Total knee arthroplasty has become one of the effective operation methods on end-stage knee osteoarthritis. However,the postoperative pain has been plaguing the clinicians. The cause of postoperative pain can be divided into iatrogenic, prosthesis and patient. Pain treatment in perioperative period includes preoperative education, analgesia in advance, and the selection and design of reinforcement; during operation mainly includes the appropriate surgical approach, keep the balance of soft tissue around the knee joint, cocktail analgesia pain around the knee joint; after operation mainly includes oral analgesic drugs, femoral nerve tissue and patient controlled analgesia. And the multimodal analgesi.a which is the analgesic methods combined application in perioperative period raised in resent years fully intervene the pain in perioperative period,so that it can effectively reduce the pain of patients after knee replacement, promote the patients do functional exercise more better and get better operation result.
Analgesia, Patient-Controlled ; Arthroplasty, Replacement, Knee ; Humans ; Nerve Block ; Pain Management ; Pain, Postoperative ; drug therapy ; etiology

The purpose of this study was to evaluate the value of Chinese herbal fumigation in the postoperative anal disease. The authors randomly divided 348 patients into treatment group and control group with 174 cases in each group. The treatment group was given to the Chinese herbal medicine hemorrhoids lotion for fumigation based on conventional anti infective therapy, routine dressing change and relaxing bowel. The control group was given to 1 000 mL 1: 5 000 potassium permanganate solution for sitz bath, fumigation based on conventional anti infective therapy, routine dressing change and relaxing bowel. The pain score, edema score, bleeding score, granulation tissue growth score and wound healing time of two groups were compared after operation. The results showed that the postoperative 6 h pain scores were higher in the two groups, the postoperative 3,5,7 d pain scores gradually decreased, the difference was statistically significant (P < 0.05). The difference of postoperative 6 h pain scores was no significant difference between the two groups, while postoperative 3,5,7 d pain scores in the treatment group were significantly lower than those in the control group (P < 0.05). 7 days after operation, anal margin of edema score and blood in the stool score in the treatment group were lower than those in control group, meat medicine growth score was higher than that of the control group, the difference had statistical meaning (P < 0.05). The healing time of two groups was respectively (13.89 + 2.78), (18.45 + 1.65) d (P < 0.05). This study suggested that Chinese herbal fumigation and washing could reduce the pain degree of patients, the anal margin of edema, and the blood in the stool, also could promote granulation tissue growth and shorten the time of wound healing, deserve the clinical expansion.
Adult ; Anal Canal ; surgery ; Digestive System Surgical Procedures ; adverse effects ; Drugs, Chinese Herbal ; administration & dosage ; Edema ; drug therapy ; etiology ; Female ; Hemorrhage ; drug therapy ; etiology ; Hemorrhoids ; Humans ; Male ; Middle Aged ; Pain, Postoperative ; drug therapy

Postoperative infections following spine surgery are usually attributable to bacterial organisms. Staphylococcus aureus is known to be the most common single pathogen leading to this infection, and the number of infections caused by methicillin-resistant Staphylococcus aureus is increasing. However, there is a paucity of literature addressing postoperative infection with Mycobacterium tuberculosis. We encountered a case of tuberculous spondylitis after spine surgery. A man had fever with low back pain three weeks after posterior interbody fusion with instrumentation for a herniated intervertebral disc at the L4-L5 level. He had been treated with antibiotics for an extended period of time under the impression that he had a bacterial infection, but his symptoms and laboratory data had not improved. Polymerase chain reaction for Mycobacterium tuberculosis turned out to be positive. The patient's symptoms finally improved when he was treated with antituberculosis medication.
Adult ; Humans ; Low Back Pain/etiology ; Lumbar Vertebrae/surgery ; Male ; Postoperative Complications/*microbiology ; Spondylitis/etiology/*microbiology ; Thoracic Vertebrae/*microbiology/pathology ; Tuberculosis/drug therapy/*microbiology ; Tuberculosis, Spinal/complications/drug therapy/*microbiology

OBJECTIVETo compare the therapeutic effect of postoperative pain of hemorrhoid treated with thread embedding at Changqiang (GV 1) and Indometacin suppository.

METHODSEighty cases were randomly divided into an acupoint catgut-embedding group (group A) and an Indometacin group (group B), forty case in each group. In group A, thread embedding at Changqiang (GV 1) was applied, and Indometacin suppository was put into rectum in group B. The pain intensity after 6, 12, 24, 72 hours of treatment and the the maximum scores of VAS in 24 hours (T24max VAS) of 1-3 days of postopration were evaluated with pain Visual Analogue Scale (VAS); the quantity demanded of analgesic and the adverse reaction were observed.

RESULTSThe scores of VAS after 6, 12, 24, 72 hours of treatment in group A were obviously lower than those in group B (all P < 0.05); the T24max VAS scores in group A were obviously lower than those in group B (all P < 0.05). Six cases in group A and 14 cases in group B were treated with non-steroidal anti-inflammatory drug as well. The total effective rate of 87.5% (35/40) in group A was superior to that of 62.5% (25/40) in group B, indicating the statistically significant differences between two groups (P < 0.05). There was no obvious adverse reaction in group A; in group B, headache, dizziness, nausea, vomiting, distention of chest and palpitation appeared, accounting for 11 cases.

CONCLUSIONThe therapeutic effect of postoperative pain of hemorrhoid treated with thread embedding at Changqiang (GV 1) is favorable, it can reduce the quantity of analgesic, the adverse reaction, its effect is better than that of Indometacin suppository.

Acupuncture Points ; Adult ; Aged ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Hemorrhoids ; complications ; Humans ; Male ; Middle Aged ; Pain, Postoperative ; drug therapy ; etiology ; Prostheses and Implants ; Young Adult

OBJECTIVETo investigate the clinical efficacy of and complications arising from low-dose ketamine combined with fentanyl for intravenous postoperative analgesia in comparison with the exclusive use of fentanyl in elderly patients.

METHODSEighty elderly patients were randomized into two equal groups following thoracoabdominal surgery, and received intravenous analgesia with the combination of 0.5 mg/ml ketamine, 5.0 microg/ml fentanyl and 50 microg/ml midazolam (KF group) and with 7.5 microg/ml fentanyl plus 50 microg/ml midazolam (FT group), respectively. The drugs used were diluted in 200 ml normal saline. For analgesic administration, a loading dose (2-4 ml) was given followed by a background infusion (2.5-3.5 ml), with patient-controlled bolus doses of 2.0-3.0 ml with lock-out time of 20 min via PCA pump (Automedical, Korea). The static pain score (VAS), sedation score, and incidences of nausea, vomiting, pruritus and hallucinations were recorded during the initial 48 h after the surgery.

RESULTSThe total analgesic dosage and PCA dosage in the two groups were similar (P>0.05). With similar VAS in the two groups (P>0.05), the sedative effect in KF group was much better than that in FT group (P<0.05) during the initial 48 h postoperatively. The incidences of nausea, vomiting and itching were lower in KF group than in FT group (P<0.05), and no illusion was reported in two groups during the initial 48 h.

CONCLUSIONFor producing comparable postoperative analgesic effect, low-dose ketamine combined with fentanyl can markedly reduce fentanyl requirement in the elderly patients and lowers the incidences of nausea, vomiting and itching in comparison with the exclusive use of fentanyl.

Aged ; Analgesics, Opioid ; administration & dosage ; Dose-Response Relationship, Drug ; Drug Therapy, Combination ; Female ; Fentanyl ; administration & dosage ; Humans ; Infusions, Intravenous ; Ketamine ; administration & dosage ; Male ; Midazolam ; administration & dosage ; Pain, Postoperative ; drug therapy ; etiology ; Thoracic Surgical Procedures ; adverse effects ; Treatment Outcome

PURPOSE: The aim of this study was to evaluate the effects and safety of a sleep aid for postoperative analgesia in patients undergoing arthroscopic rotator cuff repair. MATERIALS AND METHODS: Seventy-eight patients were prospectively assigned to either the zolpidem group (multimodal analgesia+zolpidem; 39 patients) or the control group (multimodal analgesia; 39 patients). Self-rated pain levels were assessed twice a day using a visual analog scale (VAS). The need for additional rescue analgesic, duration of functional recovery, and adverse effects were assessed for the first 5 days after surgery. RESULTS: The mean number of times that additional rescue analgesic was required during 5 days after surgery was 2.1+/-2.0 in the zolpidem group and 3.3+/-2.8 in the control group, a significant difference. There were no significant differences between the two groups in mean VAS pain scores during the first 5 days after surgery, although the zolpidem group had lower VAS pain scores than the control group. Additionally, there were no significant differences in duration of functional recovery and adverse effects between the two groups. CONCLUSION: The use of zolpidem for analgesia after arthroscopic rotator cuff repair provided a significant reduction in the need for rescue analgesic without increasing adverse effects. Nevertheless, mean VAS pain scores during the first 5 days after surgery did not differ between the zolpidem group and the control group.
Adult ; Analgesia/*methods ; Analgesics/*therapeutic use ; Arthroscopy/*adverse effects ; Female ; Humans ; Hypnotics and Sedatives/*therapeutic use ; Male ; Middle Aged ; Pain Management ; Pain Measurement ; Pain, Postoperative/drug therapy/etiology/*prevention & control ; Postoperative Period ; Prospective Studies ; Pyridines/*therapeutic use ; Rotator Cuff/injuries/*surgery ; Sleep/drug effects ; Treatment Outcome ; Visual Analog Scale

PURPOSE: In this randomized, double-blind study, we investigated the analgesic efficacy and side effects of continuous constant-dose infusions of remifentanil after total abdominal hysterectomy and compared it to fentanyl. MATERIALS AND METHODS: Fifty-six adult female patients scheduled for elective total abdominal hysterectomy were enrolled in this study. Patients were randomly assigned to two groups according to fentanyl (group F, n=28) or remifentanil (group R, n=28) for postoperative analgesia. Patients in group F were given fentanyl intravenously with an infusion rate of fentanyl 0.5 microgram/kg/hr; group R was given remifentanil with an infusion rate of remifentanil 0.05 microgram/kg/min for 2 days. Pain intensity at rest, occurrence of postoperative nausea and vomiting (PONV), dizziness, pruritus, and respiratory depression were assessed 1 hr after arrival at the post-anesthesia care unit, at 6; 12; 24; and 48 hr post-operation and 6 hr post-infusion of the study drug. Pain was evaluated by using visual analogue scale (VAS; 0-10). The time that patients first requested analgesics was recorded as well as additional analgesics and antiemetics. RESULTS: There were no significant differences in VAS, time to first postoperative analgesics, and additional analgesics between the 2 groups. The incidences and severities of PONV and opioid related side effects were not different between the groups; however, there were 3 episodes (10.7%) of serious respiratory depression in group R. CONCLUSION: Continuous infusion technique of remifentanil did not reveal any benefits compared to fentanyl. Furthermore, it is not safe for postoperative analgesia in the general ward.
Adolescent ; Adult ; Aged ; Analgesics, Opioid/administration & dosage/therapeutic use ; Drug Administration Schedule ; Female ; Fentanyl/administration & dosage/*therapeutic use ; Humans ; Hysterectomy/*adverse effects ; Infusions, Intravenous ; Middle Aged ; Pain, Postoperative/*drug therapy/etiology ; Piperidines/administration & dosage/*therapeutic use ; Treatment Outcome

According to the literature, thoracic outlet syndrome (TOS) secondary to the malunion of displaced fractures of the clavicle is rare. Various surgical methods, including simple neurolysis, resection of the first rib or clavicle and corrective osteotomy, have been reported. We report a case of TOS secondary to malunion of the clavicle that was treated by an anterior and middle scalenectomy without a rib resection.
Adult ; Humans ; Low Back Pain/etiology ; Lumbar Vertebrae/surgery ; Male ; Postoperative Complications/*microbiology ; Spondylitis/etiology/*microbiology ; Thoracic Vertebrae/*microbiology/pathology ; Tuberculosis/drug therapy/*microbiology ; Tuberculosis, Spinal/complications/drug therapy/*microbiology ; Adult ; Clavicle/*injuries ; Fractures, Malunited/*complications ; Humans ; Male ; Thoracic Outlet Syndrome/etiology/radiography/*surgery

Association between postoperative nausea and vomiting (PONV) and micro-opioid receptor A118G single nucleotide polymorphism (SNP) is undefined and might underlie inconsistent results of studies on PONV occurrence in patients undergoing general anesthesia with the opioid, remifentanil. Four hundred and sixteen Korean women undergoing breast surgery with general anesthesia were randomized to receive remifentanil 10 ng/mL (plasma-site, Minto model) using a target-controlled infusion device and either propofol for total intravenous anesthesia (T group) or sevoflurane for inhalation anesthesia (I group) with bispectral index values maintained between 40 and 60. Blood specimens were collected after anesthesia induction for A118G SNP analysis. PONV and postoperative pain were evaluated. A118G SNP type distribution among Korean female adults studied was AG (n=195)>AA (n=158)>GG (n=63). Regardless of anesthetic technique, patients with GG types had lower PONV scale on arrival at postoperative care unit (PACU) (P=0.002), while T group showed lower PONV scale than I group up to 6 hr after PACU discharge in AA and AG types. No differences were apparent for postoperative pain among opioid receptor polymorphism. PONV occurrence differs according to opioid receptor polymorphism and anesthetic technique in patients undergoing general anesthesia with remifentanil.
Adult ; Analgesics, Opioid/*adverse effects ; Anesthesia, General/*adverse effects ; Breast Diseases/surgery ; Demography ; Double-Blind Method ; Female ; Humans ; Methyl Ethers/adverse effects/therapeutic use ; Pain, Postoperative/drug therapy ; Piperidines/*adverse effects/therapeutic use ; *Polymorphism, Single Nucleotide ; Postoperative Nausea and Vomiting/*etiology ; Receptors, Opioid, mu/*genetics

OBJECTIVETo assess the efficacy and safety of lornoxicam, one non-steroidal anti-inflammatory drug (NSAID) in patient-controlled analgesia (PCA) in patients undergoing abdominal surgeries.

METHODSThirty-nine patients scheduled for abdominal surgeries were randomly assigned to different PCA treatment groups using either lornoxicam or fentanyl postoperatively. Pain intensity difference (PID) and sum of pain intensity difference (SPID) were used to assess the analgesic efficacy of both drugs during a 24-hour period.

RESULTSThe analgesic efficacy of lornoxicam is 1/66 of fentanyl, which was shown by SPID value of 3.250 and 3.058, respectively (P > 0.05). Lornoxicam caused fewer adverse events than fentanyl (33% vs. 68%, P < 0.05).

CONCLUSIONIn clinic, we can use lornoxicam to treat postoperative pain effectively and with less adverse reactions compared with fentanyl.

Adolescent ; Adult ; Aged ; Analgesia, Patient-Controlled ; Analgesics, Opioid ; therapeutic use ; Anti-Inflammatory Agents, Non-Steroidal ; therapeutic use ; Cholecystectomy ; adverse effects ; Double-Blind Method ; Female ; Fentanyl ; therapeutic use ; Humans ; Hysterectomy ; adverse effects ; Laparoscopy ; adverse effects ; Male ; Middle Aged ; Pain Measurement ; Pain, Postoperative ; drug therapy ; etiology ; Piroxicam ; analogs & derivatives ; therapeutic use