【精华】Anesthesiology，A&A 摘要翻译

GoalYou

【第347篇】乳腺癌手术后行切口及肋间神经罗哌卡因浸润在术后慢性疼痛中的作用：一项双盲随机临床试验 Anesthesiology. 118(2):318-326, February 2013.

A Double-blind Randomized Trial of Wound and Intercostal Space Infiltration with Ropivacaine during Breast Cancer Surgery: Effects on Chronic Postoperative Pain

Albi-Feldzer, Aline M.D.*; Mouret-Fourme E, Emmanuelle M.D.?; Hamouda, Smail M.D.?; Motamed, Cyrus M.D.§; Dubois, Pierre-Yves M.D.‖; Jouanneau, Ludivine Ph.D.?; Jayr, Christian M.D., Ph.D.*

Abstract

Background: The efficacy of local anesthetic wound infiltration for the treatment of acute and chronic postoperative pain is controversial and there are no detailed studies. The primary objective of this study was to evaluate the influence of ropivacaine wound infiltration on chronic pain after breast surgery.

Methods: In this prospective, randomized, double-blind, parallel-group, placebo-controlled study, 236 patients scheduled for breast cancer surgery were randomized (1:1) to receive ropivacaine or placebo infiltration of the wound, the second and third intercostal spaces and the humeral insertion of major pectoralis. Acute pain, analgesic consumption, nausea and vomiting were assessed every 30 min for 2 h in the postanesthesia care unit and every 6 h for 48 h. Chronic pain was evaluated 3 months, 6 months, and 1 yr after surgery by the brief pain inventory, hospital anxiety and depression, and neuropathic pain questionnaires.

Results: Ropivacaine wound infiltration significantly decreased immediate postoperative pain for the first 90 min, but did not decrease chronic pain at 3 months (primary endpoint), or at 6 and 12 months postoperatively. At 3 months, the incidence of chronic pain was 33% and 27% (P = 0.37) in the ropivacaine and placebo groups, respectively. During follow-up, brief pain inventory, neuropathic pain, and anxiety increased over time in both groups (P < 0.001) while depression remained stable. No complications occurred.

Conclusion: This multicenter, prospective study shows that ropivacaine wound infiltration after breast cancer surgery decreased immediate postoperative pain but did not decrease chronic pain at 3, 6, and 12 months postoperatively.
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乳腺癌手术后行切口及肋间神经罗哌卡因浸润在术后慢性疼痛中的作用：一项双盲随机临床试验

【摘要】

背景： 切口行局麻药浸润用于治疗术后急慢性疼痛的作用仍存在争议，而且目前没有具体的研究。该研究的主要目的是评价罗哌卡因切口局部浸润用于乳腺癌术后慢性疼痛的作用。

方法： 本研究为前瞻、随机、双盲、平行组设计、安慰剂对照的临床试验，236为拟行乳腺癌手术的患者随机分为两组，在切口局部，第二、三肋间隙以及胸大肌的肱骨连接处分别接受罗哌卡因或者安慰剂浸润。在麻醉恢复室的2小时内，每30分钟评估急性疼痛，镇痛药的使用量、恶心和呕吐情况，随后48小时内每6小时再次评估上述情况。术后3个月、6个月、1年通过简易疼痛量表、医院焦虑、抑郁以及神经病理性疼痛问卷评价慢性疼痛情况。

结果： 罗哌卡因切口浸润显著降低术后90分钟内的急性疼痛，但并未减轻术后3个月、6个月及12个月的慢性疼痛。在术后3个月时，罗哌卡因组和安慰剂组慢性疼痛的发生率分别为33%和27%（P = 0.37）。在随访期间，两组简易疼痛量表评分及神经病理痛、焦虑情况随着时间推移均升高（P < 0.001），然而抑郁情况相对稳定。没有并发症发生。

结论： 该多中心前瞻性研究表明乳腺癌术后罗哌卡因切口浸润减轻术后即刻疼痛，但无法减轻术后3个月、6个月、1年疼痛。

GoalYou

【第346篇】亚麻醉浓度的丙泊酚、七氟烷、瑞芬太尼和盐酸Ketamine对内脏和躯体疼痛诱发电位的作用Anesthesiology. 2013 Feb;118(2):308-17.

Effects of Propofol, Sevoflurane, Remifentanil, and (S)-Ketamine in Subanesthetic Concentrations on Visceral and Somatosensory Pain-evoked Potentials.

Untergehrer G, Jordan D, Eyl S, Schneider G.

* Research Fellow, ‡ Professor, Director, and Chair, Department of Anesthesiology, Helios Clinic Wuppertal, Witten/Herdecke University, Wuppertal, Germany. † Research Fellow, Department of Anesthesiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.

Abstract

BACKGROUND: Although electroencephalographic parameters and auditory evoked potentials (AEP) reflect the hypnotic component of anesthesia, there is currently no specific and mechanism-based monitoring tool for anesthesia-induced blockade of nociceptive inputs. The aim of this study was to assess visceral pain-evoked potentials (VPEP) and contact heat-evoked potentials (CHEP) as electroencephalographic indicators of drug-induced changes of visceral and somatosensory pain. Additionally, AEP and electroencephalographic permutation entropy were used to evaluate sedative components of the applied drugs.

METHODS: In a study enrolling 60 volunteers, VPEP, CHEP (amplitude N2-P1), and AEP (latency Nb, amplitude Pa-Nb) were recorded without drug application and at two subanesthetic concentration levels of propofol, sevoflurane, remifentanil, or (s)-ketamine. Drug-induced changes of evoked potentials were analyzed. VPEP were generated by electric stimuli using bipolar electrodes positioned in the distal esophagus. For CHEP, heat pulses were given to the medial aspect of the right forearm using a CHEP stimulator. In addition to AEP, electroencephalographic permutation entropy was used to indicate level of sedation.

RESULTS: With increasing concentrations of propofol, sevoflurane, remifentanil, and (s)-ketamine, VPEP and CHEP N2-P1 amplitudes decreased. AEP and electroencephalographic permutation entropy showed neither clinically relevant nor statistically significant suppression of cortical activity during drug application.

CONCLUSIONS: Decreasing VPEP and CHEP amplitudes under subanesthetic concentrations of propofol, sevoflurane, remifentanil, and (s)-ketamine indicate suppressive drug effects. These effects seem to be specific for analgesia.
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亚麻醉浓度的丙泊酚、七氟烷、瑞芬太尼和盐酸Ketamine对内脏和躯体疼痛诱发电位的作用

【摘要】

背景： 尽管脑电图和听觉诱发电位可反应麻醉的镇静作用，然而，目前没有特殊设备监测麻醉阻断伤害性刺激传入的情况。本研究旨在研究内脏痛诱发电位（VPEP）和热接触痛诱发电位（CHEP），如同脑电图一样，作为评价药物导致内脏和躯体疼痛改变的指标。此外，AEP和脑电图用于评估所研究药物的镇静作用。

方法： 该研究纳入60名自愿者，记录没有药物作用以及两组亚麻醉剂量丙泊酚、七氟烷、瑞芬太尼和盐酸Ketamine作用下的VPEP、CHEP和AEP。VPEP通过食管远端的双极电极产生。CHEP通过CHEP刺激器给予前臂中部热脉冲刺激产生。AEP和脑电图用于评价镇静情况。

结果： 随着丙泊酚、七氟烷、瑞芬太尼和盐酸Ketamine浓度升高，VPEP和CHEP N2-P1幅度振幅降低。AEP和脑电图结果表明药物作用未导致出现临床相关和有统计学意义差异的皮质活动度降低。

结论： 亚麻醉浓度的丙泊酚、七氟烷、瑞芬太尼和盐酸Ketamine导致VPEP和CHEP下降反应了药物的抑制作用。这些作用主要表现在镇痛方面。

小诺

好厉害呀，我要认真学习。:victory:

甜甜777

不错，认真学习中:victory:

sd667355

多谢分享，收益颇多

wuxing9915037

新进展，新收获，有利以后科研;P

tt2sw2013

太厉害了:loveliness:

猫耳朵duo

非常感谢，能不能多传一些啊？

wuxing9915037

让我们的思路更加开阔

solobruce

受益匪浅，希望继续能拜读到其他文章。