Evaluation of early effectiveness of local infiltration anesthesia with compound betamethasone in total knee arthroplasty / 中国修复重建外科杂志

OBJECTIVE@#To evaluate the early effectiveness of local infiltration anesthesia (LIA) with compound betamethasone in total knee arthroplasty (TKA).@*METHODS@#The 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.@*RESULTS@#There 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).@*CONCLUSION@#The application of compound betamethasone in LIA during TKA is a safe and optimal strategy to promote the early postoperative rehabilitation of patients.

Progress of injection sites of local infiltration analgesia in total knee arthroplasty / 中国修复重建外科杂志

OBJECTIVE@#To review the research progress of injection sites of local infiltration analgesia (LIA) in total knee arthroplasty (TKA).@*METHODS@#The relevant domestic and foreign literature in recent years was extensively reviewed. The neuroanatomy of the knee, and the research progress of the selection and the difference of effectiveness between different injection sites of LIA in clinical studies were summarized.@*RESULTS@#Large concentrations of nociceptors are present throughout the various tissues of the knee joint. Patellar tendon, subpatellar fat pad, lateral collateral ligament insertions, iliotibial band insertions, suprapatellar capsule, and posterior capsule were more sensitive to pain. Most current studies support injections into the lateral capsule, collateral ligament, retinaculum, quadriceps tendon, fat pad, and subcutaneous tissue. Whether to inject into the back of the knee and subperiosteum is controversial.@*CONCLUSION@#The relative difference of knee tissue sensitivity to pain has guiding significance for the selection of LIA injection site after TKA. Although researchers have conducted clinical trials on injection site and technique of LIA in TKA, there are certain limitations. The optimal scheme has not been determined yet, and further studies are needed.

Periarticular Infiltration (Bupivacaine, Adrenaline, Magnesium Sulphate And Dexmedetomidine) For Postoperative Analgesia In Total Knee Arthroplasty- A Cases Series Study

Background:Total knee arthroplasty is a major surgery associated with severe pain and delayed rehabilitation. Good quality analgesia with minimum side effects is required for post-operative rehabilitation andinfluences overall outcome of patients.Material And Methods:All patients were given spinal anaesthesia. Intraoperatively, all patients received periarticular infiltration with solution of bupivacaine, adrenaline, dexmedetomidine and magnesium sulphate and normal saline. Post-operatively all patients received intravenous diclofenac sodium 75 mg 12 hourly. Postoperative pain using VAS score, sedation using Ramsay sedation score and hemodynamic parameters were observed.Result:The mean VAS score for pain was <2 during the first 48 hours and provided good analgesia to the patients. During the post-operative period hemodynamic parameters remained comparable to baseline and all patients were co-operative, oriented and tranquil. None of the patient developed any side effects.Conclusion:Local infiltration with bupivacaine, adrenaline, dexmedetomidine and magnesium sulphate can be used along with intravenous diclofenac sodium in patients undergoing total knee arthroplasty and is effective, safe and reliable multimodal pain regimen.

Implementation of the IPACK (Infiltration between the Popliteal Artery and Capsule of the Knee) block into a multimodal analgesic pathway for total knee replacement / 대한마취과학회지

BACKGROUND: The Infiltration between the Popliteal Artery and Capsule of the Knee (IPACK) block is a new anesthesiologist- administered analgesic technique for controlling posterior knee pain that has not yet been well studied in total knee arthroplasty (TKA) patients. We compared pain outcomes in TKA patients before and after implementation of the IPACK with the hypothesis that patients receiving IPACK blocks will report lower pain scores on postoperative day (POD) 0 than non-IPACK patients. METHODS: With Institutional Review Board approval, we retrospectively reviewed data for consecutive TKA patients by a single surgeon 4 months before (PRE) and after (POST) IPACK implementation. All TKA patients received adductor canal catheters and peri-operative multimodal analgesia. The primary outcome was pain on POD 0. Other outcomes were daily pain scores, opioid consumption, ambulation distance, length of stay, and adverse events within 30 days. RESULTS: Post-implementation, 48/50 (96%) of TKA patients received an IPACK block, and they were compared with 32 patients in the PRE group. On POD 0, the lowest pain score (median [10th–90th percentiles]) was significantly lower for the POST group compared to the PRE group (0 [0–4.3] vs. 2.5 [0–7]; P = 0.003). The highest patient-reported pain scores on any POD were similar between groups with no differences in other outcomes. CONCLUSIONS: Within a multimodal analgesic protocol, addition of IPACK blocks decreased the lowest pain scores on POD 0. Although other outcomes were unchanged, there may be a role for new opioid-sparing analgesic techniques, and changing clinical practice change can occur rapidly.

Effect of adductor canal block combined with local infiltration anesthesia on rehabilitation of primary total knee arthroplasty / 中国修复重建外科杂志

Objective: To investigate the effect of adductor canal block combined with local infiltration anesthesia on the rehabilitation of primary total knee arthroplasty (TKA). Methods: A total of 104 patients who met the selection criteria for the first unilateral TKA between March 2017 and August 2017 were included in the study. They were randomly divided into trial group (53 cases) and control group (51 cases). In the trial group, the adductor canal block with intraoperative local infiltration anesthesia were performed. In the control group, only intraoperative local infil-tration anesthesia was performed. There was no significant difference in gender, age, body mass index, diagnosis, effected side, and the preoperative American Society of Anesthesiologists (ASA) grading between 2 groups ( P>0.05). The operation time, length of stay, and complications were compared between 2 groups, as well as visual analogue scale (VAS) score of incision at rest and during activity, the range of motion (ROM) of knee flexion and extension activity, limb swelling (thigh circumference), walking distance, and pain VAS score while walking. Results: The operation time of the trial group was significantly shorter than that of the control group ( t=-2.861, P=0.005). However, there was no significant difference in length of stay between 2 groups ( t=-0.975, P=0.332). The wound effusion occurred in 1 patient of trial group and 2 of control group; hematoma occurred in 2 patients of trial group and 3 of control group; no symptom of intermuscular venous thrombosis occurred in 1 patient in each of 2 groups; ecchymosis occurred in 14 patients of trial group and 15 of control group; there was no significant difference in the incidence of related complications between 2 groups ( P>0.05). There was no significant difference in the preoperative VAS score at rest and during activity, ROM of knee flexion and extension activity, and thigh circumference between 2 groups ( P>0.05). However, there were significant differences in the VAS score at rest and during activity after 2, 4, 8, and 12 hours, ROM of knee flexion and extension activity after 1 and 2 days, and the walking distance on the day of discharge, pain VAS scores while walking after 1 and 2 days and on the day of discharge, and thigh circumference after 1 day between 2 groups ( P<0.05). Conclusion: For the primary TKA, the adductor canal block combined with local infiltration anesthesia can early relieve the initial pain of the incision, shorten the operation time, and promote the mobility and functional recovery of the knee joint.

Comparison of Adductor Canal Block Versus Local Infiltration Analgesia on Postoperative Pain andF unctional Outcome after Total Knee Arthroplasty: A Randomized Controlled Trial

@#Introduction:Total knee arthroplasty (TKA) is associated with intense postoperative pain for which effective analgesia is essential to facilitate early postoperative recovery. Adductor canal block (ACB) and local infiltration analgesia (LIA) have become increasingly involved in postoperative pain management after TKA. We aimed to compare their efficacy and outcomes in patients undergoing TKA. Materials and Methods: Sixty patients undergoing unilateral TKA were randomized to receive either postoperative single-injection ACB (Group A) or LIA (Group L) during the operation. All patients received spinal anaesthesia. Primary outcome was total morphine consumption over postoperative 24 hours. Visual analog pain scale, time to first and total dosage of rescue analgesia, performance-based evaluations [timed-up and go (TUG) test, quadriceps strength], side-effects, length of hospital stay and patient satisfaction were measured. Results: Fifty-seven patients were available for analysis. Median total morphine consumption over 24 and 48 postoperative hours of Group A were significantly less than Group L (6/10 mg vs 13/25 mg, p, 0.008 and 0.001, respectively). Similarly, Group A had significantly lower VAS at postoperative 6, 12 and 18 hours, VAS at ambulation on postoperative (POD) 1-3, better TUG tests on POD 2 and during POD 3 than those of Group L. However, quadriceps strength and patient satisfaction were not different between both groups. Conclusion:Patients undergoing TKA with single-injection ACB required less postoperative opioids than those with LIA. Furthermore, multimodal analgesia using ACB provided better postoperative analgesia, as well as performance-based activities, than those with LIA.

Application of different postoperative analgesia methods in unilateral breast cancer radical surgery / 临床麻醉学杂志

Objective To select the appropriate postoperative analgesia,through the application of different methods in the postoperative analgesia of the patients with breast cancer.Methods Ninety female patients undergoing unilateral breast cancer radical surgery in general anesthesia,aged 35-60 years,weighing 45-80 kg,falling into ASA physical status Ⅰ or Ⅱ,were ran domly divided into simple intravenous postoperative analgesia group (group P,n =30),local infiltration plus intravenous postoperative analgesia group (group R,n =30),ultrasound guided thoracic nerve block plus intravenous postoperative analgesia (group TP,n =30),group P used dexmedetomidine 2μg/kg plus sufentanil 2μg/kg,group R used 0.375％ ropivacaine 20 ml local infiltration added dexmedetomidine 2μg/kg plus sufentanil 2 μtg/kg,group TP used 0.375％ ropivacaine 20 ml vertebral side block added dexmedetomidine 2μg/kg plus sufentanil 2 μg/kg.The VAS scores and Ramsay score was recorded 6,12,24,48 h after surgery,the deep sleep quality score at preoperative postoperative 24 h and 48 h,the number of postoperative analgesia pump pressure,the use of sufentanil and the nausea,vomiting,itching,bradycardia,respiratory depression happened in 24 h were documented.Results The VAS scores in groups R and TP 6 h after surgery were significantly lower than that of group P.The VAS scores in group TP 12 h after surgery were significantly lower than that of groups R and P (P＜0.05).The sedation scores were not statistically significant among the three groups.The deep sleep quality scores at 24 h in group TP were significantly lower than those of groups R and P (P＜ 0.05).The number of compressions and the use of the sufentanil in 24 h after surgery in group TP were significantly lower than those of groups R and P,and that in group R was significantly lower than that in group P (P＜0.05).The incidence of nausea,vomiting,itching,bradycardia,respiratory depression were not statistically significant in 24 h,and there were no postopera tive complications related to neurologic blocking of lateral vertebral nerve.Conclusion Three methods were safe and effective for postoperative analgesia in patients with radical surgery breast cancer.Ultrasound guided by thoracic nerve block combined intravenous postoperative analgesia was obviously better than local infiltration plus infiltration postoperative analgesia and infiltration postoperative analgesia in terms of postoperative analgesia,quality of sleep and the number of sufentanil.

Application of extrapedicular infiltration anesthesia in unipedicular percutaneous vertebroplasty or percutaneous kyphoplasty / 局解手术学杂志

Objective To introduce extrapedicular infiltration anesthesia as an improved method of local anesthesia which applied to unipedicular percutaneous vertebroplasty or percutaneous kyphoplasty.Methods From March 2015 to March 2016,20 patients in our hospital received percutaneous vertebroplasty or percutaneous kyphoplasty with 1％ lidocaine local infiltration anesthesia and extrapedicular infiltration anesthesia.The visual analogue score of patients during the operation and whether they needed additional sedative anesthesia were evaluated.The anaesthetic effect of nerve root block was observed.Results The visual analogue score of all the patients ranged from 1 point to 3 point,averagely (2.5 ± 0.7) point.Among the 20 patients,there were 2 cases of 1 point,7 cases of 2 point and 11 cases of 3 point.No patients required additional sedative anesthesia,and no nerve root block effects were observed.Conclusion Extrapedicular infiltration anesthesia provides good local anesthetic effects without significant complications,which deserved further use in unipedicular percutaneous vertebroplasty and percutaneous kyphoplasty.

Effects of different analgesia methods on early rehabilitation after hepatectomy under the strategy of en-hanced recovery after surgery / 临床麻醉学杂志

Objective To compare the effectiveness of postoperative analgesia and early rehabil-itation between the wound infiltration combined with intravenous analgesia and epidural analgesia after hepatectomy.Methods Forty-eight patients with liver carcinoma,37 males and 1 1 females,aged 40-65 years,ASA physical status Ⅰ or Ⅱ,were randomly divided into two groups.Patients in group T were given 0.375% ropivacaine 30 ml for incision infiltration before closing the abdomen and intrave-nous analgesia.Patients in group E were given 0.2% ropivacaine 100 ml for epidural analgesia. Pareoxib sodium 40 mg was injected intravenously 30 min toward the end of the operation.Pain scores were assessed by VAS at postoperative 2,6,12,24 and 48 h.Postoperative activity distance was re-corded on 1st,2nd,3th day after surgery;the time first getting off bed and hospital stay were recor-ded.Finally,the complications were also recorded.Results Compared with group T,VAS scores at rest and in activity 12,24 and 48 h postoperatively were significantly lower (P <0.05 ).Compared with group E,postoperative activity distance on 1st,2nd and 3th day after surgery in group T were shorter.Furthermore,the time first getting off bed and the hospital stay in group T were shorter than those in group E (P <0.05).The incidence of adverse reactions between the two groups had no sta-tistical significance.Conclusion The wound infiltration combined with intravenous analgesia is benefi-cial to early recovery and shorter hospital stay.

Preoperative evaluation of local infiltration of rectal cancer using high-resolution 3.0T MR / 实用放射学杂志

Objective To investigate the value of high-resolution 3.0T MR in the assessment of local infiltration of preoperative rectal cancer.Methods A total of 168 patients pathologically proved rectal cancer underwent both conventional pelvic and rectal high-resolution before operation, and the imaging findings were reviewed retrospectively.The accuracy of preoperative high-resolution 3.0T MR in prediction of pathological staging was assessed,and the characteristic imaging features of local infiltration in preoperative rectal cancer were discussed.Results The relationship between circumference invasion of colorectal cancer and the pathological T staging was moderately positive (rs=0.530,P=0.003).Compared the staging of colorectal cancer on MRI with pathologic T staging,the overall diagnostic accuracy was 84.52%,and there was a stronger correlation between MRI findings and pathological staging (rs=0.837,P=0.001).The best single parameters for diagnosing T3 stage rectal cancer on MRI were nodular convex of the tumor and muscular signal interruption,with 91.1% specificity and 89.7% sensitively respectively.And the best combination of parameters was the cord appearence of intestinal wall and muscular signal interruption,with 89.3% specificity and 78.0% sensitively respectively.Conclusion High-resolution 3.0T MR can be preferable to evaluating local infiltration of rectal cancer, showing a higher clinical value to asseee T staging of preoperative rectal cancer.

A Prospective Comparative Study of Post Total Knee Arthroplasty Pain Management by Epidural vs Local Infiltration.

In a randomized controlled trial, we compared whether local infiltration analgesia would result in better pain management after total knee arthroplasty (TKA) than epidural analgesia (EA). Two groups were made with 30 patients each. Group local infiltration analgesia (LIA) with a total of 30 patients (mean age of 65 years) received LIA with a periarticular injection of a mixture of ropivacaine, adrenaline, and ketorolac that was prepared under strict sterile conditions. In group EA, 30 patients (mean age of 67 years) were given EA. There was no statistically significant difference of pain at rest. The mean opioid consumption was higher in those receiving local infiltration. Most secondary outcomes were similar, but EA patients had lower pain scores when walking and during continuous passive movement. If EA is not readily available, local infiltration provides similar length of stay and similar pain scores at rest following TKA.

Comparative Effects of Periarticular Multimodal Drug Injection and Single-Shot Femoral Nerve Block on Pain Following Total Knee Arthroplasty and Factors Influencing Their Effectiveness

PURPOSE: This study compared the analgesic effects of local infiltration analgesia (LIA) and femoral nerve block (FNB) after total knee arthroplasty (TKA) and assessed factors associated with analgesia obtained by these two methods. MATERIALS AND METHODS: Study subjects included 66 patients (72 knees) who underwent TKA for osteoarthritis of the knee. Pain visual analogue scale (VAS), the amount of analgesics used, number of days to achieve 90° of flexion of the knee joint, date of initiating parallel-bar walking, range of motion of the knee joint at discharge, and adverse events were investigated. RESULTS: The VAS scores did not differ significantly between two groups, whereas the amount of analgesics used was significantly lower in the LIA group. Preoperative flexion contracture was significantly more severe in the LIA group with high VAS compared with low VAS. No serious adverse event occurred in the LIA or FNB group. CONCLUSIONS: The lower analgesic usage in the LIA group than the FNB group indicates that the analgesic effect of LIA was greater than that of singleshot FNB after TKA. There were no serious complications in either group. The postoperative analgesic effect of LIA was smaller in patients with severe than less severe preoperative flexion contracture.

The efficacy of infiltrating injection of local anesthetic and oral NSAIDs for postoperative pain of total knee arthroplasty / 安徽医科大学学报

To observe the efficacy of infiltrating injection of local anesthetic and oral NSAIDs for postoperative pain of total knee arthroplasty(TKA). 50 patients undergoing TKA were randomly assigned to two groups. The study group received intraoperative infiltrating injection of ropivacaine around knee and perioperative oral celecoxib. The control group received intravenous analgesia pump. The VAS scores in postoperative 3 days of the study group (4.2±0.6 ,4.6±0.8 ,4.6±1.1 ) were lower than the control group ( 6.5 ±0.7 ,6.4 ±1.0 ,6.1 ±0.9 ) . The differ-ence was statistically significant(P<0.05),and the dose of remedial morphine of the study group (10.6±7.7)mg was less than the control group (18.4±10.3) mg. The difference was statistically significant(P<0.05). Infiltra-ting injection of ropivacaine and oral celecoxib could effectively relieve postoperative pain of TKA which was better than intravenous analgesia pump.

Cardiac arrest induced by the local infiltration of epinephrine during desflurane anesthesia: A case report

Topical epinephrine is useful to reduce bleeding and to give a clear operative field during general anesthesia. However, epinephrine at clinical doses has adverse cardiovascular effects, such as transient hypertension and arrhythmia. We report a case of cardiac arrest following the local infiltration of epinephrine during desflurane anesthesia. The patient recovered without sequelae after intensive care. However, it is recommended that caution is exercised when the local infiltration of epinephrine is used during general anesthesia.

Nursing of elderly patients during ophthalmological operation under local infiltration anesthesia / 中国实用护理杂志

Objective To discuss the effect of nursing measure that was carried out among elderly patients during ophthalmological operation under local infiltration anesthesia, in order to improve the quality of nursing. Methods To analyze and summarize the preoperative visit and intraoperative nursing among 251 elderly patients. Results There was no nursing mistake and accident happened in all 251 patients during operations. Postoperative visit showed that there were 216 elderly patients felt very satisfied or satisfied with the nursing (86%), and 16 felt dissatisfied (6%), and 19 lost contact because of discharge (8%). Conclusions There are lots of demands from elderly patients during operation under local in-filtration anesthesia, which are different with others. Particular nursing during operation can make them live through operation safely.

Adequacy of Local Anesthesia on the Anterior Ethmoidal Nerve and the Dorsal Periosteum for the Reduction of the Fractured Nasal Bones

PURPOSE: The nose is the most prominent skeletal feature of the face and is thus prone to frequent injury. Closed reduction of nasal bone fractures can be performed under general or local anesthesia. However, the benefits and the drawbacks in either form of anesthesia chosen are seldom perceived by the surgeon. A retrospective study was performed to assess the differences in the outcome among the two groups subjected to surgery under different type of anesthesia and to introduce our method of local anesthesia and its adequacy. METHODS: Two hundred and fifteen patients during a 2-year period were included in the study. 2% Lidocaine mixed with 1:100,000 epinephrine was injected on the anterior ethmoid nerve and the periosteum. Assessment factors included intra-operative adequacy of analgesia, post-operative analgesic requirement and functional and aesthetic outcome of surgery. RESULTS: 19 patients were manipulated under general anesthesia and 196 patients were manipulated under local anesthesia on the anterior ethmoidal nerve and dorsal periosteum. No statistically signigicant variable in performance of surgery could be attributed to the mode of anesthesia employed(p>0.05). Four patients experienced complications after reduction. One developed septal deviation and three nasal obstruction. But, no secondary operations were needed. CONCLUSION: Anterior ethmoidal nerve block and dorsal periosteal injection of 2% Xylocaine, combined with topical intranasal 4% lidocaine and epinephrine provided sufficient analgesia comparable to that of general anesthesia.

Pain control after laparoscopic cholecystectomy / 第三军医大学学报

0.05). Conclusion Combination of Fentanyl transdermal system and local infiltration of ropivacaine is safe and efficient in analgesia after laparoscopic cholecystectomy.

Experimental study of protective effect of local infiltration of methylprednisolone on injured spinal nerve root / 中国临床药理学与治疗学

AimTo observe the effect of infiltration of Methylprednisolone on injured spinal nerve root and the protective function of Methylprednisolone to non-impressed spinal nerve root lesion. Methods The spinal nerve roots were injured in 20 rabbits. Three days later local Methylprednisolone infiltration of spinal nerve root profromed in rabbits in experiment group, while rabbits in the control roup received equal amount of 0.9% natriichloridi instead. The conduct velocity of spinal nerve root was measured one week after operation. The histological change of spinal nerve root and immunohistochemical stain of posterior horn of spine were observed by microscope. Results The conduct velocity was recovered obviously in experiment group. In observation of spinal nerve we found the edema and hyperaemia of matrix were impaired obviously, the lesion focus was minimized, the amount of inflammatory cells was decreased. The area of substance P positive fiber and its terminus in posterior of spinal was smaller in experiment group remarkably than in control group. ConclusionsThe local infiltration of Methylprednisolone can relieve inflammation, inhibit the transmission of pain and accelerate recovery of spinal nerve root.

Preemptive Analgesia of Local Infiltration with Bupivacaine for Laparoscopic Cholecystectomy / 대한마취과학회지

BACKGROUND: Laparoscopic cholecystectomy is of benefit to reduce postoperative pain but many patients suffer from considerable pain after the surgery. The aim of this study was to investigate whether the preoperative infiltration of bupivacaine at the trocar site reduced the intensity of the postoperative pain or not. METHODS: Sixty patients who underwent elective laparoscopic cholecystectomy were selected. In a randomozed study, patients were divided into three groups. General anesthesia was induced with pentothal and succinylcholine, and maintained with vecuronium and isoflurane. After induction, the preincisional group (n = 20) received 0.25% bupivaciane 20 ml infiltration before skin incision and the postoperative group (n = 20) was given 0.25% bupivacaine 20 ml after peritoneal closure. The control group (n = 20) did not receive bupivacaine at any time. The first time of demand for analgesics and the amount of analgesics given during postoperative 48 hours were checked and recorded. The degree of postoperative pain was assessed hourly by visual analogue scale (VAS) score until 9 hours and checked once more at 24 hours postoperatively. RESULTS: The first times of demand for analgesics were significantly delayed in the preoperative group (12.1+/-6.0 hours) as compared with the control (2.9+/-1.6 hours) and postoperative groups (6.2+/-3.9 hours). The demand for analgesics until 9-hour postoperation by the preincisional group (10.5+/-14.7) was significantly less than that of the control (42.0 20.4) and postoperative groups (31.5+/-22.8). The VAS score of the preoperative group was lower than that of the control or postoperative groups during the postoperative 24 hours. CONCLUSIONS: Local infiltration of 0.25% bupivacaine into the trocar site preincisionally could reduce the early postoperative pain after laparoscopic cholecystectomy.

Comparison of the Peripheral Analgesic Effects of Morphine, Meperidine and Fentanyl using the Formalin Test in Rats / 대한마취과학회지

BACKGROUND: Recently there have been several contradictory reports about the analgesic effects of opioids applied to peripheral tissues. To confirm the peripheral analgesic effects of opioids, this study compared the analgesic effects by observing the pain behavior in rats using the formalin test following infiltration of the commonly used opioids: morphine, meperidine and fentanyl. Furthermore, to confirm the mechanism of this analgesia, it also contrasted the differences of the analgesic effects between local infiltration and intraperitoneal injection of each opioid, and the reversal of peripheral analgesia of morphine by the administration of naloxone. METHODS: One hundred rats were divided into ten groups. The groups were a SHAM group(injection of normal saline 5 min before the formalin injection), infiltration groups(MSLO; 0.1 mL of 0.1% morphine 5 min before the formalin injection, DMLO for 1% meperidine, FTLO for 0.001% fentanyl), intraperitoneal groups(MSIP, DMIP, FTIP), reversal groups(MSLONAIP, MSLONALO) and a naloxone group(NALO). Under inhalation anesthesia, all animals were injected with an opioid according to their allocated group followed by the injection of 0.1 mL of 5% formalin in the plantar area of the hind paw. After recovery from anesthesia, all animals were observed for the number of flinches during phase 1(2~3 min, 5~6 min) and phase 2(every 1 min from 10 to 61 min) after the formalin injection. RESULTS: The flinches were significantly less in the infiltration groups(MSLO, DMLO, FTLO) than in the SHAM group(p<0.05). In addition, there were significantly different peripheral analgesia according to the type of opioid(p<0.05): morphine had a weak, prolonged but delayed onset of peripheral analgesia; meperidine had a potent, prolonged, rapid onset of analgesia but the number of flinches increased in the latter stages of the test; and fentanyl had a rapid, potent but very short duration of analgesia. Differences between peripheral and systemic analgesia were observed; the numbers of flinches in the DMLO, MSLO and FTLO groups were less than in the DMIP, MSIP and FTIP groups respectively(p<0.05). The reversals by naloxone applied locally or intraperitoneally did not increase the number of flinches in the groups of local infiltration of morphine. Furthermore, local infiltration of naloxone alone had less flinches than in the SHAM group(p<0.05). CONCLUSIONS: In this study, peripheral analgesia of opioids are readily present. Local infiltration of opioids such as morphine, meperidine and fentanyl has more potent analgesia than in systemic injection and the characteristics of these peripheral analgesia are different by the type of opioid. Moreover, these effects are not reversed by naloxone.