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Objective To investigate the current situation of perioperative pain treatment and management using questionnaire survey.Methods A questionnaire was designed by ourselves and sent to anesthesiologists in each hospital all over China via the WeChat platform within 1 month.The system automatically recorded the situation of questionnaires.Results A total of 8 447 anesthesiologists involved in the investigation,the number of valid questionnaires retrieved was 6 778,anesthesiologists in the survey came from 847 hospitals in China,distributing across China 31 provinces and cities,and there were 526 tertiary hospitals (62.1％) and 321 hospitals under tertiary grade (37.9％).Among the medication for perioperative analgesia (not including medication for anesthesia),the following analgesics (applied alone or in combination) were used by anesthesiologists,and the application rate was as follows:opioids 79.74％,nonsteroidal anti-inflammatory drugs 53.78％,paracetamol 25.76％,local analgesics for analgesia (for nerve blockade) 25.44％,other drugs (such as ketamine,gabapentin) 12.39％;combination of two or more drugs 63.65％.Six hundred forty-nine hospitals (76.6％) carried out therapy with analgesic pump after operation,and the constituent ratio of hospitals using patient-controlled analgesia (PCA) pump was 43.8％.Four hundred seventy-five hospitals (56.1％) established Acute Pain Service (APS),the organizing rate of APS was significantly higher in tertiary hospitals than in hospitals under tertiary grade (P＜ 0.01),and the majority of APS personnel was anesthesiologists (72.4％).Conclusion Multimodal analgesia and PCA technique are not widely adopted and the requirement for non-steroidal anti-inflammatory drugs and nerve blockade is lower in perioperative pain treatment in China;analgesic pump is widely used after operation,but the application rate of PCA technique is not high;APS establishment is relatively weak in pain management and anesthesiologists play a leading role in APS.
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OBJECTIVE:To optimize the dry granulation technology conditions for Yinqiao baidu tablet. METHODS:Using granulating difficulty degree and disintegration time as investigation indexes,ratio and amount of accessories microcrystalline cellu-lose and compressible starch in Yinqiao baidu tablet,moisture content of the sprayed powder were screened. Using yield of particle and angle of repose as indexes,L9(34)orthogonal test was used to optimize the wheel pressure,rotating speed and feeding speed in dry granulation technology,and verification test was conducted. RESULTS:The ratio of microcrystalline cellulose and compress-ible starch was 7:3,and mixing ratio of the two with spray powder+inclusion compound was 1:5. The moisture content of spray powder was controlled in 1％-2％. The optimal technology was as follow as wheel pressure of 3.5 MPa,roller speed of 4 r/min and feeding speed of 10 r/min. In verification test,average yield of particle was 69.2％ and angle of repose was 31.5 °. Transfer rate of chlorogenic acid had reached over 92％,and RSD of each index was below 2.53％(n=3). CONCLUSIONS:Each index of parti-cle prepared by optimized accessories formulation and technology shows good reproducibility and feasibility,and the technology is stable and suitable for production.
RESUMO
Objective To compare the efficacy of ultrasound-guided continuous fascia iliac compartment block (cFICB) and neurostimulator-guided continuous femoral nerve block (cFNB) for postoperative analgesia in patients undergoing total knee arthroplasty.Methods Sixty-six ASA Ⅰ or Ⅱ patients,aged 46-78 yr,weighing 45-88 kg,scheduled for unilateral total knee arthroplasty,were randomly divided into 2 groups (n =33 each):cFNB group (group Ⅰ) and cFICB group (group Ⅱ).At 30 min before surgery,the patients received FNB guided by neurostimulator in group Ⅰ and FICB guided by ultrasound in group Ⅱ.A bolus of 0.5％ ropivacaine 20 ml was injected and a catheter for continuous nerve block was inserted in both groups.At 0.5 h after surgery,the catheter was connected to a patient-controlled analgesia (PCA) pump.PCA with 0.2％ ropivaeaine was used for postoperative analgesia (48 h).The PCA pump was set up to deliver a 5 ml bolus dose with a 30-min lockout interval and background infusion at 5 ml/h.VAS score was maintained ≤ 3.The distribution of sensory block was assessed at 10 min after the first administration,and at 0.5,4 and 24 h after surgery.The effective rate of sensory block was calculated.When VAS score ＞ 4,tramadol 50 mg was given intravenously or orally every 12 h as a rescue analgesic.When VAS score ＞ 5,pethidine 50 mg was injected intramuscularly as a rescue analgesic.The number of attempts was recorded during 0-4 h,4-12 h and 12-24 h after surgery.The consumption of tramadol and pethidine was also recorded during 0-24 h and 24-48 h after surgery.The sleep quality score during the nighttime was also recorded during 0-24 h and 24-48 h after surgery.Vascular puncture and parasthesia during nerve block were recorded.The toxic reaction,severe nausea and vomiting (lasting for more than 1 day) and nerve damage were recorded after surgery.Results Compared with group Ⅰ,the effective rate of sensory block in the medial aspect of the thigh was significantly decreased at 10 min after the first administration,and the effective rate of sensory block in the lateral aspect of the thigh was significantly increased at 0.5 h after surgery in group Ⅱ (P ＜0.05).There was no significant difference in the number of attempts,consumption of tramadol and pethidine,and sleep quality score during the nighttime during different time periods between the two groups (P ＞ 0.05).No vascular puncture or parasthesia was found during nerve block in the two groups.No toxic reaction,severe nausea and vomiting or nerve damage was found after surge,y in the two groups.Conclusion Ultrasound-guided cFICB has the similar analgesic efficacy with neurostimulator-guided cFNB after operation,but it can provide a wider distribution of sensory blockade in patients undergoing total knee arthroplasty.
