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1.
J Chin Med Assoc ; 75(3): 114-20, 2012 Mar.
Article in English | MEDLINE | ID: mdl-22440269

ABSTRACT

BACKGROUND: Patient controlled epidural analgesia (PCEA) has been used commonly for postoperative pain management following total knee arthroplasty (TKA). The purpose of this study was to compare a single standardized PCEA protocol in patients who received unilateral TKA with patients who received simultaneous bilateral TKA. METHODS: From October 2003 to October 2008, 912 patients were enrolled. Patient-machine interaction data were retrieved from PCA machines and stratified into 12 hour intervals. The data were analyzed according to the side of surgery, gender and methods of anesthesia. Patient demographic data, pain scores and side effect scores were compared to evaluate clinical efficacy. RESULTS: There was no significant difference between the unilateral and bilateral TKA groups for pain scores, severity of side effects, and total drug use. However, there was a paradoxical increase in demand, delivery, and demand/delivery ratio of analgesics for unilateral rather than bilateral TKA. This was only noted in the first 12 hours. Both genders demanded more bolus doses than set by the standard protocol. Women with unilateral TKA received more delivery doses. All of the patients who received general anesthesia had a higher demand/delivery ratio while spinal anesthesia patients had no significant ratio difference. CONCLUSION: PCEA provided equal analgesia for patients with unilateral or bilateral TKA. However, the paradoxical increase in demand suggested that psychological factors may play a role in pain perception. A comprehensive pain management program that addresses gender and anesthesia methods in the first 12 hours will improve clinical efficacy and patient satisfaction of PCEA.


Subject(s)
Analgesia, Epidural/methods , Analgesia, Patient-Controlled/methods , Arthroplasty, Replacement, Knee , Aged , Female , Humans , Male , Pain Management , Pain Measurement , Pain Perception , Retrospective Studies , Sex Characteristics
2.
Anesth Analg ; 112(3): 710-8, 2011 Mar.
Article in English | MEDLINE | ID: mdl-21233503

ABSTRACT

BACKGROUND: In previous animal studies, preemptive treatments with N-methyl-d-aspartate (NMDA) antagonists were ineffective at preventing incision-induced allodynia. It is very likely that the model was not clinically relevant for testing treatment effects on postoperative pain. The beneficial effects of preemptive treatment can be verified only by treatments with a pharmacologically proven effect in a specific pain type or animal model. We previously showed that NMDA receptor antagonists effectively alleviate enhanced mechanical hyperalgesia after plantar incision in adult rats that had been given an intraplantar injection of carrageenan as neonates. Here, using this modified model, we tested the efficacy of preemptive treatment with the NMDA antagonist MK-801. METHODS: We injected rat pups subcutaneously with 0.25% carrageenan or saline in the plantar surface of one hindpaw on postnatal day 1. On postnatal day 50, rats were killed and the ipsilateral side of the lumbar spinal cords were harvested for biochemical analysis of the expression of NR2A and NR2B at baseline, 2 hours, 4 hours, 8 hours, and 24 hours after plantar incision (n = 5 per group for each time point). For pharmacological study, rats were allocated into one of the following groups: 1 intrathecal injection of 40 nmol MK-801 15 minutes before plantar incision, 1 intrathecal injection 30 minutes after plantar incision, or 2 injections of 20 nmol or 40 nmol given at 15 minutes and 60 minutes after plantar incision (n = 10 per group for neonatally saline-treated and 12 for carrageenan-treated rats). Paw withdrawal thresholds were measured with von Frey filaments, and weight-bearing percentages were measured hourly after plantar incision. RESULTS: Expressions of NMDA receptor subunits NR2A and NR2B were increased maximally 4 hours postoperatively and were significantly greater in carrageenan-treated rats than in saline-treated rats. Tests of pain sensitivity showed that MK-801 significantly alleviated the incision-induced mechanical hyperalgesia and increased weight-bearing percentage on the injured paw in carrageenan-treated rats. However, preincisional treatment was not superior to postincisional treatment as assessed during the 6-hour postoperative observation period. Groups with 2 successive postoperative injections exhibited prolonged analgesic effects. Only the group that received 2 postoperative injections and increased total dosage had improved analgesic indices. CONCLUSIONS: Under conditions of proven analgesic action of an NMDA antagonist, we demonstrated that preincisional treatment is not more beneficial than postincisional treatment for postoperative pain relief in the modified animal model. Increasing the duration of administration and/or total dosage had an incremental analgesic effect in comparison with a single injection.


Subject(s)
Disease Models, Animal , Dizocilpine Maleate/administration & dosage , Pain Measurement/drug effects , Pain, Postoperative/prevention & control , Receptors, N-Methyl-D-Aspartate/antagonists & inhibitors , Analgesia/methods , Animals , Animals, Newborn , Excitatory Amino Acid Antagonists/administration & dosage , Female , Male , Pain Measurement/methods , Pain, Postoperative/physiopathology , Pregnancy , Preoperative Care/methods , Rats , Rats, Sprague-Dawley , Receptors, N-Methyl-D-Aspartate/biosynthesis
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