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Objective To compare the analgesic effects of epidural Morphine versus lumbosacral plexus block in patients undergoing hip joint replacement.Methods A total of 94 ASA Ⅰ ～ Ⅱpatients undergoing hip surgery with combined spinal epidural anesthesia(CSEA) were selected and randomized into 4 groups:Group M received a single epidural injection of 2 mg Morphine for analgesia,Group MN1 received an epidural injection of 1 mg Morphine combined with lumbosacral plexus block,Group MN2 received an epidural injection of 2 mg morphine combined with lumbosacral plexus block,and Group N received lumbosacral plexus block.All patients were administered intramuscular parecoxib for 3 days after surgery and,if the visual analogue scale(VAS)≥4,additional intramuscular tramadol.Patient-controlled intravenous analgesia(PCIA) was applied if pain relief was insufficient after Tramadol treatment.Postoperative analgesic effects,the ability to ambulate and side effects were monitored.Results VAS scores gradually increased in the 4 groups after surgery and were higher between the morning of the 1st day and the evening of the next day than at 4 hours after surgery in all the 4 groups.There were no significant differences in VAS scores between rest and exercise conditions in any of the 4 groups.Ambulatory VAS scores were lower in Groups MN1 and MN2 than in Groups M and N 6 hours after surgery,while resting VAS scores had no significant differences between the 4 groups.Resting and ambulatory VAS scores were both lower in Groups MN1 and MN2 than in Groups M and N 6 hours after surgery,while they had no significant differences between either Groups MN1 and MN2 or Groups M and N 4-8 hours after surgery.Resting and ambulatory VAS scores were lower in Groups M,MN1 and MN2 than in Group M on the morning of the day after surgery,and more patients in Group N needed early tramadol and PCIA for rescue analgesia.Muscle strength was lower in Groups MN1 and MN2 than in Groups M and N 4 hours and on the morning of the day after surgery.No significant differences between the groups were found in standing ability 6 hours after surgery and in motor activity on the morning of the day after surgery.The incidence of urinary retention was higher in Groups M and MN2 than in Groups MN1 and N,and was higher in Group MN1 than in Group N.The incidence of pruritus was higher in Groups M and MN2 than in Group N.There was no significant difference in Ramsay sedation scores and postoperative nausea and vomiting (PONV) between the groups.Conclusions Epidural morphine combined with lumbosacral plexus nerve block can provide better analgesic effects than a single dose of epidural morphine or lumbosacral plexus nerve block in elderly patients undergoing hip joint replacement.Although the synergy of the combination has certain influence on early muscle strength recovery,it does not affect early postoperative rehabilitation training.With the combined use of parecoxib and lumbosacral plexus nerve block,epidural injection of 1 mg and 2 mg morphine provides similar analgesic effects,but epidural injection of 2 mg morphine results in a higher incidence of urinary retention.Thus,a small dose of epidural morphine combined with lumbosacral plexus nerve block is recommended for postoperative analgesia in elderly patients receiving hip joint replacement.
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Objective To compare the effects of different analgesic methods in patients undergoing hip surgery followed by low-molecular-weight heparin administration.Methods A total of 94 ASA Ⅰ-Ⅱ patients undergoing hip surgery with combined spinal and epidural anesthesia (CSEA) who had received a single dose of 2 mg epidural morphine were randomized into 3 groups:Group M (n=30,patients receiving a single dose of epidural morphine combined with intramuscular tramadol if VAS≥4),Group E [n=34,patients receiving a single dose of epidural morphine combined with patient-controlled epidural analgesia (PCEA)],and Group Ⅰ [n=30,patients receiving a single dose of epidural morphine combined with patient-controlled intravenous analgesia (PCIA)].Infusion quantity during operation,bleeding volume and postoperative drainage volume,visual analogue scales (VAS) 24 h and 48 h after operation,Ramsay sedation scores,and nausea and vomiting were recorded.Venous blood samples were taken at admission,the end of operation,and 24 h,48 h and 7 d after operation for hemorheological data,coagulation tests and blood platelet counts (PLT).Color Doppler ultrasonography of lower limb vessels was conducted by the same clinician before and 7 days after operation.Results VAS at 48 h after operation were higher in Group M than in Group E and Group Ⅰ,and there were more patients refusing to initiate ambulation because of pain in Group M than in Group E and Group Ⅰ (P＜0.01).Ramsay scores at 24 h and 48 h in Group Ⅰ were higher than those in Group M and Group E,and there was no significant difference in Ramsay scores between Group M and Group E (P＞0.05).The occurrence of post-operative nausea and vomiting (PONV) was higher in Group M and Group Ⅰ than in Group E (P＜0.05),and there were more patients refusing to initiate ambulation because of nausea and vomiting in Group M and Group Ⅰ than in Group E (P＜0.01).There was no significant difference in DVT occurrence,hemorheological parameters or coagulation function between the 3 groups (each P＞0.05).Conclusions A single dose of epidural morphine does not achieve satisfactory analgesia,as evidenced by a large proportion of patients refusing to initiate rehabilitation training due to pain,and the incidence of PONV is high in elderly patients undergoing hip surgery.A single dose of epidural morphine combined with PCIA offers enhanced analgesia,but it also results in increased PONV.A single dose of epidural morphine combined with PCEA provides improved analgesia and reduced PONV,but shows no added advantage with the application of low-molecular-weight heparin in deep venous thrombosis prevention.
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Objective To compare the changes in blood coagulation, fibrinolysis and endothelial damage in patients undergoing laparoscopic cholecystectomy with different durations of carbon dioxide pneumoperitoneum. Methods Sixty-four ASA Ⅰ orⅡpatients, aged 23-60 yr, weighing 45-82 kg, scheduled for elective laparoscopic cholecystectomy, were randomly divided into 3 groups according to the duration of pneumoperitoneum: duration of pneumoperitoneum ≤30 min group (group Ⅰ, n=21), 30 min ＜ duration of pneumoperitoneum ＜ 60 min (group Ⅱ, n=23) and duration of pneumoperitoneum≥ 60 min (group Ⅲ , n=20).The intra-abdominal pressure was maintained at 12-14 mm Hg. Venous blood samples were taken before surgery (baseline, T0 ),at the end of surgery(T1), and at 1, 2 and 3 d after surgery (T2-4) for determination of prothrombin time, activated partial thromboplastin time, concentrations of prothrombin fragment 1+2(F1+2), fibrinogen (Fib), tissue plasminogen activator and plasminogen activator inhibitor type-1 (PAI-1), and activities of antithrombin Ⅲ(AT-Ⅲ)and von Willebrand factor(vWF).Results Compared with groupⅠ , the vWF activity and PAI-1 concentration at T2 , concentrations of Fib, F1+2, PAI-1 and activity of vWF at T3 and concentrations of Fib and F1+2 at T4 were significantly increased, while the AT-IE activity at T3 was significantly decreased in group Ⅲ(P＜0.05) .Conclusion When the duration of pneumoperitoneum is short, no obvious changes in the blood coagulation, fibrinolysis and endothelial damage are observed postoperatively in patients undergoing laparoscopic cholecystectomy, and along with the prolongation of the duration of pneumoperitoneum, increased blood coagulation, reduced fibrinolysisand aggravated endothelial damage are observed postoperatively.
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Objective To observe the effect of duration of carbon dioxide pneumoperitoneum on coagulation, fibrinolysis and endothelial activation in elderly patients undergoing laparoscopic cholecystectomy (LC). Methods The 45 elderly patients with cholelithiasis scheduled for LC, aged over 60 yeas, were placed in different groups respectively after surgery according to the duration of pneumoperitoneum. The duration of pneumoperitoneum was ≤60 minutes in group A (n=21),and more than 60 minutes in group B (n=24). Venous blood samples were taken on admission (baseline), at the end of surgery, the 1st, 2nd and 3rd day after surgery for determination of prothrombin time (PT), activated partial thromboplastin time (APTT), prothrombin fragment F1+2 (F1+2), antithrombin 3 (AT-Ⅲ activity), fibrinogen (Fib), tissue plasminogen activator (t-PA), plasminogen activator inhibitor type-1 (PAI-1), D-dimer (D-D), von Willebrand factor (vWF activity). Results Concerning the coagulation activation, at the 3rd postoperative day, the level of F1+2 was significantly higher in group B than in group A [(1.60±0.26) μg/L vs. (1.32±0.24) μg/L, P＜0.05]; AT-III was significantly higher in group B than in group A [(84.82%±20.21%) vs. (97.49%±16.87%), P＜0.05]. At the 2nd and 3rd postoperative day, the levels of Fib were significantly higher in group B than in group A [(3.87±0.62) g/L vs. (3.42±0.72) g/L, (3.98±0.77) g/L vs. (3.42±0.63) g/L, respectively, P＜0.05]. Concerning fibrinolysis, But at the 2nd and 3rd postoperative day, the level of PAI-1 was significantly higher in group B than in group A [(33.93±10.42) μg/L vs. (26.69±9.49) μg/L, (32.90±11.25) μg/L vs. (26.31±7.06) μg/L respectively, P＜0.05]. Concerning endothelial activation, at the 2nd and 3rd postoperative day, vWF was significantly higher in group B than in group A [(174.53%±44.03%) vs. (134.37%±37.74%), (176.31%±47.6%) vs. (131.21%±36.34%), respectively, P＜0.05]. Conclusions Marked activations of coagulation-fibrinolysis and endothelial activation are observed postoperatively in elderly patients undergoing laparoscopic cholecystectomy. Along with prolonged duration of pneumoperitoneum, more pronounced alterations of increased coagulation, reduced fibrinolysis and endothelial activation are observed, which could constitute an imbalanced situation of coagulation-fibrinolysis and increases the risk of venous thrombosis.
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Objective To explore the feasibility of using unilateral continuous spinal anesthesia(UCSA)with hypobaric levobupivacaine in elderly patients undergoing hip replacement.Methods Sixty ASAⅠ~Ⅲ patients aged 63~91 were randomized to one of two groups:group U unilateral continuous spinal anesthesia(UCSA)(n=30)and group S single spinal epidural anesthesia(SSEA)(n=30).Patients in group U were performed at L2,3 or L3,4 interspace with the patients in the lateral position with the diseased leg upper most.The patients received a continuous spinal catheter,Hypobaric 0.375% levobupinacaine solution 0.5～1.0ml was injected.If analgesia did not reach T10 after 5～10min the same dose was repeated.Patients in group S were performed at L2,3 or L3,4 interspace with the patients in the lateral position with the diseased leg down most.Hyperbaric 0.375% bupivacaine solution 3 ml was injected into subarach noid through spinal needle,which was threaded through epidural needle.Then epidural catheter was placed.The position was adjusted to the analgesia level to reach T10.Parameters of circulation and respiration function were recorded.The level of block and degree of motor blockade were measured and recorded.The intraoperative and postoperative complication associated with spinal or epidural anesthesia were recorded.Results MAP was slightly decreased after initial dose of local anesthetics as compared to the baseline MAP in both groups.The incidences of hypotension was significantly lower in group U than in group S.There was no significant decreasement in SpO2 and no significant change in HR during operation in both groups.There was lower sensory block in group U than in group S.There was no significant difference in degree of motor blockade,dose of innovar,incidences of tremble,nausea and vomiting,headache and neural complication after operation between the two groups.Conclusion Both UCSA and SSEA can produce satisfactory sensory block for hip replacement.But UCSA can produce stabler hemodynamics and is anesthesia method of choice in elderly patients undergoing hip replacement.
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Objective To observe the preventive effect of granisetron on postoperative nausea and vomiting(PONV) after laparoscopic cholecystectomy(LC).Methods A total of 120 ASAⅠ~Ⅱ patients undergoing LC were randomly divided into(3 groups) with 40 patients in each group.After operation,the Group A was given an intravenous injection of 3 mg granisetron,the Group B received 6 mg granisetron,and the Group C received 6 ml normal saline.The incidence of nausea,vomiting,headache,and dizziness of the 3 groups at 0~4 h,4~8 h,8~24 h,and 24~48 h after operation was observed.Results The incidence of PONV in the Group A and B was significantly lower than that in the Group C(P