OBJECTIVETo observe analgesic and sedative effect of acupuncture combined with medicine (ACM) on patients undergiong cardiac surgery.

METHODSA total of 50 patients with cardiac surgery from January 2012 to October 2014 were randomly assigned to the conventional analgesia group (group A) and the ACM analgesia group (group B), 25 in each group. Patients in group A were subjected to analgesia and sedation by injecting dexmedetomidine, while patients in group B were subjected to analgesia and sedation by electro-acupuncture [EA, Shenting (GV24); Yintang (EX-HN3)] combined with injection of dexmedetomidine. Morphine hydrochloride injection was performed when analgesia and sedation effect was ineffective in the two groups. The indicators of patients at different time points in the two groups were observed, such as static and dynamic VAS scores, SAS scores, mean arterial pressure (MAP), heart rate (HR), oxygen saturation (SpO2). The injection dosage of dexmedetomidine and morphine hydrochloride, analgesia satisfaction rate, sedation satisfaction rate, the incidences of adverse reactions during treatment such as bradycardia and low blood pressure, mechanical ventilation time, ICU time, and hospitalization expense were observed and recorded in the two groups.

RESULTSThere was no statistical difference in static and dynamic VAS scores, SAS score, MAP, HR and SpO2 between the two groups at different time points (P > 0.05). The injection dosage of dexmedetomidine and morphine hydrochloride was significantly reduced in group B than in group A (P < 0.05). The analgesia satisfaction rate of patients in group B was much higher than that in group A (P < 0.05). The incidence of bradycardia also obviously decreased more in group B than in group A (P < 0.05). There was no statistical difference in patients' sedation satisfaction rate, incidences of low blood pressure, delirium, vomiting; mechanical ventilation time, ICU time, or hospitalization expense between the two groups (P > 0.05).

CONCLUSIONThe analgesia method of ACM could reduce the dosage of traditional analgesic drugs and the occurrence of partial adverse reactions.

Acupuncture Analgesia ; Analgesia ; methods ; Analgesics ; therapeutic use ; Cardiac Surgical Procedures ; Dexmedetomidine ; therapeutic use ; Electroacupuncture ; Heart Rate ; Humans ; Hypnotics and Sedatives ; therapeutic use ; Morphine ; therapeutic use ; Pain ; prevention & control ; Pain Management ; methods ; Respiration, Artificial

OBJECTIVETo study the acting mechanism of anti-morphine conditioned place preference (CPP) between aqueous extract of Corydalis yanhusuo and L-THP and compare their effects.

METHODThe CPP model was established by injecting morphine in rats with a increasing dose for 10 days, with the initial dose of 10 g x kg(-1) and the final dose of 100 g x kg(-1), 10 mg x kg(-1) was increased each day, thus 100 mg x kg(-1) was injected by d 10. Having been treated with differential doses (2, 1 and 0.5 g x kg(-1)) of C. yanhusuo (containing L-THP: 0.153, 0.077 and 0.038 mg x kg(-1) respectively) and L-THP (3.76, 1.88 and 0.94 mg x kg(-1)) for six days, the CPP effect in rats was detected. Both colorimetry and immunohistochemistry methods were adopted to detect the content of glutamate neurotransmitter in each brain region and the expression of NR2B in VTA-NAc-PFC neuroanatomical circuit.

RESULTCompared with the physiological saline treatment group, C. yanhusuo (2, 1 g x kg(-1)) and L-THP (3.76 and 1.88 mg x kg(-1)) groups showed a notably shorter retention period of rats in white boxes (morphine-accompanied boxes) (P < 0.05 or P < 0.01) and remarkably lower glutamic acid content in VTA, NAc and PFC and NR2B expression.

CONCLUSIONBoth C. yanhusuo and L-THP can substantially inhibit the effect of morphine CPP, reduce the increasing glutamic acid content in VTA-NAc-PFC neuroanatomical circuit and down-regulated NR2B expression, which may be one of mechanisms on reducing the effect of morphine CPP. C. yanhusuo preparations containing L-THP (1 x ) showed 24-fold effect of L-THP monomer of single application in terms of the behaviouristics of inhibitory effect on CPP as well as the similarity in terms of transmitter glutamic acid of in VTA-NAc-PFC neuroanatomical circuit and pharmacological mechanism of NR2B.

Animals ; Berberine Alkaloids ; therapeutic use ; Conditioning, Operant ; drug effects ; Corydalis ; chemistry ; Disease Models, Animal ; Dose-Response Relationship, Drug ; Drugs, Chinese Herbal ; therapeutic use ; Humans ; Male ; Morphine ; antagonists & inhibitors ; Morphine Dependence ; drug therapy ; psychology ; Rats ; Rats, Sprague-Dawley

BACKGROUNDPost-operation pain is a very subjective phenomenon. The aim of this study was to find out the effects of acupuncture or electro-acupuncture on post-cesarean pain.

METHODSSixty women, who had had spinal anesthesia during cesarean section at the Department of Obstetrics of China Medical University Hospital, were randomly assigned to the control group, the acupuncture group, and the electro-acupuncture group. After the operation, we applied subjects with acupuncture or electro-acupuncture on the bilateral acupuncture point, San Yin Jiao (Sp6), and the patient controlled analgesia (PCA). The first time of requesting morphine, the frequency of PCA demands in 24 hours, and the doses of PCA used were recorded double blindly. In addition, monitoring the subjects' vital signs, the opioid-related side effects, and the pain scores was done.

RESULTSThe results showed that the acupuncture group and the electro-acupuncture group could delay the time of requesting morphine up to 10 - 11 minutes when compared with the control group. The total dose of PCA used within the first 24 hours was 30% - 35% less in the acupuncture group and the electro-acupuncture group when compared with the control group, which was indicated in statistical significance. However, there was no significant difference between the acupuncture group and the electro-acupuncture group. The electro-acupuncture group's and the acupuncture group's pain scores were lower than the control group's within the first 2 hours. Both were statistically significant. However, two hours later, there were no significant differences of the visual analogue scale (VAS) scores between either of the treatment groups and the control group. Finally, the incidence of opioid-related side effects, such as dizziness, was less in the acupuncture group and electro-acupuncture group than in the control group.

CONCLUSIONSThis study shows that the application of acupuncture and electro-acupuncture could definitely delay the time of requesting pain relief medication after cesarean section and decrease the PCA doses used within the first 24 hours.

Acupuncture Therapy ; methods ; Adult ; Analgesics ; therapeutic use ; Cesarean Section ; Female ; Humans ; Male ; Morphine ; therapeutic use ; Pain, Postoperative ; drug therapy ; therapy ; Pregnancy

PURPOSE: Pain in terminal cancer patients may be refractory to systemic analgesics or associated with adverse drug reactions to analgesics. Epidural analgesia has been effectively used in such patients for pain control. However, this method does not provide pain relief to all patients. The efficacy and complications of continuous epidural analgesia were evaluated for expanding efficacy in terminal cancer patients. MATERIALS AND METHODS: The charts of patients who received epidural analgesia for over 5 years for the control of terminal cancer pain were reviewed retrospectively. RESULTS: Ninety-six patients received 127 epidural catheters. The mean duration for epidural catheterization was 31.5+/-55.6 (5-509) days. The dose of epidural morphine increased by 3.5% per day. The efficacy of epidural analgesia at 2 weeks follow up revealed improved pain control (n=56), as the morphine equivalent drug dose dropped from 213.4 mg/day to 94.1 mg/day (p<0.05) at 2 weeks follow up. Accordingly, after 2 weeks institution of epidural analgesia, there was a significant reduction in the proportion of patients with severe pain, from 78.1% to 19.6% (p<0.05). CONCLUSION: Epidural analgesia was an effective pain control method in patients with terminal cancer pain, however, a systematized algorithm for the control of cancer-related pain in needed.
Adult ; Analgesia, Epidural/*methods ; Bupivacaine/therapeutic use ; Female ; Humans ; Male ; Middle Aged ; Morphine/therapeutic use ; Neoplasms/*physiopathology ; Pain/*drug therapy ; Retrospective Studies

BACKGROUNDAbdominal pain is a common symptom among patients with acute appendicitis, yet these patients have long been denied relief from suffering because of widespread misconceptions associated with the use of opioids. We determined whether morphine hydrochloride masked the physical signs in adults with acute appendicitis and assessed the efficacy of morphine in relieving abdominal pain.

METHODSA prospective, double-blind, placebo controlled, clinical trial was conducted with 106 adult patients between 16 and 70 years old with acute appendicitis. Patients were randomly divided into a morphine group (n=54) or a normal saline group (n=52). All patients presented with acute abdominal pain with onset within 3 days. The morphine group received hypodermic injection of morphine (0.15 mg/kg; maximum 20 mg) and the control group members were given an equivalent volume of normal saline solution. The clinical symptoms, physical signs, and patients' cooperation during physical examination were assessed before and after 30 minutes of morphine or normal saline administration.

RESULTSAbdominal pain was significantly relieved and the patients' cooperation was improved in the morphine group after 30 minutes treatment compared with the control group and before morphine administration (P<0.05). The physical signs were unaffected by either treatment (P>0.05).

CONCLUSIONSMorphine relieved abdominal pain and improved the patients' cooperation for treatment and care. Furthermore, the morphine did not mask the physical signs of acute appendicitis.

Abdominal Pain ; drug therapy ; pathology ; Adolescent ; Adult ; Aged ; Analgesics, Opioid ; therapeutic use ; Appendicitis ; drug therapy ; pathology ; Female ; Humans ; Male ; Middle Aged ; Morphine ; therapeutic use ; Young Adult

OBJECTIVETo observe the effect of electro-acupuncture (EA) for treatment of morphine sulfate caused constipation in tumor patients.

METHODSSixty-six tumor patients suffering from constipation caused by oral taking of morphine sulfate controlled-release tablet were equally randomized into the treated group treated with EA [on the bilateral Zusanli (ST36) and Tianshu (ST25) points] and the control group treated with citrate-mosapride tablet. The overall therapeutic effect and scores of constipation in both groups were estimated after treatment.

RESULTSScores of constipation in terms of frequency, time, and difficulty degree of defecation, as well as stool properties, were all improved in both groups after treatment (P<0.01, P<0.05); the total score of constipation was 5.52 +/- 1.54 and 5.70 +/- 2.49 in the two groups respectively, which in the treated group was better, and showed significant difference compared with the score in the control group (P<0.01). The overall effective rate was 97.0% in the treated group and 87.9% in the control group.

CONCLUSIONEA has a good effect in treating constipation caused by oral taking of morphine sulfate controlled-release tablet.

Adult ; Aged ; Aged, 80 and over ; Benzamides ; therapeutic use ; Constipation ; chemically induced ; therapy ; Electroacupuncture ; Female ; Humans ; Male ; Middle Aged ; Morphine ; adverse effects ; Morpholines ; therapeutic use ; Neoplasms

BACKGROUND: Patients commonly develop postoperative pain after total knee arthroplasty (TKA). Acupuncture-related techniques and low-level laser therapy could be beneficial for pain management for older individuals. OBJECTIVE: To examine the effect of low-level laser acupuncture (LA) in reducing postoperative pain, pain-related interference in daily life, morphine consumption, and morphine-related side effects in older patients with knee osteoarthritis who underwent TKA. DESIGN, SETTING, PARTICIPANTS AND INTERVENTION: A single-blind randomized placebo-controlled trial was conducted. Patients (N = 82) were recruited and randomly assigned via a computer-generated list to the LA group or a placebo group. The LA group received low-level laser therapy at Sanyinjiao (SP6), Taixi (KI3), Kunlun (BL60), Fengshi (GB31), Futu (ST32) and Neiguan (PC6) after TKA, while the placebo acupuncture group received the same treatment procedure without laser energy output. MAIN OUTCOME MEASURES: The primary outcome was postoperative pain intensity, and it was measured at baseline and hours 2, 6, 10, 24, 48 and 72 after TKA. The secondary outcomes, including relative pain, postoperative pain-related interference in daily life and morphine consumption, were measured at hours 24, 48 and 72 after TKA. RESULTS: Generalized estimating equations revealed significant between-group differences in pain intensity (P = 0.01), and trend differences in pain intensity for the LA group starting at hours 10 to 72 (P < 0.05) and morphine consumption at hours 48 and 72 (P < 0.05). The changes in pain-related interference in daily life were significant (P < 0.05) at 72 h, with the exception of the parameters for worst pain, mood, and sleep. Nausea and vomiting side effects from morphine had significant between-group differences at hours 10 and 24 (P < 0.05). CONCLUSION: Low-level LA gradually reduced older patients' postoperative pain intensity and morphine consumption within the first 72 h after their TKA for osteoarthritis. Low-level LA may have benefits as an adjuvant pain management technique for clinical care. TRIAL REGISTRATION ClinicalTrials.gov registration number NCT03995446.
Acupuncture Therapy ; Aged ; Analgesics, Opioid/therapeutic use* ; Arthroplasty, Replacement, Knee/adverse effects* ; Double-Blind Method ; Humans ; Morphine/therapeutic use* ; Pain, Postoperative/drug therapy* ; Single-Blind Method

Background Ultrasound-guided continuous thoracic paravertebral block can provide pain-relieving and opioid-sparing effects in patients receiving open hepatectomy. We hypothesize that these effects may improve the quality of recovery (QoR) after open hepatectomy. Methods Seventy-six patients undergoing open hepatectomy were randomized to receive a continuous thoracic paravertebral block with ropivacaine (CTPVB group) or normal saline (control group). All patients received patient-controlled intravenous analgesia with morphine postoperatively for 48 hours. The primary outcome was the global Chinese 15-item Quality of Recovery score on postoperative day 7, which was statistically analyzed using Student's t-test. Results Thirty-six patients in the CTPVB group and 37 in the control group completed the study. Compared to the control group, the CTPVB group had significantly increased global Chinese 15-item Quality of Recovery scores (133.14 ± 12.97 vs. 122.62 ± 14.89, P = 0.002) on postoperative day 7. Postoperative pain scores and cumulative morphine consumption were significantly lower for up to 8 and 48 hours (P < 0.05; P = 0.002), respectively, in the CTPVB group. Conclusion Perioperative CTPVB markably promotes patient's QoR after open hepatectomy with a profound analgesic effect in the early postoperative period.
Anesthetics, Local/therapeutic use* ; Double-Blind Method ; Hepatectomy/adverse effects* ; Humans ; Morphine/therapeutic use* ; Pain Measurement ; Pain, Postoperative/etiology* ; Ultrasonography, Interventional

OBJECTIVETo investigate the protective effects of morphine postconditioning on myocardial ischemia-reperfusion (I/R)injury and the potential mechanisms in rabbits.

METHODSThirty-two New Zealand male white rabbits were randomly assigned into 4 groups: Group 1 (Sham), Group 2 (I/R), Group 3 (ischemic postconditioning), Group 4 (ischemia and morphine postconditioning). Group 1 was perfused for 160 min; Group 2 underwent 40 min ischemia and 120 min reperfusion; Group 3 underwent three cycles of 30 s reperfusion and 30 s left anterior descending coronary artery re-occlusion immediately after 40 min ischemia and before 120 min reperfusion; Group 4 was given morphine 1.0 mg/kg immediately after 40 min ischemia in 1 min and before 120 min reperfusion. Blood samples were taken from arterial line at 20 min before occlusion, 20 min after occlusion, 40 min after occlusion, 1 h after reperfusion and 2 h after reperfusion for determination of the plasma levels of cardiac troponin I (cTnI). At the end of the reperfusion, infarct size (IS) and area at risk were defined by Evans and TTC staining. Plasma SOD activity and MDA were determined at the end of reperfusion.

RESULTThe levels of cTnI were significantly lower during reperfusion in the two postconditioning groups than those in I/R group. The plasma MDA content was significantly lower and SOD activity was significantly higher in the two postconditioning groups than those in I/R group, but there was no difference between two postconditioning groups. Morphine significantly reduced infarct size of the left ventricular area at risk as compared with I/R group (P<0.05).

CONCLUSIONMorphine postconditioning is as effective as ischemic postconditioning in the protection of myocardium against I/R injury in rabbits. Decrease in oxygen free radicals and increased antioxidant activity might be involved in its mechanism.

Animals ; Coronary Artery Disease ; drug therapy ; Ischemic Preconditioning, Myocardial ; Male ; Malondialdehyde ; blood ; Morphine ; therapeutic use ; Rabbits ; Random Allocation ; Reperfusion Injury ; prevention & control ; Superoxide Dismutase ; blood

OBJECTIVETo probe the effect of previous analgesia of scalp acupuncture.

METHODSSixty cases of radical operation of intestinal cancer were randomly divided into 2 groups: a scalp acupuncture plus epidural analgesia (scalp acupuncture group) and an epidural analgesia group, 30 cases in each group. The scalp acupuncture group received scalp acupuncture from 20 min before operation to the end of the operation, and epidural analgesia at the end of the operation. The epidural analgesia group only received epidural analgesia at the end of the operation. Recovery of VAS scores, BCS scores and gastrointestinal function after operation were investigated to probe into effects of scalp acupuncture on epidural morphine analgesia after operation in the patient of intestinal cancer.

RESULTSThe VAS scores at 6 h, 12 h, 24 h and 48 h in the scalp acupuncture group were lower than the epidural analgesia group, with significant differences at 6 h and 12 h between the two groups (P < 0.05). BCS scores at the 4 time points in the scalp acupuncture group were lower than the epidural analgesia group with significant differences between the two groups (all P < 0.05). The scalp acupuncture group in recovery of bowel sound, exsufflation from the anus in the scalp acupuncture group was faster than the epidural analgesia group (P < 0.01).

CONCLUSIONScalp acupuncture has a certain previous analgesic effect, reducing discomfort of the patient after operation and promoting the recovery of gastrointestinal functions.

Acupuncture Analgesia ; methods ; Aged ; Analgesia, Epidural ; Female ; Humans ; Intestinal Neoplasms ; surgery ; Male ; Middle Aged ; Morphine ; therapeutic use ; Pain, Postoperative ; therapy ; Scalp