Efficacy of adductor canal combined with IPACK block for multimodal analgesia after total knee arthroplasty / 中华麻醉学杂志

Objective To evaluate the efficacy of adductor canal combined with interspace between the popliteal artery and the capsule of the posterior knee (IPACK) block for multimodal analgesia after total knee arthroplasty (TKA).Methods Sixty American Society of Anesthesiologists physical status Ⅰ-Ⅲ patients of both sexes,aged 55-78 yr,scheduled for elective unilateral TKA under combined spinal-epidurai anesthesia,were assigned into 2 groups (n =30 each) using a computer random number method:adductor canal combined with IPACK block group (group A+Ⅰ) and adductor canal block group (group A).Preventive multimodal analgesia was applied as follows:preoperative pain management education was performed;flurbiprofen 50 mg was intravenously injected before induction of anesthesia,and celecoxib 200 mg was taken orally after surgery,twice a day,to control inflammatory pain;ultrasound-guided adductor canal combined with IPACK block was performed in group A+Ⅰ,and ultrasound-guided adductor canal block was performed in group A to inhibit incisional pain;nalbuphine 0.08 mg/kg was intravenously injected to inhibit breakthrough pain.Postoperative numeric rating scale (NRS) scores at rest (NRSr) and on movement (NRSm) were maintained ＜ 5 within 48 h after surgery.The area under the curve (AUC) of NRSr and NRSm (AUCNRsr and AUCNSm) were calculated within 48 h after surgery.The requirement for nalbuphine as rescue analgesic was recorded.The maximum number of ambulatory steps and maximum range of knee motion were recorded on 1 and 2 days after surgery.The development of nerve block-and postoperative rehabilitation training-related adverse events and postoperative length of hospitalization were also recorded.ResuRs Compared with group A,AUCNRSr and AUCNRSm were significantly decreased,the consumption of nalbuphine was reduced,and the maximum number of ambulatory steps and maximum range of knee motion were increased (P＜0.05),and no significant change was found in the requirement for nalbuphine or length of hospitalization in group A+Ⅰ (P＞0.05).No nerve block-and postoperative rehabilitation training-related adverse events were found in neither group.Conclusion Adductor canal combined with IPACK block can provide a relatively perfect efficacy when used for multimodal analgesia after TKA and is helpful for patient's recovery.

Comparison of different doses of oxycodone combined with propofol target controlled infusion in patients with choledocholithiasis undergoing endoscopic therapy / 实用医学杂志

Objective To investigate the anesthetic effect and adverse events on different doses of oxyco-done combined with propofol target controlled infusion(TCI)in patients with choledocholithiasis undergoing endo-scopic retrograde cholangio pancreatography(ERCP)with endoscopic sphincterotomy(EST).Methods One hun-dred and twenty patients with choledocholithiasis underwent ERCP with EST in Department of Gastroenterology, Fuzhou General Hospital,from January,2016 to March,2017 were enrolled in this study.Patients were randomly divided into 4 groups(n=30 in each group)including the sufentanil control group(Group A),low dose of oxyco-done group(Group B),moderate dose of oxycodone group(Group C),and high dose of oxycodone group(Group D).Patients in Group A received 0.10 μg/kg intravenous sufentanil,and patients in Group B,C,and D received 0.08 mg/kg,0.10 mg/kg,and 0.12 mg/kg intravenous oxycodone,respectively,at 5 min before induction of gener-al anesthesia followed by propofol TCI. Effect of compartment concentration(Ce)of propofol,mean arterial pres-sure(MAP),and heart rate(HR)at the given time point when patients transferring to operation room(T0),after induction(T1),endoscope through throat(T2),and endoscope through major duodenal papilla(T3)were record-ed.The accumulative dose of propofol,duration of operation,and recovery time were also recorded.Intraoperative sever hypotension,bradycardia,respiratory depression,coughing and moving,and postoperative nausea and vom-iting were recorded. Results Propofol Ce at T1~T3as well as MAP and HR at T2and T3in Group B were signifi-cantly higher than those in Group A,C,and D,respectively(P < 0.05). The accumulative dose of propofol in Group B was more than that in Group A and C,while the accumulative dose of propofol in Group D was less than that in Group A,B,and C,respectively(P<0.01).Recovery time in Group D was longer than that in Group A, B,and C,respectively(P<0.05).Similar incidences of intraoperative sever hypotension,bradycardia,respiratory depression,coughing and moving,and postoperative nausea and vomiting were also observed. Conclusions 0.10 mg/kg intravenous oxycodone at 5 min before induction of general anesthesia combined with propofol TCI presents a favorable anesthetic effect in patients with choledocholithiasis undergoing ERCP with EST without a prolonged recovery time and the increased incidence of adverse events.

Effect of anti-microbial-coated central venous catheter on catheter-associated deep venous thrombosis / 临床麻醉学杂志

Objective To evaluate the effect of anti-microbia-l coated central venous catheter (CVC),compared with routine CVC,on catheter-associated deep venous thrombosis (CADVT). Methods A total of 1 359 patients,aged 26-82 years,ASA physical status Ⅰ-Ⅲ,undergoing internal jugular,axillary-subclavian,or femoral vein CVC catheterization during January to June of 2017,were retrospectively reviewed.The patients were divided into intoanti-microbial-coated CVC group (group A)and routine CVC group (group B).Gender,age,ASA class,pre-operative risk of thrombus (Caprini score),CVC site,surgical site,ultrasound-guided catheterization,and anticoagu-lation therapy,CADVT and the degree,as well as the other adverse events were recorded.Results A total of 938 patients were successfully matched.There were 323 (34.4%)articipants diagnosed with CADVT with bedside point-of-care ultrasound,in which 172 cases (36.7%)in group A and 151 (32.2%)in group B.There was no statistical significance of CADVT and the degree between the two groups.The subgroup analysis results indicated that the patients using anti-microbial-coated CVC with high risk of thrombus (Caprini score ≥ 5 points)(OR 1.34,95% C I 1.01-1.78),undergoing catheterization according to anatomical landmark (OR 1.69,95% C I 1.04-2.74),and not-receiving anticoagulation therapy (OR 1.39,95% C I 1.01-1.92)had an increased risk of CADVT compared with those using routine CVC.A significantly decreased incidence of catheter-associated infection in group A was observed compared with group B (0.9% vs 4.1%,P<0.05).Conclusion Anti-micro-bial-coated CVC does not increase the incidence of CADVT.

Median effective volume of 0.3％ ropivacaine in old patients with femoral intertrochanteric fracture undergoing ultrasound-guided fascia iliaca compartment block / 临床麻醉学杂志

Objective To identify the median effective volume (EV50) of 0.3 ％ ropivacaine in the old patients with femoral intertrochanteric fracture undergoing ultrasound-guided fascia iliaca compartment block (FICB).Methods Thirty-nine patients,18 males and 21 females,aged 65-98 years old,ASA physical status Ⅱ or Ⅲ,scheduled for femoral intertrochanteric fracture surgery were sequentially received ultrasound-guided FICB.Patients were sequentially given a pre-set volume of 0.3％ ropivacaine according to our pilot study.A sign of "+" was marked if the patient was positive to FICB and totally pain-free 30 min after block,and the next patient would be assigned to a lower volume of ropivacaine.Otherwise,a sign of was marked if the patient was negative to FICB that was partially or not pain-reliefed 30 min after block,and the next patient would be assigned to a larger volume of ropivacaine.The trial was terminated when 7 inflection points appeared.The EV50 of 0.3％ ropivacaine with 95％ confidence interval (CI) was calculated according to sequential method.Results Twenty (51.3％) in a total of 39 patients received a successful ultrasound-guided FICB.The EV50 and 95 ％ CI of 0.3 ％ ropivacaine using ultrasound-guided FICB in old patients with femoral intertrochanteric fracture was 25.37 ml (95％CI 22.06-29.19 ml).Conclusion The EV50 of 0.3％ ropivacaine using ultrasound-guided FICB in the old patients with femoral intertrochanteric fracture is 25.37 ml.

Sedative effect of administration of different doses of buccal dexmedetomidine in pediatric patients under-going tonsillectomy and/or adenoidectomy / 临床麻醉学杂志

Objective To investigate the sedative effect of different doses of buccal dexmedeto-midine premedication during peri-anesthesia in pediatric patients undergoing tonsillectomy and/or ade-noidectomy.Methods Eighty pediatric patients undergoing tonsillectomy and/or adenoidectomy in department of otorhinolaryngology,54 males and 26 females,aged 4-12 years,ASA Ⅰ or Ⅱ,from June,2014 through May,201 6 were enrolled,n =20 in each group.Children were randomly assigned to receive buccal dexmedetomidine 0 μg/kg (group A),1 μg/kg (group B),2 μg/kg (group C)and 4μg/kg (group D)60 min before transporting to operating room.Sedation score (OAA/S scale)was monitored before and after administering buccal dexmedetomidine.Time of post-operative first spon-taneous respiration,opening eyes,extubation,anxiety score (SAS scale),as well as OAA/S scale, pain intensity (FLACC),and adverse events 60 min after surgery were recorded.Results Compared with group A and group B,markedly superior OAA/S within 60 min after administering buccal dexmedeto-midine in group C and group D were observed (P < 0.05 ).Compared with group A and group B,the OAA/S score 5 min after extubation was lower in group D.FLACC scores within 30 and 60 min after extu-bation in group D were lower than those in group A.Group D showed obviously prolonged time of post-op-erative first spontaneous respiration,opening eyes and extubation compared with the other groups (P <0.05).All the rates of adverse events were similar.Conclusion 2 or 4 μg/kg premedecation of buccal dexmedetomidine 60 min before transporting to operating room can effectively and safely sedate pediatric pa-tients when entered operating room,improve parental separation,mask and sevoflurane acceptance,as well as decrease the stress induced by intubation and post-operative pain.

Green tea extract improves the lipid metabolism in patients with metabolic syndrome: a meta-analysis / 中华内分泌代谢杂志

Objective To systematically evaluate the efficacy and safety of green tea extract (GTE) in improving lipid metabolism in patients with metabolic syndrome (MS).Methods All relevant published articles in Chinese and English literature database were searched to collect the randomized controlled trials comparing the efficiency and safety of GTE in patients with MS.The meta-analysis was performed using RevMan 5.2 software.Results Nine studies involving 566 patients were included.The results of recta-analysis showed that:GTE significantly reduced the level of low-density lipoprotein cholesterol (LDL-C) (SMD =-0.33,95％ CI-0.56 ～ -0.09,P=0.007)compared with placebo at the treatment endpoint.There were no statistical significance in high-density lipoprotein cholesterol (SMD =0.19,95 ％ CI-0.04 ～ 0.43,P =0.10),total cholesterol (SMD =-0.13,95％ CI-0.39 ～ 0.13,P =0.33),and triglyceride (SMD =-0.07,95％ CI-0.46 ～ 0.33,P =0.74) levels between two groups.There was no significant difference in the overall rate of adverse events between two groups (OR =0.97,95 ％ CI 0.54 ～ 1.76,P =0.93).Conclusion GTE significantly reduces the level of LDL-C in patients with MS,and the adverse events were rare and mild.

Efficacy of green tea extract on weight control in metabolic syndrome: a meta-analysis / 中华老年医学杂志

Objective To systematically evaluate the efficacy of green tea extract (GTE) on weight control in metabolic syndrome (MS).Methods Related randomized controlled trials (RCTs) about GTE and MS were searched and identified from PubMed,Scopus,PsycINFO,EMBase,the VIP database,CNKI,and Wanfang Resource Database.Valid data were extracted according to strict inclusion and exclusion criteria.The RevMan 5.2.2 software was used to carry out the meta-analysis.Results A total of 10 trials involving 626 patients were ultimately included.Meta analysis showed that:1) compared with the placebo group,body weight (SMD=0.19,95％ CI-0.34 to-0.03,Z 2.34,P=0.02) and waist circumference (SMD=-0.19,95％CI-0.36 to-0.02,Z=2.15,P=0.03) were significantly decreased in the GTE group;2) no significant difference was found between the two groups in BMI (SMD=0.14,95％ CI-0.31 to 0.03,Z=1.63,P=0.10),hip circumference (SMD=0.15,95％CI-0.11 to 0.42,Z=1.12,P=0.26) or waist-to-hip ratio (WMD=-0.02,95％CI-0.05 to 0.01,Z=1.32,P=0.19).Conclusions Green tea extract can significantly reduce body weight and waist circumference in patients with metabolic syndrome.

Spatio-temporal expression of P2X3 receptor in rats with diabetic mechanical allodynia / 解剖学报

Objective To investigate the spatio-temporal expression of P2X3 receptor ( P2X3R) in rats with diabetic mechanical allodynia ( DMA ) .Methods DMA model in rats was induced by intraperitoneal injection of streptozocin ( STZ) .The von Frey filaments were applied to identify the changes of the paw withdrawal threshold ( PWT) in DMA rats.Immunofluorescence was employed to detect the spatio-temporal expression of P2X3R in the spinal dorsal horn (SDH), dorsal root ganglion (DRG) and hind paw skin on different time points after intraperitoneal injection of STZ , respectively.The protein expression of P2X3R in SDH and DRG was further semi-quantitatively analyzed by Western blotting.Results Compared with control group , intraperitoneal injection STZ induced significant mechanical allodynia indicated by the reduced PWT from 7 days, and which reached the peak on 14d and maintained to 28days (P<0.05). The expression of P2X3R in DRG neurons was significantly increased on 14 days and 21 days (P<0.05), while that in SDH and skin was markedly increased on 21 days and 28 days, compared with control group (P<0.05).Conclusion With the progress of DMA, the expression of P2X3R was significantly increased in the SDH, DRG and skin, which was almost parallel with the mechanical allodynia , but the changes in SDH and skin were 1 week later than that in DRG .These results suggest that P2X3R may play a key role in the maintenance of the DMA .