Neuraxial analgesia is the gold standard method for pain relief in labor. Several techniques can optimize both the initiation and maintenance of neuraxial labor analgesia. Initiation techniques such as combined spinal-epidural or dural puncture epidural may offer some advantages over standard epidural insertion. The use of ultrasound to assist with landmarking and optimizing block placement improves neuraxial success, and is particularly useful in certain patient populations. Maintaining labor analgesia with a regimen that includes background programmed intermittent boluses with a patient-controlled epidural analgesia component affords the best combination of pain relief and avoidance of undesired effects. These techniques are most effective when dilute local anesthetics with lipophilic opioids are utilized.
Analgesia* ; Analgesia, Epidural ; Analgesia, Obstetrical ; Analgesia, Patient-Controlled ; Analgesics, Opioid ; Anesthetics, Local ; Humans ; Methods ; Pain Management ; Punctures ; Ultrasonography

Patient controlled epidural anlagesia is a commonly used method for postoperative pain management. The purpose of this study is to determine the optimal concentration of sufentanil for patient controlled epidural analgesia. Twenty eight patients who underwent elective gastrectomy were enrolled in this study. Patients were randomly assigned to one of two groups of 0.5 µg/mL (group S1) and 0.7 µg/mL (group S2). At 2 hours, 1 day, 2 days and 3 days after surgery, the patient's pain degree was checked by numerical rating scale (NRS) and the presence of side effects was assessed. In both groups, the NRS decreased linearly with time. The NRS of the two groups differed but the trend of decrease did not show significant difference. The overall incidence of side effects was 45.5% (group S1) and 58.8% (group S2), respectively. Patient controlled epidural analgesia using sufentanil was effective in controlling postoperative pain, which was found to decrease with time. When comparing the two concentrations used in this study, 0.5 µg/mL had a lower incidence of side effects than the concentration of 0.7 µg/mL, and the pain relief trends of the two concentrations were similar.
Analgesia, Epidural* ; Analgesia, Patient-Controlled ; Gastrectomy* ; Humans ; Incidence ; Methods ; Pain, Postoperative ; Sufentanil*

Analgesia, Patient-Controlled ; Arthroplasty, Replacement, Knee ; methods ; Female ; Humans ; Male ; Middle Aged ; Nerve Block ; methods

BACKGROUND: This study investigated the efficacy and safety of combined subacromial and intravenous patient-controlled analgesia for control of postoperative pain after arthroscopic rotator cuff repair. METHODS: Between May 2012 and August 2014, 60 patients who underwent arthroscopic rotator cuff repair with acromioplasty and received patient-controlled analgesia were studied prospectively. Cases were divided into 2 groups: combined subacromial and intravenous infusion group (group A, 30 cases) and solitary intravenous infusion group (group B, 30 cases). The visual analogue scale was used to record the patient's level of pain every 12 hours during postoperative 72 hours and the following 48 hours after the suspension of patient-controlled analgesia. RESULTS: The mean preoperative visual analogue scale score was 7.8 in group A and 7.6 in group B, and the immediate postoperative visual analogue scale score was 7.9 and 8.1 for each group. At postoperative time (From 12 hours to 72 hours after operation), the scores of combined subacromial and intravenous infusion were significantly lower than those of solitary intravenous infusion. Significant difference in the frequency of supplemental analgesic injections was observed between group A and group B (p=0.008). However, no significant difference in complication rate was observed between the two groups (p=0.562). CONCLUSIONS: Combined subacromial and intravenous patient-controlled analgesia after arthroscopic rotator cuff repair is more effective than solitary intravenous infusion without significantly increasing complications. Therefore, combined subacromial and intravenous patient-controlled analgesia could be a effective pain control method.
Analgesia, Patient-Controlled* ; Humans ; Infusions, Intravenous ; Methods ; Pain, Postoperative ; Prospective Studies ; Rotator Cuff*

BACKGROUNDSystemic non-steroidal anti-inflammatory drugs have been evaluated for their possible preemptive analgesic effects. The efficacy of flurbiprofen axetil for preemptive analgesia in patients undergoing radical resection of esophageal carcinoma via the left thoracic approach needs further investigation. The aim of this study was to research the preemptive analgesic effects of flurbiprofen axetil in thoracic surgery, and the influence of preoperative administration on postoperative respiratory function.

METHODSThis randomized, double-blind, controlled trial enrolled 60 patients undergoing radical resection of esophageal carcinoma via the left thoracic approach. Anesthesia management was standardized. Each patient was randomly assigned to receive either 100 mg flurbiprofen axetil intravenously 15 minutes before incision (PA group) or intravenous normal saline as a control (C group). Postoperative analgesia was with sufentanil delivered by patient-controlled analgesia pump. Postoperative sufentanil consumption, visual analog scale pain scores, plasma levels of interleukin-8, and oxygenation index were measured.

RESULTSCompared with the preoperative baseline, postoperative patients in the PA group had no obvious increase in pain scores (P > 0.05), but patients in the C group had significantly increased pain scores (P < 0.05). Pain scores in the C group were significantly higher at 24 hours postoperatively than preoperatively. Intergroup comparisons showed lower visual analog scale scores at 2 - 24 hours postoperatively in the PA group than the C group (P < 0.05). Sufentanil consumption and plasma interleukin-8 levels at 2 and 12 hours postoperatively were significantly lower in the PA group than the C group (P < 0.05). The oxygenation index at 2 and 12 hours postoperatively was significantly higher in the PA group than the C group (P < 0.05).

CONCLUSIONSIntravenous flurbiprofen axetil appears to have a preemptive analgesic effect in patients undergoing radical resection of esophageal carcinoma via the left thoracic approach, and appears to contribute to recovery of respiratory function and to reduction of the postoperative inflammatory reaction.

BACKGROUND: This study investigated the efficacy and safety of combined subacromial and intravenous patient-controlled analgesia for control of postoperative pain after arthroscopic rotator cuff repair. METHODS: Between May 2012 and August 2014, 60 patients who underwent arthroscopic rotator cuff repair with acromioplasty and received patient-controlled analgesia were studied prospectively. Cases were divided into 2 groups: combined subacromial and intravenous infusion group (group A, 30 cases) and solitary intravenous infusion group (group B, 30 cases). The visual analogue scale was used to record the patient's level of pain every 12 hours during postoperative 72 hours and the following 48 hours after the suspension of patient-controlled analgesia. RESULTS: The mean preoperative visual analogue scale score was 7.8 in group A and 7.6 in group B, and the immediate postoperative visual analogue scale score was 7.9 and 8.1 for each group. At postoperative time (From 12 hours to 72 hours after operation), the scores of combined subacromial and intravenous infusion were significantly lower than those of solitary intravenous infusion. Significant difference in the frequency of supplemental analgesic injections was observed between group A and group B (p=0.008). However, no significant difference in complication rate was observed between the two groups (p=0.562). CONCLUSIONS: Combined subacromial and intravenous patient-controlled analgesia after arthroscopic rotator cuff repair is more effective than solitary intravenous infusion without significantly increasing complications. Therefore, combined subacromial and intravenous patient-controlled analgesia could be a effective pain control method.
Analgesia, Patient-Controlled ; Humans ; Infusions, Intravenous ; Methods ; Pain, Postoperative ; Prospective Studies ; Rotator Cuff

Successful pain management of perioperative shoulder arthroscopy may allow patients to go home earlier, improve the quality of life in perioperative period, and facilitate rehabilitation. A comprehensive method to perioperative pain control has three stages including preoperative, intraoperative and postoperative phase. Successful pain reduction should begin preoperatively because of an excellent communication between patient and physician, moreover, preoperative analgesia also should be administered. Intraoperative efforts should include local wound infiltration and the administration of anesthetic medication intra-articularly. Postoperative management should include oral analgesics, constant infusion devices, Patient Controlled Analgesia (PCA), sedative-hypnotic drug, continuous cryotherapy and vicarious treatment.
Acupuncture Analgesia ; Analgesia ; methods ; Analgesia, Patient-Controlled ; Arthroscopy ; Humans ; Pain, Postoperative ; therapy ; Perioperative Period ; Shoulder Joint ; surgery ; Transcutaneous Electric Nerve Stimulation

BACKGROUND: Control of postoperative pain is an important aspect of postoperative patient management. Among the methods of postoperative pain control, patient-controlled analgesia (PCA) has been the most commonly used. This study tested the convenience and safety of a PCA method in which the dose adjusted according to time. METHODS: This study included 100 patients who had previously undergone orthognathic surgery, discectomy, or total hip arthroplasty, and wished to control their postoperative pain through PCA. In the test group (n = 50), the rate of infusion was changed over time, while in the control group (n = 50), drugs were administered at a fixed rate. Patients' pain scores on the visual analogue scale, number of rescue analgesic infusions, side effects, and patients' satisfaction with analgesia were compared between the two groups. RESULTS: The patients and controls were matched for age, gender, height, weight, and body mass index. No significant difference in the mount of drug administered was found between the test and control groups at 0-24 h after the operation; however, a significant difference was observed at 24-48 h after the operation between the two groups. No difference was found in the postoperative pain score, number of side effects, and patient satisfaction between the two groups. CONCLUSIONS: Patient-controlled anesthesia administered at changing rates of infusion has similar numbers of side effects as infusion performed at a fixed rate; however, the former allows for efficient and safe management of postoperative pain even in small doses.
Analgesia ; Analgesia, Patient-Controlled ; Anesthesia ; Arthroplasty, Replacement, Hip ; Body Mass Index ; Diskectomy ; Humans ; Infusion Pumps ; Methods ; Morphine ; Orthognathic Surgery ; Pain, Postoperative* ; Passive Cutaneous Anaphylaxis ; Patient Satisfaction

This study was designed to evaluate whether the nurses' assessment of postoperative pain can be an alternative to patients' self-reporting. We examined 187 patients receiving postoperative intravenous patient-controlled analgesia. The nurses assessed the patients' pain with three pain indices (therapeutic efficacy, pain intensity, and facial pain expression) 8 hr after operation. The patients recorded their resting and movement pain using 100-mm visual analog scales immediately following the nurses' assessment. There was an acceptable correlation between overall pain measurement assessed by patients and that assessed by nurses (canonical correlation coefficient=0.72, p=0.0001). The resting pain was more reliably reflected than the movement pain in overall measurement assessed both by nurses and by patients. Among the three pain indices assessed by nurses, the pain intensity most reliably reflected the patients' self-reports. The pain intensity assessed with a simple verbal descriptor scale therefore is believed to be an effective alternative to the patients' self-reports of postoperative pain at rest. However, it mirrored the patients' self-reports during movement less reliably. Therapeutic efficacy and facial pain expression indices were not effective alternatives to patients' self-reporting.
Analgesia, Patient-Controlled ; Facial Expression ; Human ; Nursing Assessment/*methods/standards ; Pain Measurement ; Pain, Postoperative/*nursing ; Perioperative Nursing/*methods ; Reproducibility of Results

Adult ; Aged ; Amides ; administration & dosage ; Analgesia, Patient-Controlled ; methods ; Humans ; Middle Aged ; Pain, Postoperative ; prevention & control ; Young Adult