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Objective@#To evaluate the analgesic effect of a new combined analgesic mode in the early stage of non-operative treatment of adult traumatic rib fractures.@*Methods@#A total of 93 patients with rib fractures who did not receive surgical treatment from January 2014 to January 2018 were prospectively included, and randomly divided into the traditional analgesia group, subcutaneous analgesia group and combined analgesia group(31 cases each). There were 56 males and 37 females totally with a median age of(47.3±13.2)years. All patients have moderate to severe pain with VAS scores greater than 5. Traditional analgesia group: lornoxicam 8 mg intravenous injection twice daily. Subcutaneous analgesia group: only subcutaneous self-controlled analgesia pump was used for treatment. Combined analgesia group: on the basis of the traditional analgesia group, subcutaneous self-controlled analgesia pump was added for treatment, and the dosage of the pump drug was the same as that of subcutaneous analgesia group. The VAS scores at tranquillization and cough were compared before analgesia treatment(T1), 24 h(T2), 48 h(T3) and 72 h(T4) after analgesic treatment in each group during bed brake within 3 days after injury. The VAS scores after 78 hours of analgesic treatment during ambulation were compared. When sudden pain with VAS score greater than 7 occurred within 72 hours of bed staying treatment in each group, the average daily use times of bucinnazine hydrochloride 100mg remedial analgesia were compared. The number of adverse reactions such as nausea and pneumonia in each group was compared.@*Results@#The VAS scores of resting pain and cough pain at the observation time point(T2-T4) in the combined analgesia group were better than those in the subcutaneous analgesia group and the traditional analgesia group, showing a significant difference(P<0.05). When getting out of bed, there were significant differences in pain scores among the three groups, and the pain score of the combined analgesia group was the lowest. There was a significant difference among the three groups in the number of daily additions of bucinnazine hydrochloride during remedial analgesia(P<0.05), the combined analgesia group was the least. Between the two groups of patients using analgesic pump, the number of self-compressions in the combined analgesia group was lower than that in the subcutaneous analgesia group(P<0.05). The incidence of pneumonia in the combined analgesia group was lower than that in the other two groups and the incidence of other adverse reactions such as nausea was lower than that in the simple analgesia group.@*Conclusion@#In the early stage of non-operative treatment of traumatic rib fractures in adults, the multi-mode analgesic effect of traditional intravenous intermittent administration combined with subcutaneous continuous administration is superior to the single analgesic mode of traditional intravenous or subcutaneous administration with no obvious adverse reactions.
RESUMO
Objective To evaluate the analgesic effect of a new combined analgesic mode in the early stage of non-opera-tive treatment of adult traumatic rib fractures. Methods A total of 93 patients with rib fractures who did not receive surgical treatment from January 2014 to January 2018 were prospectively included, and randomly divided into the traditional analgesia group, subcutaneous analgesia group and combined analgesia group(31 cases each). There were 56 males and 37 females total-ly with a median age of(47.3 ±13.2)years. All patients have moderate to severe pain with VAS scores greater than 5. Tradi-tional analgesia group: lornoxicam 8 mg intravenous injection twice daily. Subcutaneous analgesia group: only subcutaneous self-controlled analgesia pump was used for treatment. Combined analgesia group: on the basis of the traditional analgesia group, subcutaneous self-controlled analgesia pump was added for treatment, and the dosage of the pump drug was the same as that of subcutaneous analgesia group. The VAS scores at tranquillization and cough were compared before analgesia treatment (T1), 24 h(T2), 48 h(T3) and 72 h(T4) after analgesic treatment in each group during bed brake within 3 days after inju-ry. The VAS scores after 78 hours of analgesic treatment during ambulation were compared. When sudden pain with VAS score greater than 7 occurred within 72 hours of bed staying treatment in each group, the average daily use times of bucinnazine hydrochloride 100mg remedial analgesia were compared. The number of adverse reactions such as nausea and pneumonia in each group was compared. Results The VAS scores of resting pain and cough pain at the observation time point(T2-T4) in the combined analgesia group were better than those in the subcutaneous analgesia group and the traditional analgesia group, showing a significant difference(P<0. 05). When getting out of bed, there were significant differences in pain scores among the three groups, and the pain score of the combined analgesia group was the lowest. There was a significant difference among the three groups in the number of daily additions of bucinnazine hydrochloride during remedial analgesia(P<0. 05),the com-bined analgesia group was the least. Between the two groups of patients using analgesic pump, the number of self-compressions in the combined analgesia group was lower than that in the subcutaneous analgesia group(P<0. 05). The incidence of pneumo-nia in the combined analgesia group was lower than that in the other two groups and the incidence of other adverse reactions such as nausea was lower than that in the simple analgesia group. Conclusion In the early stage of non-operative treatment of traumatic rib fractures in adults, the multi-mode analgesic effect of traditional intravenous intermittent administration combined with subcutaneous continuous administration is superior to the single analgesic mode of traditional intravenous or subcutaneous administration with no obvious adverse reactions.
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Introducción: la cirugía descompresiva en el síndrome doloroso de hombro es relativamente frecuente. El dolor posquirúrgico dificulta la rehabilitación temprana de estos pacientes y su reincorporación social y laboral. Objetivo: evaluar y demostrar la eficacia del uso de la combinación de bupivacaína-morfina vs. bupivacaína sola, administradas a través de catéter intrarticular para la analgesia y rehabilitación posoperatoria en cirugía de hombro. Métodos: se realizó un estudio longitudinal prospectivo y analítico a 80 pacientes entre 40 y 65 años de edad, de ambos sexos, atendidos en el Hospital Militar Central "Dr. Luis Díaz Soto" de La Habana, que comprendió los meses desde octubre de 2009 hasta mayo de 2010. Los pacientes se dividieron al azar en 2 grupos de 40 individuos cada uno. Al Grupo I se le añadió al anestésico local, 2 mg de morfina liofilizada cada 24 horas. Al Grupo II solo bupivacaína al 0,25 % (20 mL) cada 6 horas. Se evaluó analgesia posoperatoria según la Escala Visual Análoga (EVA). Se compararon los resultados mediante prueba de Chicuadradocon un grado de confiabilidad de 95 %. Resultados: la prolongación de la analgesia posoperatoria combinada en el Grupo I fue de un promedio de 13,5 horas vs. 4,55 horas en el Grupo II donde se usó solo bupivacaína durante las primeras 24 horas; y se notó igualmente una mejor evolución del dolor en las siguientes 24 a 48 horas para el Grupo I. Conclusiones: la utilización de la mezcla anestésica con el analgésico, para aliviar el dolor posoperatorio mediante catéter intrarticular en cirugía de hombro, es más eficaz, con leves efectos colaterales de fácil manejo, lo que permite una rehabilitación precoz.
Introduction: decompressive surgery is relatively common in shoulder pain syndrome. Postsurgical pain hampers the early rehabilitation of these patients and their reincorporation to work and social life. Objective: dvaluate and demonstrate the efficacy of the use of the bupivacaine-morphine combination vs. bupivacaine alone, administered through an intra-articular catheter, for postoperative analgesia and rehabilitation in shoulder surgery. Methods: an analytical prospective longitudinal study was conducted with 80 patients of both sexes aged 40-65 cared for at "Dr. Luis Diaz Soto" Central Military Hospital in Havana, which extended from October 2009 to May 2010. The patients were randomly distributed into 2 groups, each with 40 members. In Group I, 2 mg of lyophilized morphine were added to the local anesthetic every 24 hours. In Group II, only 0.25 % bupivacaine (20 mL) was added every 6 hours. Postoperative analgesia was evaluated with the Analog Visual Scale (AVS). Results were compared by means of a chi-square test with a 95 % confidence degree. Results: on average, prolongation of combined postoperative analgesia in Group I was 13.5 hours vs. 4.55 hours in Group II, where only bupivacaine was used during the first 24 hours. A better evolution of pain was also observed in Group I during the next 24 to 48 hours. Conclusions: Administration of the anesthetic mixture combined with the analgesic through an intra-articular catheter to relieve postoperative pain in shoulder surgery is more effective, with mild, easily manageable side effects, thus enabling early rehabilitation.