Given the rising incidence of opioid misuse and opioid-related deaths worldwide, it is imperative to find nonopioid analgesic adjuncts for perioperative pain management. Perioperative opioid exposure in opioid-na<s...Given the rising incidence of opioid misuse and opioid-related deaths worldwide, it is imperative to find nonopioid analgesic adjuncts for perioperative pain management. Perioperative opioid exposure in opioid-na<span style="color:#4F4F4F;font-family:-apple-system, "font-size:14px;white-space:normal;background-color:#F7F7F7;">ï</span>ve patients for even minor surgical procedures may result in significant opioid dependence. Although the use of intravenous lidocaine in the perioperative period is not novel, recently it has been proposed as an important adjunct to multimodal analgesia. In addition to improving acute pain, lidocaine may reduce the incidence of chronic post-operative pain syndrome (CPPS), improve bowel function, and decrease post-operative nausea and vomiting (PONV) thereby speeding up the post-operative recovery process. Furthermore, lidocaine has efficacy in a variety of procedures including abdominal, gynecological, and urological surgeries. The aim of this narrative review is to evaluate the effects of intravenous lidocaine compared to traditional analgesic methods on post-operative pain control and recovery for various surgical procedures.展开更多
Pain is a sensation related to potential or actual damage in some tissue of the body. The mainstay of medical pain therapy remains drugs that have been around for decades, like non-steroidal anti-inflammatory drugs （...Pain is a sensation related to potential or actual damage in some tissue of the body. The mainstay of medical pain therapy remains drugs that have been around for decades, like non-steroidal anti-inflammatory drugs （NSAIDs）, or opiates. However, adverse effects of opiates, particularly tolerance, limit their clinical use. Several lines of investigations have shown that systemic （intraperitoneal） administration of NSAIDs induces antinociception with some effects of tolerance. In this review, we report that repeated microinjection of NSAIDs analgin, clodifen, ketorolac and xefocam into the central nucleus of amygdala, the midbrain periaqueductal grey matter and nucleus raphe magnus in the following 4 days result in progressively less antinociception compared to the saline control testing in the tail-flick reflex and hot plate latency tests. Hence, tolerance develops to these drugs and cross-tolerance to morphine in male rats. These findings strongly support the suggestion of endogenous opioid involvement in NSAIDs antinociception and tolerance in the descending pain-control system. Moreover, the periaqueductal grey-rostral ventro-medial part of medulla circuit should be viewed as a pain-modulation system. These data are important for human medicine. In particular, cross-tolerance between non-opioid and opioid analgesics should be important in the clinical setting.展开更多
Chronic musculoskeletal pain(CMP)is a common occurrence in clinical practice and there are a variety of options for the treatment of it.However,the pharmacological therapy is still considered to be a primary treatment...Chronic musculoskeletal pain(CMP)is a common occurrence in clinical practice and there are a variety of options for the treatment of it.However,the pharmacological therapy is still considered to be a primary treatment.The recent years have witnessed the emergence of opioid crisis,yet there are no relevant guidelines on how to treat CMP with non-opioid analgesics properly.The Chinese Medical Association for the Study of Pain convened a panel meeting to develop clinical practice consensus for the treatment of CMP with non-opioid analgesics.The purpose of this consensus is to present the application of nonsteroidal antiinflammatory drugs,serotonin norepinephrine reuptake inhibitors,serotonin and norepinephrine reuptake inhibitors,muscle relaxants,ion channel drugs and topical drugs in CMP.展开更多
目的探讨艾司氯胺酮无阿片全身麻醉对老年全髋关节置换术(THR)患者神经源炎性因子、脑氧代谢、麻醉及苏醒质量的影响。方法选取2022年4月—2023年4月择期行THR的老年患者86例,随机将其分为观察组和对照组2组各43例。观察组行艾司氯胺酮...目的探讨艾司氯胺酮无阿片全身麻醉对老年全髋关节置换术(THR)患者神经源炎性因子、脑氧代谢、麻醉及苏醒质量的影响。方法选取2022年4月—2023年4月择期行THR的老年患者86例,随机将其分为观察组和对照组2组各43例。观察组行艾司氯胺酮无阿片麻醉,对照组行常规麻醉。比较2组麻醉诱导前、气管插管时(T2)、切皮时(T3)、拔出气管导管时(T4)血流动力学[平均动脉压(MAP)和心率(HR)]、神经源炎性因子[神经生长因子(NGF)、前列腺素E_(2)(PGE_(2))、P物质和神经激肽A(NKA)]、脑保护作用指标[脑氧摄取率(CERO_(2))、动脉-颈内静脉球部血氧差(Da-jvO_(2))、神经元特异性烯醇化酶(NSE)和S-100β蛋白],术后第1、2、3天疼痛视觉模拟评分法(VAS)、术后恶心呕吐(PONV)评分,术前和术后第1、3、7天简明精神状态量表(MMSE)评分,苏醒质量,以及术中、术后不良反应。结果T2~T4时,2组MAP和HR均呈现升高趋势,NGF、PGE_(2)、SP、NKA、CERO_(2)、Da-jvO_(2)、NSE和S-100β蛋白均呈现降低趋势;且观察组MAP和HR均高于对照组,NGF、PGE_(2)、SP、NKA、CERO_(2)、Da-jvO_(2)、NSE和S-100β蛋白均低于对照组(P<0.05)。术后第1、2及3天,2组VAS和PONV评分均呈下降趋势,术后第1、3及7天MMSE评分均呈升高趋势;且观察组术后第1、2及3天VAS和PONV评分低于对照组,术后第1、3及7天MMSE评分高于对照组(P<0.05)。观察组拔管时间和苏醒时间均短于对照组,拔管后10 min Ramsay评分低于对照组(P<0.05)。术中和术后,观察组不良反应发生率为11.63%(5/43)低于对照组37.21%(16/43)(P<0.05)。结论艾司氯胺酮无阿片全身麻醉用于老年THR患者有利于稳定血流动力学,提高术后苏醒质量,缓解疼痛感,且能改善脑氧代谢,降低不良反应发生率,分析可能与其调节神经源炎症反应有关。展开更多
文摘Given the rising incidence of opioid misuse and opioid-related deaths worldwide, it is imperative to find nonopioid analgesic adjuncts for perioperative pain management. Perioperative opioid exposure in opioid-na<span style="color:#4F4F4F;font-family:-apple-system, "font-size:14px;white-space:normal;background-color:#F7F7F7;">ï</span>ve patients for even minor surgical procedures may result in significant opioid dependence. Although the use of intravenous lidocaine in the perioperative period is not novel, recently it has been proposed as an important adjunct to multimodal analgesia. In addition to improving acute pain, lidocaine may reduce the incidence of chronic post-operative pain syndrome (CPPS), improve bowel function, and decrease post-operative nausea and vomiting (PONV) thereby speeding up the post-operative recovery process. Furthermore, lidocaine has efficacy in a variety of procedures including abdominal, gynecological, and urological surgeries. The aim of this narrative review is to evaluate the effects of intravenous lidocaine compared to traditional analgesic methods on post-operative pain control and recovery for various surgical procedures.
基金supported by the grant from Georgian National Science Foundation,No.GNSF/ST07/6-234
文摘Pain is a sensation related to potential or actual damage in some tissue of the body. The mainstay of medical pain therapy remains drugs that have been around for decades, like non-steroidal anti-inflammatory drugs （NSAIDs）, or opiates. However, adverse effects of opiates, particularly tolerance, limit their clinical use. Several lines of investigations have shown that systemic （intraperitoneal） administration of NSAIDs induces antinociception with some effects of tolerance. In this review, we report that repeated microinjection of NSAIDs analgin, clodifen, ketorolac and xefocam into the central nucleus of amygdala, the midbrain periaqueductal grey matter and nucleus raphe magnus in the following 4 days result in progressively less antinociception compared to the saline control testing in the tail-flick reflex and hot plate latency tests. Hence, tolerance develops to these drugs and cross-tolerance to morphine in male rats. These findings strongly support the suggestion of endogenous opioid involvement in NSAIDs antinociception and tolerance in the descending pain-control system. Moreover, the periaqueductal grey-rostral ventro-medial part of medulla circuit should be viewed as a pain-modulation system. These data are important for human medicine. In particular, cross-tolerance between non-opioid and opioid analgesics should be important in the clinical setting.
文摘Chronic musculoskeletal pain(CMP)is a common occurrence in clinical practice and there are a variety of options for the treatment of it.However,the pharmacological therapy is still considered to be a primary treatment.The recent years have witnessed the emergence of opioid crisis,yet there are no relevant guidelines on how to treat CMP with non-opioid analgesics properly.The Chinese Medical Association for the Study of Pain convened a panel meeting to develop clinical practice consensus for the treatment of CMP with non-opioid analgesics.The purpose of this consensus is to present the application of nonsteroidal antiinflammatory drugs,serotonin norepinephrine reuptake inhibitors,serotonin and norepinephrine reuptake inhibitors,muscle relaxants,ion channel drugs and topical drugs in CMP.
文摘目的探讨艾司氯胺酮无阿片全身麻醉对老年全髋关节置换术(THR)患者神经源炎性因子、脑氧代谢、麻醉及苏醒质量的影响。方法选取2022年4月—2023年4月择期行THR的老年患者86例,随机将其分为观察组和对照组2组各43例。观察组行艾司氯胺酮无阿片麻醉,对照组行常规麻醉。比较2组麻醉诱导前、气管插管时(T2)、切皮时(T3)、拔出气管导管时(T4)血流动力学[平均动脉压(MAP)和心率(HR)]、神经源炎性因子[神经生长因子(NGF)、前列腺素E_(2)(PGE_(2))、P物质和神经激肽A(NKA)]、脑保护作用指标[脑氧摄取率(CERO_(2))、动脉-颈内静脉球部血氧差(Da-jvO_(2))、神经元特异性烯醇化酶(NSE)和S-100β蛋白],术后第1、2、3天疼痛视觉模拟评分法(VAS)、术后恶心呕吐(PONV)评分,术前和术后第1、3、7天简明精神状态量表(MMSE)评分,苏醒质量,以及术中、术后不良反应。结果T2~T4时,2组MAP和HR均呈现升高趋势,NGF、PGE_(2)、SP、NKA、CERO_(2)、Da-jvO_(2)、NSE和S-100β蛋白均呈现降低趋势;且观察组MAP和HR均高于对照组,NGF、PGE_(2)、SP、NKA、CERO_(2)、Da-jvO_(2)、NSE和S-100β蛋白均低于对照组(P<0.05)。术后第1、2及3天,2组VAS和PONV评分均呈下降趋势,术后第1、3及7天MMSE评分均呈升高趋势;且观察组术后第1、2及3天VAS和PONV评分低于对照组,术后第1、3及7天MMSE评分高于对照组(P<0.05)。观察组拔管时间和苏醒时间均短于对照组,拔管后10 min Ramsay评分低于对照组(P<0.05)。术中和术后,观察组不良反应发生率为11.63%(5/43)低于对照组37.21%(16/43)(P<0.05)。结论艾司氯胺酮无阿片全身麻醉用于老年THR患者有利于稳定血流动力学,提高术后苏醒质量,缓解疼痛感,且能改善脑氧代谢,降低不良反应发生率,分析可能与其调节神经源炎症反应有关。
