Comparison of three analgesic methods for postoperative pain relief and their effects on plasma interleukin-6 concentration following radical surgery for gastric carcinoma / 南方医科大学学报

<p><b>OBJECTIVE</b>To compare the efficacy of preemptive epidural analgesia combined with postoperative epidural analgesia, postoperative epidural analgesia alone and intravenous analgesia for postoperative pain relief and their effects on plasma interleukin-6 (IL-6) concentration following radical surgery for gastric carcinoma.</p><p><b>METHODS</b>Sixty-six patients with gastric carcinoma scheduled for gastrectomy were randomly divided into 3 groups, namely group P (n=22), group E (n=22) and group V (n=22), to receive preemptive epidural analgesia combined with postoperative epidural analgesia, exclusive postoperative epidural analgesia, and exclusive postoperative intravenous analgesia, respectively. Hemodynamic data were recorded for all the patients during the operation, and visual analogue scale (VAS) was used to assess the pain intensity at 4, 8, 16, 24, 48 and 72 h after surgery. Plasma IL-6 concentration was determined before surgery and at 24, 48, 72 h after surgery.</p><p><b>RESULTS</b>No significant changes occurred in the hemodynamics during the preoperative periods. VAS and IL-6 were lower in group P than in group E and V, and group E had lower measurement than group V (P<0.05).</p><p><b>CONCLUSION</b>Preemptive epidural analgesia combined with postoperative epidural analgesia provides more satisfactory pain relief and more effectively prevents IL-6 increment than exclusive epidural analgesia or intravenous analgesia after gastrectomy for gastric carcinoma.</p>

Efficacy of ropivacaine combined with fentanyl for patient-controlled epidural analgesia after suprapubic prostatectomy / 中华麻醉学杂志

Objective To investigate the efficacy of patient-controlled epidural analgesia(PCEA)with ropivacaine plus fentanyl for postoperative analgesia after suprapubic prostatectomy(SPP).Methods Thirty-six ASAⅡorⅢpatients aged 62-78 yrs weighing 52-84 kg undergoing SPP were randomly divided into 3 groups with 12 patients in each group:groupⅠreceived PCEA with 0.12% ropivacaine and fentanyl 1?g?ml~(-1);groupⅡreceived PCEA with 2% ropivacaine and fentanyl 1?g?ml~(-1) and groupⅢreceived patient-controlled intravenous analgesia(PCIA)with morphine 0.2 mg?ml~(-1).Postoperative pain was assessed using VAS(0=no pain,10= worst pain).The degree of motor blockade(modified Bromage scale)was evaluated at 6,24,48 and 72 h after operation(T_(1-4)).Bladder spasm episodes were recorded.Side effects including nausea,vomiting and pruritus and the total number of RBC in rinse solution were also recorded.Results(1)Bromage score(0=no motor block,3 =inability to flex ankle joint)was significantly higher in groupⅠandⅡthan in groupⅢat T1(6 h after op.), but significantly lower in groupⅠandⅢthan in groupⅡat T_(2-4)(24-72 h after operation).(2)VAS score(0= no pain,10=worst pain)was not significantly different among the 3 groups without bladder spasm but significantly higher in groupⅢthan in other 2 groups during episodes of bladder spasm.(3)The number of bladder spasm episodes was not significantly different among the 3 groups within 6h after operation,but was significant larger in groupⅢthan in the other two groups during 6-72 h after operation.During 6-24 h after operation more bladder spasm attacks occurred in groupⅠthan in groupⅡ.(4)The incidence of side effects was significantly lower and the total number of RBC in rinse solution was significantly smaller in groupⅠandⅡthan in groupⅢConclusion PCEA with 0.12% or 2% ropivacaine plus fentanyl can effectively reduce the number of bladder spasm attack and postoperative bladder bleeding.Different concentrations of ropivacaine should be used for PCEA during different postoperative periods.