Objective
To study the effect of preemptive analgesia with tramadol on ovarian cancer patients with stress reaction.
Methods
80 cases with ovarian cancer undergoing elective surgery under general anesthesia were divided into the observation group and the control group according to the computer randomly generated control table, 40 cases in each group.Patients in the observation group with PECA were pumped into tramadol after anesthesia induction, while the control group was in the same conditions of pumping tramadol after operation.Patients were all treated with intravenous patient-controlled analgesia with sufentanil after waking up.The blood concentrations of cortisol (COR), adrenal cortical hormone (ACTH), angiotensin Ⅱ (AT Ⅱ) were determined by radioimmunoassay, and the blood concentrations C reactive protein (CRP) was determined by immune turbidity method.The adverse reactions and the VAS score of patients after 2h, 6h, 12h, 24h, 48h were recorded.
Results
The COR, ACTH, AT Ⅱ, CRP concentrations of the two groups had no significant differences (all P>0.05) before operation.After each time point, COR[(208.5±31.6)ng/mL vs (446.3±19.8)ng/mL], ACTH[(35.7±8.2)pg/mL vs (63.5±9.1)pg/mL], AT Ⅱ[(46.8±10.9)pg/mL vs (75.9±12.5)pg/mL], CRP[(3.9±0.7)mg/mL vs (40.5±2.9)mg/mL]concentrations were significantly higher than those of pre-operation(all P 0.05); At the time of coughing, the two groups were significantly different only at the 6h[(2.5±0.6) vs (3.1±0.8)]and 12h[(2.1±0.6) vs (2.9±0.4)]time point (t=13.406, P=0.012; t=12.625, P=0.025).
Conclusion
Preemptive analgesia with tramadol and sufentanil for postoperative analgesia can effectively reduce the radical resection of postoperative pain and the stress reaction after surgery.It is a safe and effective analgesic method.
Key words:
Ovarian cancer; Tramadol; Preemptive analgesia; Stress reaction
During the COVID-19 outbreak, there was a sharp increase in generalized anxiety disorder (GAD). Acupuncture therapy has the advantages of accurate clinical efficacy, safety and reliability, few adverse reactions, and no dependence, and is gradually becoming one of the emerging therapies for treating GAD. We present a study protocol for a randomized clinical trial with the aim of exploring the mechanism of brain plasticity in patients with GAD and evaluate the effectiveness and reliability of acupuncture treatment. Transcranial magnetic stimulation (TMS) will be used to assess cortical excitability in GAD patients and healthy people. Sixty-six GAD patients meeting the inclusion criteria will be randomly divided into two groups: TA group, (treatment with acupuncture and basic western medicine treatment) and SA group (sham acupuncture and basic western medicine treatment). Twenty healthy people will be recruited as the control group (HC). The parameters that will be evaluated are amplitude of motor evoked potentials (MEPs), cortical resting period (CSP), resting motor threshold (RMT), and Hamilton Anxiety Scale (HAMA) score. Secondary results will include blood analysis of γ-aminobutyric acid (GABA), glutamate (Glu), glutamine (Gln), serotonin (5-HT), and brain-derived nerve growth factor (BDNF). Outcomes will be assessed at baseline and after the intervention (week 8). This study protocol is the first clinical trial designed to detect differences in cerebral cortical excitability between healthy subjects and patients with GAD, and the comparison of clinical efficacy and reliability before and after acupuncture intervention is also one of the main contents of the protocol. We hope to find a suitable non-pharmacological alternative treatment for patients with GAD.
Background: The prevalence of neuropathic pain is estimated to be between 7 and 10% in the general population. The efficacy of intravenous (IV) lidocaine has been studied by numerous clinical trials on patients with neuropathic pain. The aim of this systematic review and meta-analysis was to evaluate the efficacy of IV lidocaine compared with a placebo for neuropathic pain and secondly to assess the safety of its administration. Methods: A literature search on PubMed, Scopus, CENTRAL (Cochrane Central Register of Controlled Trials), and Google scholar databases was performed for relevant studies published up to February 2019. Randomized controlled trials (RCTs) evaluating IV lidocaine treatment for pain relief in patients with neuropathic pain were included. Results: 26 articles met the inclusion criteria. Patients with varied etiology of neuropathic pain were among the patient samples of these studies. Fifteen articles were included for quantitative analysis. Lidocaine was superior to a placebo in relieving neuropathic pain in the early post-infusion period [Mean Difference (MD) = -11.9; 95% Confidence interval (CI): -16.8 to -7; p < 0.00001]. Multiple infusions of lidocaine over a period of 4 weeks, however, had no significant effect on reliving neuropathic pain (MD = -0.96; 95% CI: -2.02 to 0.11; p = 0.08). IV lidocaine was also associated with a significant number of adverse events compared to a placebo [Odds Ratio (OR) = 7.75; 95% CI: 3.18-18.92; p < 0.00001]. Conclusion: Our study indicates that while IV lidocaine is effective in pain control among patients with neuropathic pain in the immediate post-infusion period, it does not have a long-lasting, persistent effect. IV infusions of the drug are associated with an increased risk of side effects compared to a placebo. However, the risk of serious adverse events is negligible. Further, well-designed RCTs evaluating the effects of various dosages and infusion periods of IV lidocaine are required to provide clear guidelines on its clinical use.
Objective
To investigate the effects of two anesthetic modes on cognitive function in elderly patients undergoing laparoscopic cervical cancer resection.
Methods
From August 2016 to April 2018, 60 elderly patients undergoing laparoscopic cervical cancer resection in the General Hospital of Armed Police were divided into control groupand observation group according to odd and even of bed number, with 30caese in each group.Intravenous anesthesia was used in the control group, and intravenous anesthesia combined with inhalation anesthesia was used in the observation group.The anesthetic effect, MMSE score, MoCA score and the incidence of cognitive dysfunction were compared between the two groups.
Results
The anesthesia effect time, extubation time and recovery time of the observation group were (1.62±0.30)min, (15.68±3.26)min, (8.69±3.68)min, respectively, which were significantly shorter than those of the control group[(4.68±0.91)min, (27.46±4.03)min, (20.36±4.58)min](all P 0.05). At 2 h, 6 h, 1 d after operation, the MoCA scores in the observation group were significantly higher than those in the control group (all P<0.05). The incidence of cognitive dysfunction in the observation group was 6.67%(2/30), which was significantly lower than 26.67%(8/30) in the control group (P<0.05).
Conclusion
Compared with intravenous anesthesia alone, intravenous anesthesia combined with inhalation anesthesia for elderly patients undergoing laparoscopic cervical cancer resection has a good anesthetic effect and can reduce the incidence of cognitive dysfunction, which is worthy of further application in clinical practice.
Key words:
Uterine cervical neoplasms; Cognition disorders; Laparoscopy; Anesthesia, intravenous; Anesthesia, inhalation; Propofol; Sevoflurane; Aged
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