目的 探讨疼痛综合管理策略在儿童日间全麻下口腔治疗中的应用效果。方法 2020年1月至8月某院接受日间全身麻醉下口腔治疗儿童,年龄3~7周岁,按美国麻醉医师协会(American Society of Anesthesiologists,ASA)分级为Ⅰ~Ⅱ级,治疗牙齿数≥1...目的 探讨疼痛综合管理策略在儿童日间全麻下口腔治疗中的应用效果。方法 2020年1月至8月某院接受日间全身麻醉下口腔治疗儿童,年龄3~7周岁,按美国麻醉医师协会(American Society of Anesthesiologists,ASA)分级为Ⅰ~Ⅱ级,治疗牙齿数≥10颗。120名儿童被随机分配到2组,综合策略组(H组,n=60)采用疼痛综合管理策略,包括超前镇痛、疼痛管理指导、微信评估(在术后4、6、24 h通过扫描二维码进行疼痛评估)三项内容;对照组(C组,n=60)无超前镇痛及疼痛管理指导,仅进行微信评估疼痛。术后2 h采用表情、下肢、活动、哭闹、可安慰性(face,legs,activity,cry and consolability,FLACC)量表对2组进行疼痛评估。术后4、6、24 h采用父母疼痛测量量表(parents postoperative pain measure,PPPM)对2组进行疼痛评估。结果 与C组相比,H组术后2 h FLACC得分显著降低,差异有统计学意义(P <0.05)。H组在术后4、6、24 h三个时间点显著疼痛(PPPM≥6分)发生率均低于C组(P <0.05),且PPPM得分较C组显著降低(P <0.05)。H组91.7%的家长及时进行疼痛评估,而C组71.6%的家长及时评估疼痛,H组父母依从性更高(P <0.05)。结论 疼痛综合管理策略可降低儿童日间全麻下口腔治疗后疼痛的发生率,是安全有效的日间口腔治疗后疼痛管理方法。展开更多
髋部术后疼痛多为中重度,严重影响患者早期康复训练,进而影响患者整体康复进程。因此,髋部术后疼痛管理对患者康复质量至关重要。关节囊周围神经群阻滞(pericapsular nerve group block,PENGB)是一种新型的镇痛手段,能完全阻滞髋关节前...髋部术后疼痛多为中重度,严重影响患者早期康复训练,进而影响患者整体康复进程。因此,髋部术后疼痛管理对患者康复质量至关重要。关节囊周围神经群阻滞(pericapsular nerve group block,PENGB)是一种新型的镇痛手段,能完全阻滞髋关节前囊的神经,同时对股四头肌的肌力影响较小,符合加速康复外科的理念,倍受麻醉科医生关注。本文基于PENGB在髋部术后疼痛管理中的广泛应用,对2020年1月至2022年12月在国内外医学期刊数据库发表的随机对照试验(randomized controlled trial,RCT)和临床试验注册中心注册的在研临床试验进行检索汇总并进行前沿综述(state-of-the-art literature review,SotA),总结研究者共同关注的热点和研究方向。本综述共纳入14项已发表的RCT及30项在研临床试验,探讨了PENGB的多个研究方向,包括镇痛优势、对下肢肌力的影响、术后康复质量等。根据现有证据显示,PENGB是髋部术后疼痛管理的重要手段,在术后镇痛和康复方面具有明显优势,将成为促进髋部手术后患者康复的重要策略之一。展开更多
We investigated the efficacy of ultrasound-guided pectoral nerves (PECS) block for modified radical mastectomy surgery retrospectively. Methods: We measured that pain scores and the use of additional analgesic drugs w...We investigated the efficacy of ultrasound-guided pectoral nerves (PECS) block for modified radical mastectomy surgery retrospectively. Methods: We measured that pain scores and the use of additional analgesic drugs were recorded in the postoperative care unit within 24 hours after the operation. Postoperative complications (i.e., nausea and vomiting) were noted. Results: Patients who received the PECS block under general anesthesia (PECS group) reported lower visual analog scale pain scores at 0, 1, 2, 4, 6, 12, 24 hours after the operation than patients who did not receive PECS block under general anesthesia (control group). Moreover, the use of additional analgesic drugs during the first 24 hours after surgery was lower in the PECS group than in the control group. While in the postoperative care unit, the PECS group had less nausea and vomiting than the control group. Conclusion: The PECS block provides effective postoperative analgesia within the first 24 hours after breast cancer surgery.展开更多
Background: There are six Anesthesiology training centers in Thailand that are approved to operate the training program. An evidence of residents’ knowledge about pediatric postoperative pain management is needed for...Background: There are six Anesthesiology training centers in Thailand that are approved to operate the training program. An evidence of residents’ knowledge about pediatric postoperative pain management is needed for improving the program. Objective: To assess the third year anesthesiology residents’ knowledge about pediatric postoperative pain management. Materials and Methods: The questionnaire was adapted from previous studies. The questionnaire has 35 questions consisted of 17 multiple choice questions and 18 true or false questions to cover 2 domains: 1) use of age-appropriate pediatric pain assessment (10 questions) and 2) pediatric pain treatment (25 questions). Minimal passing level of the questionnaire rated by three young anesthesiology staffs was 76.2%. All 62 participants were the 3rd year anesthesiology residents from 6 training centers. Data were analyzed by descriptive statistics. Results: The response rate was 95.2%. Seventy-one percent of participants reported that they had learned about pediatric pain treatment. Of those, 55.9% rated their remaining knowledge at median level. The proportion of the correct score was 67.7% (mean 23.7 ± 2.9 SD) which was lower than the minimal passing level. The highest score was 29 and the lowest score was 16. For pain assessment domain;the mean proportion of correct score was 65% (range 90%-40%). For pain treatment domain;the mean proportion of correct score was 68.8% (range 88%-44%). Conclusion: Anesthesiology residents’ knowledge about pediatric postoperative pain management needs to be improved.展开更多
文摘髋部术后疼痛多为中重度,严重影响患者早期康复训练,进而影响患者整体康复进程。因此,髋部术后疼痛管理对患者康复质量至关重要。关节囊周围神经群阻滞(pericapsular nerve group block,PENGB)是一种新型的镇痛手段,能完全阻滞髋关节前囊的神经,同时对股四头肌的肌力影响较小,符合加速康复外科的理念,倍受麻醉科医生关注。本文基于PENGB在髋部术后疼痛管理中的广泛应用,对2020年1月至2022年12月在国内外医学期刊数据库发表的随机对照试验(randomized controlled trial,RCT)和临床试验注册中心注册的在研临床试验进行检索汇总并进行前沿综述(state-of-the-art literature review,SotA),总结研究者共同关注的热点和研究方向。本综述共纳入14项已发表的RCT及30项在研临床试验,探讨了PENGB的多个研究方向,包括镇痛优势、对下肢肌力的影响、术后康复质量等。根据现有证据显示,PENGB是髋部术后疼痛管理的重要手段,在术后镇痛和康复方面具有明显优势,将成为促进髋部手术后患者康复的重要策略之一。
文摘We investigated the efficacy of ultrasound-guided pectoral nerves (PECS) block for modified radical mastectomy surgery retrospectively. Methods: We measured that pain scores and the use of additional analgesic drugs were recorded in the postoperative care unit within 24 hours after the operation. Postoperative complications (i.e., nausea and vomiting) were noted. Results: Patients who received the PECS block under general anesthesia (PECS group) reported lower visual analog scale pain scores at 0, 1, 2, 4, 6, 12, 24 hours after the operation than patients who did not receive PECS block under general anesthesia (control group). Moreover, the use of additional analgesic drugs during the first 24 hours after surgery was lower in the PECS group than in the control group. While in the postoperative care unit, the PECS group had less nausea and vomiting than the control group. Conclusion: The PECS block provides effective postoperative analgesia within the first 24 hours after breast cancer surgery.
文摘Background: There are six Anesthesiology training centers in Thailand that are approved to operate the training program. An evidence of residents’ knowledge about pediatric postoperative pain management is needed for improving the program. Objective: To assess the third year anesthesiology residents’ knowledge about pediatric postoperative pain management. Materials and Methods: The questionnaire was adapted from previous studies. The questionnaire has 35 questions consisted of 17 multiple choice questions and 18 true or false questions to cover 2 domains: 1) use of age-appropriate pediatric pain assessment (10 questions) and 2) pediatric pain treatment (25 questions). Minimal passing level of the questionnaire rated by three young anesthesiology staffs was 76.2%. All 62 participants were the 3rd year anesthesiology residents from 6 training centers. Data were analyzed by descriptive statistics. Results: The response rate was 95.2%. Seventy-one percent of participants reported that they had learned about pediatric pain treatment. Of those, 55.9% rated their remaining knowledge at median level. The proportion of the correct score was 67.7% (mean 23.7 ± 2.9 SD) which was lower than the minimal passing level. The highest score was 29 and the lowest score was 16. For pain assessment domain;the mean proportion of correct score was 65% (range 90%-40%). For pain treatment domain;the mean proportion of correct score was 68.8% (range 88%-44%). Conclusion: Anesthesiology residents’ knowledge about pediatric postoperative pain management needs to be improved.
