnel using 3‒point verbal rating scale (VRS) and patient complaints using numerical rating scale (NRS) in nausea diary for chemotherapy‒induced nausea. Patients and Method： In this study, we targeted patients who received chemotherapy at the gynecology department in our hospital and who recorded information in nausea diary. The discrepancy was estimated from NRS in nausea diary and the degree of nausea obtained by medical interview at approximately the same time period. We classified it into overvaluation, undervaluation or non‒discrepancy. Result： A total of 663 cases was analyzed, and 54 patientswere enrolled. The discrepancy was 25.2％ (undervaluation 5.4%; overvaluation 19.8％), and mostly overvaluation was observed. NRS in nausea diary had a significant correlation with the degree of nausea obtained by medical interview（P<0.001, r=0.66） , and the kappa statistic was 0.36. Conclusion： Ratio of non‒undervaluation is approximately 95%; hence, we conclude that interview by medical personnel using VRS accurately reflects the degree of nausea.

A drug utilization study of analgesics for management of postoperative pain in patients admitted at a tertiary care teaching hospital.

Background: Postoperative pain is very common and develops naturally as a warning. After surgery, its development can be predicted and should be prevented and treated. Besides the disagreeable aspects and physiological repercussions of postoperative pain, it delays ambulation and hospital discharge. Despite the drugs and anesthetic techniques available, the prevalence of postoperative pain is still high. Methods: Pain assessment was done by BP cuff inflation method and Numerical rating scales both pre and postoperatively. Results: Complain of postoperative pain is more in female patient. Over all complain of postoperative pain was observed more in 31-45 year age group. Complain of postoperative pain was more at 18 hour time interval. Postoperative pain complains was more in patients undergoing general surgery. Postoperatively out of 310 patients 298 patients were received diclofenac only and 18 patients were received diclofenac + tramadol combination of these 112 and 13 patients complained of post-operative pain respectively. Conclusions: 112 patients from diclofenac only received group and 13 patients from diclofenac + tramadol received group complain of post operative pain. Post-operative pain control at 12 hours is sufficient but high post-operative pain scores at 18 hour of post-operative time interval suggesting needs of additional pain control. Majority of study patients received single analgesic (Diclofenac sodium).

Investigation of chronic pain in maintenance hemodialysis patients / 中华肾脏病杂志

ObjectiveTo investigate the incidence and the cause of chronic pain in maintenance hemodialysis(MHD) patients,and the effect of chronic pain on quality of life.Methods Seventy MHD patients in dialysis centre of our hospital were enrolled in the study and divided into 2 groups according to pain symptoms.There were 32 patients with chronic pain in pain group,and 38 patients without chronic pain in painless group.Pain degree was evaluated by numerical rating scale (NRS,1 to 10) in pain group.Parathyroid hormone (PTH),β2-microglobulin (β2-MG) and bone mineral density(BMD) of all the patients were measured.Depression and insomnia degrees were examined by Beck depression index (BDI) and Pittsburgh sleep quality index (PSQI) respectively.Correlations were performed among parameters.Results The incidence of chronic pain in MHD patients was 45.7％ and the mean pain intensity of NRS was 5.71±1.86(95％ CI,5.04-6.38).There were significant differences of PTH,BMD,β2-MG,BDI score and PSQI score between two groups(all P＜0.01).The painful degree was positively correlated with levels of PTH and β2-MG,and the scores of PSQI and BDI,and was negatively correlated with BMD in pain group.Conclusion Chronic pain is common in MHD patients with different location and moderate degree,which can aggravate the depression and insomnia and may be associated with the changes of PTH,β2-MG and BMD.

Correlations between Numerical Rating Scale and Visual Analog Scale Pain Scores in the Assessment of Postoperative Pain / 대한마취과학회지

BACKGROUND: We wondered what type of pain scores is more available and reliable during the immediate postoperative period. In this study, we compared a numerical rating scale (NRS) with a visual analog scale (VAS) pain scores to assess postoperative pain. METHODS: Fifty patients were educated as to how to describe pain intensity using the NRS (11-point) and VAS (10 cm) scores during the evening before elective laparoscopic cholecystectomy. Following their operation, patients checked their pain intensity using NRS and VAS at postoperative 1 hour in the recovery room with the assistance of an anesthesiologist, and 3, 6, 12, 18 and 24 h by themselves. The absolute values of the NRS and VAS scores were analyzed for inter-individual variability and for correlations between the two. RESULTS: Forty-eight patients finished this study. The absolute value of the mean NRS score was slightly higher than that of the mean VAS score at each time point. However, the mean difference was only 0.4. Overall, the two parameters correlated well at each of the six measurement times. The correlation coefficients between the absolute values of the NRS and VAS pain scores for all measurement times were over 0.95. CONCLUSIONS: This data suggests that NRS and VAS pain scores are well correlated, and that they are equally useful at assessing immediate postoperative pain.

Postoperative Pain Evaluation after Evisceration with Continuous Intravenous Infusion of Butorphanol Using Silicone Balloon Infuser

PURPOSE: The analgesic efficacy and side-effects of continuous intravenous infusion of Butorphanol for postoperative pain relief after evisceration were evaluated. METHODS: We evaluated the postoperative pain using Numerical Rating Scale in 19patients undergoing evisceration under general anesthesia. One group (group2, 9patients) received continuous intravenous injection of Butorphanol 14 mg mixed with 5% D/W 100ml using silicone balloon infuser for 2days. The other group (group1, 10patients) was not received it. RESULTS: The second group patients reported less pain compared to the first group patients in the first and second post operative day. The total NRS value of pain was 28.1+/-4.73 (group1) vs 11.22+/-0.99 (group2). CONCLUSIONS: For 48hr post operative pain relief in patients undergoing evisceration, the analgesic efficacy of the continuous intravenous injection of Butorphanol is useful.

Can Ketamine Substitute for Fentanyl in Gynecologic Cone Biopsy Anesthesia? / 대한마취과학회지

BACKGROUND: In a gynecologic cone biopsy, fentanyl is commonly used with propofol for its analgesic effect, but it has many side effects, such as bradycardia, respiratory depression and hypotension. A subanesthetic dose of ketamine has an analgesic effect and minimal cardiovascular effects. We wanted to know whether ketamine can be safely used with propofol in a gynecologic cone biopsy instead of fentanyl. METHODS: Forty woman patients were randomly allocated to two groups. All patients were anesthesized with a propofol infusion. Fentanyl 1mug/kg IV was injected 2 minutes before LMA (laryngeal mask airway) insertion in group I, ketamine 0.25 mg/kg IV was injected also in group II. Blood pressure and heart rate were measured before fentanyl or ketamine injection, 1 minute, 3 minutes and 5 minutes after LMA insertion, and during the operation. A numerical rating scale (NRS) for pain and other side effects were checked for 24 hours after the operation. RESULTS: There were no significant differences between the two groups in blood pressure, heart rate, NRS and side effects, but a more stable systolic blood pressure in the ketamine group occured. CONCLUSIONS: For a gynecologic cone biopsy, propofol anesthesia combined with fentanyl or ketamine was not different for stable cardiovascular results, postoperative pain relief and side effects. Therefore, ketamine as an analgesic combined with propofol could replace fentanyl in gynecologic cone biopsy anesthesia.