Applying a stimulating current to acupoints through acupuncture needles–known as electroacupuncture–has the potential to produce analgesic effects in human subjects and experimental animals. When acupuncture was app...Applying a stimulating current to acupoints through acupuncture needles–known as electroacupuncture–has the potential to produce analgesic effects in human subjects and experimental animals. When acupuncture was applied in a rat model, adenosine 5-triphosphate disodium in the extracellular space was broken down into adenosine, which in turn inhibited pain transmission by means of an adenosine A1 receptor-dependent process. Direct injection of an adenosine A1 receptor agonist enhanced the analgesic effect of acupuncture. The analgesic effect of acupuncture appears to be mediated by activation of A1 receptors located on ascending nerves. In neuropathic pain, there is upregulation of P2X purinoceptor 3 （P2X3） receptor expression in dorsal root ganglion neurons. Conversely, the onset of mechanical hyperalgesia was diminished and established hyperalgesia was significantly reversed when P2X3 receptor expression was downregulated. The pathways upon which electroacupuncture appear to act are interwoven with pain pathways, and electroacupuncture stimuli converge with impulses originating from painful areas. Electroacupuncture may act via purinergic A1 and P2X3 receptors simultaneously to induce an analgesic effect on neuropathic pain.展开更多
Good perioperative analgesia following total knee arthroplasty facilitates rehabilitation and may reduce hospital stay. We present the patient analgesic requirements and rehabilitation of a prospective single surgeon ...Good perioperative analgesia following total knee arthroplasty facilitates rehabilitation and may reduce hospital stay. We present the patient analgesic requirements and rehabilitation of a prospective single surgeon series after the introduction of a multimodal drug injection during his total knee arthroplasty. Basic epidemiological data as well as analgesic, antiemetic requirements and time to straight leg raised was collected on 27 consecutive patients (group 1) whom received the multimodal drug injection, consisting of levobupivacaine, ketorolac and adrenaline at the time of their total knee arthroplasty under spinal anaesthesia. Their rehabilitation was compared to a retrospective review of patients who were case matched by age and sex (group 2n = 26), whom had received the unit standard of spinal anaesthetic and a femoral and sciatic block at the time of their operation. Patients in group 1 had significantly lower analgesic and antiemetic requirements than group 2. Group 1 also had a significantly shorter hospital stay. We have demonstrated that periarticular multimodal drug injection can improve perioperative analgesia and mobilisation following total knee arthroplasty as well as reducing opioid requirements and side effects.展开更多
<b><span>Introduction:</span></b><span> Blind fascia iliaca compartment block (FICB) and ultrasound guided femoral nerve block (FNB) are two types of peripheral nerve blocks, commonl...<b><span>Introduction:</span></b><span> Blind fascia iliaca compartment block (FICB) and ultrasound guided femoral nerve block (FNB) are two types of peripheral nerve blocks, commonly used in preoperative pain management in patients with hip fractures in Danish emergency departments. The aim of this study was to compare the efficacy </span><span>in pain management of </span><span>these two types of peripheral nerve blocks in the preoperative period in patients with hip fractures. </span><b><span>Method:</span></b><span> We performed a randomized controlled study. The primary outcome was the proportion of patients with a numeric rating scale (NRS) pain score equal to three or less at rest and after passive leg raise</span><span> </span><span>test</span><span> three hours after block administration. </span><b><span>Results:</span></b><span> A total of 88 patients were included in the study and 67 patients in the statistical analysis with 33 in the FICB group and 34 in the FNB group. The results showed a significant reduction in the proportion of patients with a</span><span>n</span><span> NRS score higher than three, three hours after administration of either FICB or FNB compared to at inclusion. There was no significant difference in pain scores between patients receiving FICB versus patients receiving FNB at rest or after passive leg raise (p = 0.25 and p = 0.86, respectively). </span><b><span>Conclusion:</span></b><span> Blind FICB and ultrasound guided FNB were effective in preoperative pain management in patients with hip fractures. The results showed that the two types of peripheral nerve blocks were equally </span><span>efficient</span><span> in providing pain management in the preoperative period.</span>展开更多
AIM:The localization of CB1 receptors in the spinal cord,spinal roots,dorsal root ganglion(DRG),and peripheral nerve of the rat was determined.METHODS:We studied the distribution of CB1 cannabinoid receptors by immuno...AIM:The localization of CB1 receptors in the spinal cord,spinal roots,dorsal root ganglion(DRG),and peripheral nerve of the rat was determined.METHODS:We studied the distribution of CB1 cannabinoid receptors by immunohistochemistry using an antibody raised against the N-terminal of the receptor.RESULTS:The spinal cord showed numerous transverse fibers labelled for CB1 receptors throughout and concentrated in the dorsal horn.Lightly-stained cells were observed throughout the spinal cord gray matter.The DRG also showed cells and fibers labelled for CB1 receptors.Labelled fibers were observed in both dorsal and ventral roots as well as in peripheral nerves.CONCLUSION:The presence of CB1 receptors in the DRG,the dorsal root,and the dorsal horn is in accordance with the analgesic effects of cannabinoids.The presence of labelled cells and fibers in the ventral horn and ventral root provides a substrate for cannabinoid-induced muscle relaxant and antispastic effects.展开更多
In older patients with comorbidities,hip fractures are both an important and debilitating condition.Since multimodal and multidisciplinary perioperative strategies can hasten functional recovery after surgery improvin...In older patients with comorbidities,hip fractures are both an important and debilitating condition.Since multimodal and multidisciplinary perioperative strategies can hasten functional recovery after surgery improving clinical outcomes,the choice of the most effective and safest pathway represents a great challenge.A key point of concern is the anesthetic approach and above all the choice of the locoregional anesthesia combined with general or neuraxial anesthesia.展开更多
文摘Applying a stimulating current to acupoints through acupuncture needles–known as electroacupuncture–has the potential to produce analgesic effects in human subjects and experimental animals. When acupuncture was applied in a rat model, adenosine 5-triphosphate disodium in the extracellular space was broken down into adenosine, which in turn inhibited pain transmission by means of an adenosine A1 receptor-dependent process. Direct injection of an adenosine A1 receptor agonist enhanced the analgesic effect of acupuncture. The analgesic effect of acupuncture appears to be mediated by activation of A1 receptors located on ascending nerves. In neuropathic pain, there is upregulation of P2X purinoceptor 3 （P2X3） receptor expression in dorsal root ganglion neurons. Conversely, the onset of mechanical hyperalgesia was diminished and established hyperalgesia was significantly reversed when P2X3 receptor expression was downregulated. The pathways upon which electroacupuncture appear to act are interwoven with pain pathways, and electroacupuncture stimuli converge with impulses originating from painful areas. Electroacupuncture may act via purinergic A1 and P2X3 receptors simultaneously to induce an analgesic effect on neuropathic pain.
文摘Good perioperative analgesia following total knee arthroplasty facilitates rehabilitation and may reduce hospital stay. We present the patient analgesic requirements and rehabilitation of a prospective single surgeon series after the introduction of a multimodal drug injection during his total knee arthroplasty. Basic epidemiological data as well as analgesic, antiemetic requirements and time to straight leg raised was collected on 27 consecutive patients (group 1) whom received the multimodal drug injection, consisting of levobupivacaine, ketorolac and adrenaline at the time of their total knee arthroplasty under spinal anaesthesia. Their rehabilitation was compared to a retrospective review of patients who were case matched by age and sex (group 2n = 26), whom had received the unit standard of spinal anaesthetic and a femoral and sciatic block at the time of their operation. Patients in group 1 had significantly lower analgesic and antiemetic requirements than group 2. Group 1 also had a significantly shorter hospital stay. We have demonstrated that periarticular multimodal drug injection can improve perioperative analgesia and mobilisation following total knee arthroplasty as well as reducing opioid requirements and side effects.
文摘<b><span>Introduction:</span></b><span> Blind fascia iliaca compartment block (FICB) and ultrasound guided femoral nerve block (FNB) are two types of peripheral nerve blocks, commonly used in preoperative pain management in patients with hip fractures in Danish emergency departments. The aim of this study was to compare the efficacy </span><span>in pain management of </span><span>these two types of peripheral nerve blocks in the preoperative period in patients with hip fractures. </span><b><span>Method:</span></b><span> We performed a randomized controlled study. The primary outcome was the proportion of patients with a numeric rating scale (NRS) pain score equal to three or less at rest and after passive leg raise</span><span> </span><span>test</span><span> three hours after block administration. </span><b><span>Results:</span></b><span> A total of 88 patients were included in the study and 67 patients in the statistical analysis with 33 in the FICB group and 34 in the FNB group. The results showed a significant reduction in the proportion of patients with a</span><span>n</span><span> NRS score higher than three, three hours after administration of either FICB or FNB compared to at inclusion. There was no significant difference in pain scores between patients receiving FICB versus patients receiving FNB at rest or after passive leg raise (p = 0.25 and p = 0.86, respectively). </span><b><span>Conclusion:</span></b><span> Blind FICB and ultrasound guided FNB were effective in preoperative pain management in patients with hip fractures. The results showed that the two types of peripheral nerve blocks were equally </span><span>efficient</span><span> in providing pain management in the preoperative period.</span>
文摘AIM:The localization of CB1 receptors in the spinal cord,spinal roots,dorsal root ganglion(DRG),and peripheral nerve of the rat was determined.METHODS:We studied the distribution of CB1 cannabinoid receptors by immunohistochemistry using an antibody raised against the N-terminal of the receptor.RESULTS:The spinal cord showed numerous transverse fibers labelled for CB1 receptors throughout and concentrated in the dorsal horn.Lightly-stained cells were observed throughout the spinal cord gray matter.The DRG also showed cells and fibers labelled for CB1 receptors.Labelled fibers were observed in both dorsal and ventral roots as well as in peripheral nerves.CONCLUSION:The presence of CB1 receptors in the DRG,the dorsal root,and the dorsal horn is in accordance with the analgesic effects of cannabinoids.The presence of labelled cells and fibers in the ventral horn and ventral root provides a substrate for cannabinoid-induced muscle relaxant and antispastic effects.
文摘In older patients with comorbidities,hip fractures are both an important and debilitating condition.Since multimodal and multidisciplinary perioperative strategies can hasten functional recovery after surgery improving clinical outcomes,the choice of the most effective and safest pathway represents a great challenge.A key point of concern is the anesthetic approach and above all the choice of the locoregional anesthesia combined with general or neuraxial anesthesia.
