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

Xie's articular needling is handed down from the older generations of the family of Mr. XIE Jiguang, which is approved to have extensive indications and capable to treat various pain syndromes and Bi syndromes. Articular needling is a technique of puncturing the area at the junction of the joints, tendons and muscles. Local points and distal points are often combined in the application. The four pain-relieving points are held as distal points in articular needling, which refers to Sanjian (LI 3), Houxi (SI 3), Taibai (SP 3) and Shugu (BL 65). If pain occurs at one side of the body, the four points are supposed to be selected on the opposite side the affected area. While if pain occurs on both sides or for chronic cases, all the 8 points on both sides should be applied. For treatment of local and chronic pain, local points must be combined. Reinforcing manipulations with superficial insertion should be applied for deficient syndrome at the healthy side in most of the situations. Moreover, points around the umbilicus should be selected for tonifying the primary qi.
Acupuncture Analgesia ; methods ; Acupuncture Points ; Humans ; Joints

Acupuncture Analgesia ; methods ; Acupuncture Points ; Humans

Esophagectomy is one of the most complicated procedures. Satisfactory anesthesia not only ensures the safety in terms of low morbidity and mortality postoperatively, but also one of the potential factors relevant to long-term survival. Most of physicians, however, ignore the significance of anesthesia. This article focuses on the recent advances of anesthesia for esophagectomy in preoperative preparation for induction, rapid-sequence induction, one-lung ventilation, fluid management during surgery and postoperative early extubation and analgesia.
Analgesia ; Anesthesia ; methods ; Esophagectomy ; methods ; Fluid Therapy ; Humans

Orthopaedic postoperative pain not only brings a lot of side effects to patients, but also directly affects early rehabilitation after surgery. Effective preoperative pain management mainly includes three-stage individual pattern analgesia, which refers to preoperative, intraoperative and postoperative analgesia. The purpose is to reduce pain in multiple planes and three-dimension, strengthen the effect of analgesics and reduce dosage and side effect of single drug. This paper summaries new progress on individual-multiple-pattern analgesics, pain assessment method and various therapies.
Analgesia ; methods ; Humans ; Orthopedics ; methods ; Preoperative Period ; Treatment Outcome

Analgesia, Epidural ; methods ; Esophagectomy ; methods ; Humans ; Male ; Middle Aged

The relief of acute pain is a key link in modern emergency medicine. Procedural sedation and analgesia is a necessary technique for emergency physicians. This article summarizes its application in emergency therapy.
Analgesia ; adverse effects ; instrumentation ; methods ; Emergency Medicine ; methods ; Humans

OBJECTIVE: To confirm that acupuncture applied to patients would improve the clinical curative effect and accelerate the patient's recovery by introducing the application of acupuncture in pre-operation, during operation, and post-operation. DATA SOURCES: Literature cited in this review was retrieved from PubMed, Web of Science, and China National Knowledge Infrastructure (CNKI) and was primarily published in English or Chinese from 2010 to 2018, with keywords of "acupuncture," "electroacupuncture," "perioperative period," "sedation," "analgesia," and "recovery." Relevant citations in the retrieved articles were also screened to include more data. STUDY SELECTION: All retrieved literature was scrutinized, most typical articles related on perioperative acupuncture application in clinical study were reviewed. RESULTS: Acupuncture could relieve anxiety and stress during the preoperative stage. It reduces the usage of narcotics and stress response, and maintains the respiratory stability and homeostasis during surgery. It also exerts a protective effect on vital organs, and during the postoperative stages, enhances the recovery while effectively alleviating the postoperative pain. This phenomenon prevents common postoperative discomforts such as nausea and vomiting. In addition, it might improve the patients' long-term prognosis. CONCLUSIONS The novel concept "perioperative acupuncture medicine" is to focus on the optimal treatment in the perioperative period of surgical patients. The review reveals the important role of acupuncture in enhancing rapid recovery of patients during the perioperative period.
Acupuncture Analgesia ; methods ; Acupuncture Therapy ; methods ; Humans ; Perioperative Period

BACKGROUNDThe palpation method is widely used in clinical practice to identify the puncture site of combined spinal-epidural (CSE) blocks, but it is usually difficult to accurately locate the puncture site in obese parturients. Accurate identification of the puncture site is crucial for successful CSE block. The objective of this study was to evaluate the impact of ultrasound imaging on the success rate of CSE puncture in obese parturients.

METHODSSixty obese parturients with a body mass index ≥ 30 kg/m(2) who were scheduled for caesarean section were randomized into two equal-sized groups for location of the puncture site: an ultrasound group and a palpation group. The success rate of puncture at the first puncture site, the number of puncture attempts, duration of CSE procedure, time taken to determine the puncture site, and the depth of the epidural space were compared between groups. The frequencies of complications such as puncture site hemorrhage, neurological damage, and inadvertent dural puncture were also studied.

RESULTSThere were no differences in age, body weight, height, body mass index, or gestational age between the two groups. The success rate of puncture at the first puncture site was significantly higher in the ultrasound group than the palpation group (100.00% vs. 70.00%, P = 0.004). The number of puncture attempts was significantly lower in the ultrasound group than the palpation group (χ(2) = 6.708, P = 0.035). The time taken for determining the puncture site was (0.30 ± 0.12) minutes in the palpation group and (2.60 ± 0.61) minutes in the ultrasound group (P < 0.001). The duration of CSE procedure was (7.67 ± 1.52) minutes in the palpation group and (9.37 ± 1.35) minutes in the ultrasound group (P < 0.001). The depth of the epidural space was similar in both groups (P = 0.586). Puncture site hemorrhage was observed in 6 (20.00%) patients in the palpation group and 2 (6.67%) patients in the ultrasound group (P = 0.255).

CONCLUSIONSUltrasound imaging improves the rate of successful puncture at the first puncture site and decreases the number of puncture attempts. It facilitates CSE puncture in obese parturients.

Adult ; Analgesia, Epidural ; methods ; Analgesia, Obstetrical ; methods ; Female ; Humans ; Obesity ; complications ; Pregnancy ; Spinal Puncture ; methods ; Ultrasonography, Interventional

OBJECTIVETo observe the analgesic effect and safety of acupuncture-anesthetic composite anesthesia (AACA) in hysteroscopic surgery.

METHODSTotally 93 patients undergoing hysteroscopic surgery were randomly assigned to the intravenous anesthesia group (A group, 30 cases), the AACA group (B group, 32 cases), and the acupuncture combined with intravenous anesthesia group (C group, 31 cases). Patients in Group A were anesthetized by sufentanil combined propofol. Those in Group B were anesthetized by sufentanil combined acupuncture. Those in Group C were anesthetized by sufentanil, propofol combined acupuncture. Yinlian and Ququan (LR8) were needled for patients in Group B and C. The peri-operative mean arterial pressure (MAP), heart rate (HR), and oxygen saturation (SpO2), the surgical time, the recovery time, the sufentanil and propofol dosages, adverse anesthesia reactions were observed. Meanwhile, the OAA/S score, Ramsay sedation score, and Visual Analogue Score (VAS) were also measured.

RESULTSCompared with Group A and C, patients in Group B were awake, with obvious increased OAA/S score (P < 0.01). Ramsay sedation score was significantly lower (P < 0.01).The MAP and HR were elevated (P < 0.05). The patient case of SpO2 less than 85% during the operation decreased (P < 0.05). The incidence of postoperative dizziness was reduced (P < 0.05). Compared with Group A, the propofol consumption decreased in Group C (P < 0.05). There was no statistical difference in the operation time, the sufentanil dosage, VAS score, the incidence of postoperative nause- a and vomiting among the three groups (P > 0.05).

CONCLUSIONSThe patients were awake in AACA. The intraoperative sedation was better than that obtained by intravenous anesthesia. But the analgesic effect was similar to that obtained by intravenous anesthesia.

Acupuncture Analgesia ; Adult ; Analgesia ; methods ; Anesthesia, Intravenous ; Female ; Humans ; Hysteroscopy ; Young Adult