ABSTRACT
There are few studies on the impact of postoperative pain management (such as Acute Pain Service, APS) on the prognosis of patients, especially the research on large samples, even less data on Chinese patients. It is reported that only 25.12 % of hospitals in China have established APS or similar teams, and less than 10 % of them are responsible for the whole process of postoperative analgesia services. Tongji Hospital affiliated to Tongji Medical College of Huazhong University of Science and Technology has established a professional APS team led by anesthesiologists (TJ-APS), and has a standardized workflow and management system. Based on the TJ-APS standardized postoperative pain management, the incidence and adverse effects of postoperative pain in different types of surgical patients were analyzed. In total, 107,802 patients receiving intravenous PCA from the Tongji Hospital affiliated to Tongji Medical College of Huazhong University of Science and Technology were selected between January 2016 and December 2021, which were under TJ-APS standardized postoperative analgesia process, postoperative analgesia strategy based on the principle of "low opioid, multimodal, specialization and individualization", as well as regular ward rounds and 24-h on call on-duty system. We assessed the incidence and adverse effects of postoperative pain in different types of surgical patients. Based on the TJ-APS standardized postoperative pain management, the incidence of poor postoperative analgesia in patients with intravenous PCA is significantly lower than that reported in the current literature (20 %), and mainly occurs in biliary-pancreatic surgery, extrahepatic surgery and gastrointestinal surgery. The overall incidence of adverse effects was 5.52 %, of which nausea and vomiting was the highest, especially among gynecological tumors and gynecological patients, which were 10.75 % and 8.68 % respectively, but both were lower than the level reported in the current literature (20 %). This APS multimodal management and analgesia process can provide reference and guidance for PCA management of postoperative acute pain.
ABSTRACT
Objective To evaluate the efficacy and safety of domestic palonosetron hydrochlo-ride injection on its prevention of postoperative nausea and vomiting.Methods A multi-centered,ran-domized,double-blinded and placebo-controlled clinical trial was carried out.A total of 281 patients were enrolled,with 141 of patients in study group and 140 of patients in control group respectively. 0.075 mg of intravenous palonosetron hydrochloride injection was delivered in the study group before anesthesia induction.The drug was substituted by 1.5 ml of NS in the control group.All anesthesia inductions were conducted by the intravenous injection of propofol,fentanyl and rocuronium,and were maintained with sevoflurane and fentanyl.Complete remission rate and treatment failure cut-off time of vomiting were evaluated at 0-6 h,6-72 h,0-72 h postoperatively.Results In the study group CR% 0-6 h,6-72 h and 0-72 h were 107 (75.89%),104 (73.76%)and 92 (65.25%),the control group was 81 (57.86%),70 (50%)and 62 (42.86%),CR% of the study group was significantly higher than that of the control group (P <0.01).Insignificant statistical difference but significant clin-ical difference exists in their treatment failure cut-off time,386.5 min and 300.0 min,respectively be-tween the groups.Conclusion Domestic palonosetron hydrochloride injection is safe and effective in the prevention of postoperative nausea and vomiting.
ABSTRACT
Objective To explore the antiemetic mechanism of propofol in patients subjected to laparoscopic cholecystectomy under general anesthesia Methods Sixty ASA Ⅰ Ⅱ patients of either sex undergoing elective laporoscopic cholecystectomy were randomly assigned to three groups : control group (group C), ondansetron group (group O) and propofol group(group P) Anesthesia was induced with thiopental 5 7 mg?kg -1 and intubation was facilitated with succinylcholine 1 1.5mg?kg -1 In group C and O anesthesia was maintained with inhalation of 1 0% 1 5% isoflurane and intermittent bolus of vecuronium In group O ondansetron 4 mg was given intravenously before induction of anesthesia In group P anesthesia was maintained with continuous intravenous infusion of 1% propofol at a rate of 50 150 ?g?kg -1 ?min -1 and intermittent bolus of vecuronium At the end of operation neostigmine 1mg and atropine 0 5 mg were regularly given to antagonize the residual neuromuscular blockade Venous blood samples were taken before anesthesia (baseline), after intubation, at the end of operation and 6h after operation for determination of plasma motilin(MTL) level Postoperative nausea and vomiting (PONV) was assessed according to WHO standard in four grades from no nausea to severe vomiting with gastric content Results In group C the plasma MTL level at the end of operation was significantly higher than that before anesthesia (P
