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Effect of ankle versus thigh tourniquets on post-operative pain in foot and ankle surgery

World Journal of Orthopedics 2024年第2期15卷 163-169页

作者： Ashish Mishra Ahmed Barakat Jitendra Mangwani Jakub Kazda Sagar Tiwatane Sana Mohammed Aamir Shaikh Linzy Houchen-Wolloff Vipul Kaushik Department of Trauma and Orthopedics University Hospitals LeicesterLeicester LE15WWUnited Kingdom Department of Trauma and Orthopedics Leicester University Hospitals-NHS TrustLeicester LE15WWLeicestershireUnited Kingdom Academic Team of Musculoskeletal Surgery University Hospitals of Leicester NHS TrustLeicester LE39QPUnited Kingdom Department of Anaesthesia York&Scarborough Teaching Hospitals NHS Foundation TrustNorth Yorkshire YO318HEUnited Kingdom Department of Anaesthesia Royal Free London NHS TrustLondon NW32QGUnited Kingdom Department of Trauma&Orthopaedics Breach Candy Hospital TrustMumbai 400026India Department of Physiotherapy University Hospitals of Leicester NHS TrustLeicester LE39QPUnited Kingdom Department of Anasthesia University Hospitals of Leicester NHS TrustLeicester LE15WWUnited Kingdom

BACKGROUND Tourniquets are commonly used in elective extremity orthopaedic surgery to reduce blood loss,improve visualization in the surgical field,and to potentially reduce surgical time.There is a lack of consensus in existing guidelines regarding the optimal tourniquet pressure,placement site,and duration of use.There is a paucity of data on the relationship between the site of a tourniquet and postoperative pain in foot and ankle surgery.AIM To explore the relationship between tourniquet site and intensity of post-operative pain scores in patients undergoing elective foot and ankle surgery.METHODS Retrospective analysis of prospectively collected data on 201 patients who underwent foot and ankle surgery in a single institution was undertaken.Intraoperative tourniquet duration,tourniquet pressure and site,and postoperative pain scores using Visual Analogue Score were collected in immediate recovery,at six hours and at 24 h post-op.Scatter plots were used to analyse the data and to assess for the statistical correlation between tourniquet pressure,duration,site,and pain scores using Pearson correlation coefficient.RESULTS All patients who underwent foot and ankle surgery had tourniquet pressure of 250 mmHg for ankle tourniquet and 300 mmHg for thigh.There was no correlation between the site of the tourniquet and pain scores in recovery,at six hours and after 24 h.There was a weak correlation between tourniquet time and Visual Analogue Score immediately post-op(r=0.14,P=0.04)but not at six or 24 h post-operatively.CONCLUSION This study shows that there was no statistically significant correlation between tourniquet pressure,site and postop pain in patients undergoing foot and ankle surgery.The choice of using a tourniquet is based on the surgeon's preference,with the goal of minimizing the duration of its application at the operative site.

关键词： Lower limb surgery Tourniquet time Tourniquet pressure Tourniquet site post-operative pain pain scores

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The Utility of Telemedicine to Manage post-operative pain

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Open Journal of Anesthesiology 2022年第7期12卷 229-239页

作者： Vishal Dhruva Dennis Grech Rutgers New Jersey Medical School Newark USA

Telemedicine is defined as practicing medicine via a virtual interface, including email, telephone calls, text messages, video chatting, and personalized online programs. Telemedicine has increased over the past few decades, mainly in psychology and primary care. Recently, surgical specialties have also begun to utilize telemedicine for post-operative care. There are many studies examining telemedicine’s use in managing post-operative pain. This review paper focuses on 17 on postoperative pain management. They found that telemedicine can assist physicians in managing post-operative pain remotely by increasing adherence to post-operative regimens (p post-operative pain medication dependence (p = 0.04).

关键词： Telemedicine post-operative pain Orthopedic Surgery Urogynecological Surgery Oncology Surgery

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Strengthening post-operative pain Assessment in Patients with Major Abdominal Surgery, University Teaching Hospitals, Zambia

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pain Studies and Treatment 2020年第2期8卷 23-34页

作者： Ruth Wahila Etienne Bwana-Fwamba-Koshe Odimba Catherine Ngoma Department of Basic and Clinical Nursing Sciences School of Nursing Sciences University of Zambia Lusaka Zambia Department of Surgery School of Medicine University of Zambia Lusaka Zambia Department of Midwifery Women’s and Child Health School of Nursing Sciences University of Zambia Lusaka Zambia

Systematic, routine pain assessment using standardized clinical guidelines is the foundation of effective pain management for patients who are unable to self-report pain. In Zambia, there are no context appropriate standardised clinical guidelines for post-operative pain observations. This study sought to develop such a clinical guideline in form of an assessment tool. The study adopted an exploratory sequential mixed method through a three-phased approach and an adapted Clinical Decision Making Survey instrument was used. Snowball sampling was employed and in phases II and III, purposive sampling was used. The study was conducted at the University Teaching Hospitals where 120 participants were enrolled in the study. Phases II and III provided preliminary internal validation processes of the developed tool, where discussions, orientation and trial implementation of the tool were done. In phase II of the study, 47 participants comprising of nurses participated while in phase III, there were 11 nurses and 32 participants. The results yielded the first ever standardised post-operative pain assessment tool for patients with major abdominal surgery in Zambia. The tool is made up of six dimensions of the identified nonverbal indicators of post-operative pain in patients with major abdominal surgery namely: facial expressions, mobility, activity intolerance, behavioural disturbance, communication ability and vital signs. The present study showed that the developed post-operative pain assessment tool for Zambia is acceptable for use among patients who have had major abdominal surgery and can facilitate improved post-operative pain management for most patients.

关键词： Development post-operative pain Assessment Tool Nonverbal Indicators Major Abdominal Surgery

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Treatment duration of wrist-ankle acupuncture for relieving post-thyroidectomy pain:A randomized controlled trial

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Journal of Integrative Medicine 2023年第2期21卷 168-175页

作者： Xin-rui Han Wei Yue Hui-chao Chen Wei He Jiang-he Luo Shan-xia Chen Na Liu Ming Yang Department of Nursing Chengdu Integrated TCM&Western Medicine HospitalSichuan 610041Sichuan ProvinceChina School of Nursing Guangzhou University of Chinese MedicineGuangzhou 510006Guangdong ProvinceChina Department of Nursing Guangdong Provincial Hospital of Traditional Chinese MedicineGuangzhou 510120Guangdong ProvinceChina Department of General Surgery Guangdong Provincial Hospital of Traditional Chinese MedicineGuangzhou 510120Guangdong ProvinceChina Department of Gynecology and Obstetrics Guangzhou Women and Children’s Medical CenterGuangzhou 510120Guangdong ProvinceChina

Background Treatment duration of wrist-ankle acupuncture(WAA)is uncertain for post-thyroidectomy pain relief.Objective This study evaluated the effect of different WAA treatment duration on post-operative pain relief and other discomforts associated with thyroidectomy.Design,setting,participants and intervention This randomized controlled trial was conducted at a single research site in Guangzhou,China.A total of 132 patients receiving thyroidectomy were randomly divided into the control group(sham WAA,30 min)and three intervention groups(group 1:WAA,30 min;group 2:WAA,45 min;group 3:WAA,60 min),with group allocation ratio of 1:1:1:1.Acupuncture was administered within 1 hour of leaving the operating room.Outcomes and measures Primary outcome was patients’pain at the surgical site assessed by visual analogue scale(VAS)at the moment after acupuncture treatment(post-intervention).Secondary outcomes included the patients’pain VAS scores at 6,12,24,48 and 72 h after the thyroidectomy,the 40-item Quality of Recovery(QoR-40)score,the grade of post-operative nausea and vomiting(PONV),and the use of additional analgesic therapy.Results The adjusted mean difference(AMD)in VAS scores from baseline to post-intervention in group 1 was-0.89(95%confidence interval[CI],-1.02 to-0.76).The decrease in VAS score at post-intervention was statistically significant in group 1 compared to the control group(AMD,-0.43;95%CI,-0.58 to-0.28;Ppain relief within 6 h after su

关键词： Thyroidectomy Thyroid tumor Wrist-ankle acupuncture post-operative pain Randomized controlled trial

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Effects of the pestle needle therapy,a type of acupoint stimulation,on post-hemorrhoidectomy pain:A randomized controlled trial

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Journal of Integrative Medicine 2020年第6期18卷 492-498页

作者： Xian Wang Xuan Yin Xiu-tian Guo Yan Wang Wen-qi Jin Ai-jun Mao Lixing Lao Zhang-jin Zhang Jie Zhang Shi-fen Xu Department of Nursing Shanghai Municipal Hospital of Traditional Chinese MedicineShanghai University of Traditional Chinese MedicineShanghai 200071China Department of Acupuncture and Moxibustion Shanghai Municipal Hospital of Traditional Chinese MedicineShanghai University of Traditional Chinese MedicineShanghai 200071China Department of Proctology Shanghai Municipal Hospital of Traditional Chinese MedicineShanghai University of Traditional Chinese MedicineShanghai 200071China School of Chinese Medicine Li Ka Shing Faculty of MedicineThe University of Hong KongHong KongChina Virginia University of Integrative Medicine FairfaxVA 22031USA

Background:Hemorrhoids are one of the most common conditions that lead to surgery,and until now surgical hemorrhoidectomy has been the major effective treatment.post-operative pain from hemorrhoidectomy has been experienced by thousands of patients and remains a major inconvenience of the operation.Objective:This study evaluates the clinical efficacy of the pestle needle therapy,an acupoint stimulation method,for relief of post-hemorrhoidectomy pain.Design,setting,participants and interventions:This was a single-center,patient-assessor-blinded and randomized controlled trial with 154 patients receiving Milligan hemorrhoidectomy surgery.Eligible patients were randomly assigned to either a treatment group or a control group at a ratio of 1:1.The treatment group received the pestle needle therapy,with manual stimulation at Yaoshu(DU2),Mingmen(DU4),Changqiang(DU1),Chengshan(BL57),Erbai(EX-UE2)and the perianal points(1,3,5,7,9,and 11 o’clock around the lesion);while the control group received a sham treatment with very light pressure.Three sessions of treatment were performed at 30 min,4 h and 12 h after the surgery,and each lasted for 15 min.Main outcome measures:The primary outcome was post-operative pain measured with the visual analogue scale(VAS)at 12 h after surgery.The secondary outcomes included the VAS scores measured at0.5,2,4,6,8,24 and 48 h after surgery,the analgesic dose,the time and the VAS score of the patients’first defecation after surgery,as well as the Hamilton Rating Scale for Anxiety(HAMA)evaluated before discharge.Results:The mean pain score of the treatment group was significantly lower than that of the control group(3.10±1.27 vs 4.82±1.29;P<0.001)at 12 h after surgery.Compared with the control group,patients in the treatment group needed a smaller dose of analgesic within the first 24 hours after surgery(P=0.002);and their HAMA scores before discharge were lower(4.07±2.40 vs 5.10±2.45,P=0.009).Compared to the treatment group,patients in the control group had a greater time to the first defecat

关键词： Pestle needle Acupoint stimulation Hemorrhoidectomy post-operative pain Randomized controlled trial

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The effect of adjunct caudal block on postoperative analgesia in robot-assisted laparoscopic radical prostatectomy: A prospective randomized controlled, single blinded pilot study in a tertiary centre

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Asian Journal of Urology 2018年第2期5卷 122-126页

作者： Kenneth Chen Allen Sim Alex Ford Kan Department of Urology Singapore General HospitalSingapore Department of Anaesthesiology Singapore General HospitalSingapore

Objective:Caudal block provides satisfactory postoperative pain relief in lower abdominal operations.This pilot study explores its safety and effect on postoperative pain control in patients who underwent robot-assisted laparoscopic radical prostatectomy(RARP).Methods:From 2013 to 2014,40 consecutive patients were randomized into two groups d one received caudal block using ropivacaine immediately after operation,the other received standard analgesia.Primary outcome measure was pain score based on 11-point Likert scale(0e10)recorded at recovery room,and at 6,12,24,48,and 72 h after operation.All analgesic requirements,opioid-related adverse events and time to passage of flatus were examined.Results:Mean age of the two groups was similar(60.4 vs.62.3 years,p Z 0.33),as was American Society of Anaesthesiologists(ASA)class,body mass index(BMI)and operation times.No significant difference in median pain scores was reported in recovery room(2 vs.3,p Z 0.34),and at 6 h(2 vs.2,p Z 0.94),12 h(0 vs.0,p Z 0.62),24 h(1 vs.0,p Z 0.58),48 h(1 vs.0,p Z 0.36)and 72 h(0 vs.0,p Z 0.78)postoperatively between control and caudal block groups,respectively.There was a higher mean opioid usage in the caudal block group which was not statistically significant.Although this was statistically insignificant while no significant difference in mean paracetamol usage was observed postoperatively.Median time to passage of flatus was similar(2.0 vs.2.0 days,p Z 0.97).There was one case of superficial wound infection and no opioid-related adverse events observed.Hospital stay was similar in both groups(2.5 vs.2.5 days,p Z 0.96).

关键词： Caudal block Robotic radical prostatectomy post-operative pain Analgesia Opioid

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Perioperative electro-acupuncture combined with fentanyl produce analgesic effect in a rat model of post-laparotomy pain

Perioperative electro-acupuncture combined with fentanyl pro...

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中国神经科学学会第四次会员代表大会暨第八届全国学术会议

作者： Xiao-Ming FENG,Jian-Wei JIANG,Yan-Qing WANG,Gen-Cheng WU~* Department of Integrative Medicine and Neurobiology,Shanghai medical college,Fudan University,Shanghai 200032, China

＜正＞Objective post-operative pain remains a major health care problem affecting 19-56%of patients following surgical operation,according to statistic data from Euroanaesthesia（ESA）.Combined acupuncture and medicine anaesthesia has shown its clinical effectiveness in keeping patient’s homeostasis during surgical operation,reducing side effects of anesthetics,as well as relieving post-operative pain.However,when referred to mechanical research,there are few animal models that can mostly comply with clinical surgical procedures.The present study was undertaken to determine the severity and duration of post-laparotomy pain of SD rats,and then to assess whether electroacupuncture combined with fentanyl（aμ-receptor agonist fentanyl） have analgesic effect on the model.Methods Eight animals in each group were given intramusculosa（i.m.） saline（0.2 ml/100 g）,fentanyl（5,10,20μg/kg）,electroacupuncture（2/15 or 2/100Hz） or electroacupuncture（2/15 or 2/100Hz） combined with fentanyl（5μg/kg）.Bilateral electroacupuncture stimulation of "Zusanli"（ST36） and "Sanyinjiao"（SP6） was applied for analgesic induction 10min before operation and all through operation,then 10min after operation for maintenance,altogether 30min.The paw withdrawal threshold（PWT） and abdominal constriction threshold（ACT） were measured with von Frey hairs at baseline and 0.5,1,2,4,6 and 24 h following laparotomy respectively.Results PWT and ACT were markedly suppressed following laparotomy and lasted for 24 h after laparotomy.Fentanyl at 10 and 20μg/kg dose dependently relieved mechanical allodynia in the first l～2h post surgery.Bilateral electroacupuncture stimulation of "Zusanli"（ST36） and "Sanyinjiao"（SP6） at 2/15Hz showed better analgesic effect than 2/100Hz at 1h while 2/100 was better at 24h.Electroacupuncture combined with fentanyl（5μg/kg） produced significant analgesic effect compared to fentanyl（5μg/kg） alone,and 2/15Hz plus fentanyl showed prolonged analgesic effect than 2/15Hz or fentanyl alone.Conclusion These results suggested that electroacupuncture

关键词： electroacupuncture post-operative pain fentanyl laparotomy mechanical allodynia

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