Meperidine Research Articles

Ultrasound-guided single injection transversus abdominis plane block of isobaric bupivacaine with or without dexamethasone for bariatric patients undergoing laparoscopic vertical banded gastroplasty: a comparative study of different doses

Background Dexamethasone has anti-inflammatory properties that can prolong postoperative analgesia when added to isobaric bupivacaine transversus abdominis plane (TAP) block for bariatric patients undergoing laparoscopic vertical banded gastroplasty. Patients and methods A total of 111 bariatric patients, scheduled for laparoscopic vertical banded gastroplasty under ultrasound-guided TAP block, were randomized blindly into three parallel groups: Group BC that received TAP block using 20 ml of isobaric bupivacaine hydrochloride 0.25%+2 ml saline 0.9%; low-dose dexamethasone group (Group DB4) that received TAP block using 20 ml of isobaric bupivacaine hydrochloride 0.25%+4 mg dexamethasone; and high-dose dexamethasone group (Group DB8) that received TAP block using 20 ml of isobaric bupivacaine hydrochloride 0.25%+8 mg dexamethasone. Results Postoperatively, pain scores were significantly lower in Group BD4 and Group BD8 compared with Group BC at rest and on movement at 6, 8, 12, and 24 h. There was a significant difference with respect to the duration of analgesia ( P = 0.0001), 24 h consumption of paracetamol ( P = 0.0001), 24 h consumption of meperidine hydrochloride ( P = 0.001), the number of patients who needed meperidine hydrochloride rescue analgesic ( P = 0.008), time to ambulation ( P = 0.0001), and incidence of postoperative nausea and/or vomiting ( P = 0.03) among groups. Conclusion Adding dexamethasone (4 or 8 mg) to isobaric bupivacaine TAP block reduces postoperative pain, reduces analgesic requirement, and promotes early ambulation in bariatric patients undergoing laparoscopic vertical banded gastroplasty in comparison with isobaric bupivacaine TAP block alone.

Comparison of three general anesthesia methods for retrieve of endobronchial foreign body in children

Objective To compare three general anesthesia methods for retrieve of endobronchial foreign body in children.Methods Three hundred children undergoing endobronchial foreign body retrieve were randomly assigned into three groups:group A (ketamine +pethidine +midazolam +dexmedetomidine),group B (ketamine +fentanyl +midazolam +cis-atracurium),group C (sevoflurane +propofol +remifentanil +succinylcholine).The time required for endobronchoscope insertion,difficulty grade of endobronchoscope placement,and times of the procedure interruption caused by body movement or desaturation were recorded.The artery oxygen saturation (SpO2) and heart rate (HR) were closely monitored during the anesthesia.The HR and SpO2 at entering the OR (T0),endobronchoscope placement (T1),and the end of the procedure (T2),and the time required for consciousness recovery (T3) were observed.The arterial blood-gas analysis was performed at the end of the procedure.The times required for procedure andrecovery were also recorded.Results In group A,HR was (106±9) beats/min,(99±9) beats/min and (97±10) beats/min at observed points of T1,T2 and T3,respectively,time required for recovery was (118±10) min.The breath holding was observed in group A but without carbon dioxide accumulation.In group B,time required for recovery was (58±7) min,Compared to group A and group C,group B had a quicker recovery time and faster HR(P＜0.01).No breath holding was noted in group B but with obvious carbon dioxide accumulation.Group C had the shortest recovery time (21±5) min,a relative stable HR and no breath holding during anesthesia,but with some extent of carbon dioxide accumulation compared to group A and group C (P＜0.01).The rate of hypoxemia was not statistically different among three groups.Conclusions The three general anesthesia methods described above have their advantages and disadvantages.They should be selected based on the physical conditions of the patients and proficiency of the anesthesiologist. Key words: Foreign body; Anesthesia

Analgesics for 80 cases undergoing ESWL

Objective To develop some management strategies and to provide some references for rationally using drugs investigating preventive use of analgesics before ESWL.Methods 80 patients undergoing ESWL were selected from our hospital from January to June,2013; among which 40 took meperidine and the other 40 tramadolin.The situation and rationality of the peri-operative and preventive use of analgesics were evaluated.Results The utilization rate of analgesics use before ESWL was 100％ at our hospital.Meperidine has the same analgesic effect as tramadolin for patients undergoing ESWL.Conclusions Tramadolin and meperidine are both effective for patients undergoing ESWL.However,tramadolin is less addictive than meperidin and can be used more conveniently,so it could be the first-choice anti-pain drug for ESWL. Key words: Meperidine; Tramadolin; ESWL

Effects of different drugs on patients undergoing endoscopic variceal ligation

Objective To study the sedative and analgesic effects of different drugs on patients under-going endoscopic variceal ligation( EVL). Methods Sixty patients undergoing selective EVL were randomly assigned to three groups:pethidine group( A),propofol-fentanyl group( B)and dexmedetomidine-fentanyl group(C). Data concerning blood pressure,heart rate,peripheral oxygen saturation,Ramsay score,endo-scopic operation and anesthesia time,surgeons' satisfaction and adverse reactions were recorded. Follow-up was done 24 hours later to confirm the patients' satisfaction and incidence of intraoperative awareness. Results The Ramsay scores of group B(5. 2 ± 0. 3)and C(3. 5 ± 0. 4)were significantly higher than group A (1. 6 ± 0. 4)(P<0. 05). There was no cough,body movement and high blood pressure during the EVL in group B or C,while the incidences of these symptoms in group A(40%,40% and 30%)were obviously higher (P<0. 05). The surgeons'satisfaction of group B(9. 2 ± 0. 3)and C(9. 6 ± 0. 4)were significantly higher than that of group A(5. 0 ± 0. 4)(P<0. 05). The patients' satisfaction scores of group B(9. 6 ± 0. 3)and C (9. 6 ± 0. 4)were also markedly higher than that of group A(5. 4 ± 0. 3)(P<0. 05). There was no difference of operation time among the three groups. The anesthesia time of group A(44 ± 6)was obviously longer than those of group B(35 ± 4)and C(36 ± 5)(P<0. 05). There was no difference in patients'or surgeons'satis-faction,or anesthesia time between group B and C. But the incidences of bradycardia( 40%),hypotension(30%)and hyoxemia(30%)in group B were obviously higher than those of group C(5%,0,0)(P<0. 05). There was no intraoperative awareness in group B or C. Conclusion Both dexmedetomidine and propofol com-bined with fentanyl are superior to pethidine for patients undergoing EVL,while dexmedetomidine provides bet-ter hemodynamics and respiratory conditions compared with propofol. Key words: Endoscope ; Pethidine ; Propofol ; Dexmedetomidine ; Esophageal varices liga-tion ;

Comparison of the Analgesic Efficacy of Dexketoprofen Trometamol and Meperidine HCl in the Relief of Renal Colic

In this study, the analgesic effects of dexketoprofen trometamol and meperidine hydrochloride were compared in patients diagnosed with renal colic. This study was a prospective, randomized, double-blind study. Fifty-two patients, between the ages of 18 and 70 years who were diagnosed with renal colic, were enrolled in the study after obtaining ethics committee approval. Before drug injection, dexketoprofen trometamol and meperidine hydrochloride were placed in closed envelopes, and the patients were randomly given a single dose of intravenous infusion for 20 minutes. Severity of pain and symptoms was evaluated with the numerical rating scale and renal colic symptom score for each patient immediately before administration of drugs and 30 minutes after the end of the application. At the same time, systolic arterial blood pressure, diastolic arterial pressure, respiratory rate, heart rate, nausea, vomiting, and reactions due to drug administration were recorded before and after drug administration. In statistical methods, t test, analysis of variance, and repeated measure analysis were used for the analysis of normally distributed continuous variables and the Mann-Whitney U, Kruskal-Wallis and Friedman tests were used for analysis of not-normally distributed continuous variables. In the analysis of discrete variables, the χ test was used. In both groups, a significant decrease was found in numerical rating scale values measured 30 minutes after drug administration, but the decline in dexketoprofen trometamol group (P = 0.02) was found to be more. Although a significant decrease was found in the renal colic symptom score (P < 0.001) values measured after drug administration in the dexketoprofen trometamol group, no significant decrease was found in the meperidine HCl (P = 0.058) group. After drug administration, a statistically significant decrease was found in the systolic arterial blood pressure, heart rate, and respiratory rate in both groups. Also, a statistically significant decrease was found in the diastolic arterial pressure in the meperidine group. But these changes in vital findings were not serious enough to disrupt patients' clinical status. With this study, we concluded that dexketoprofen trometamol, from the nonsteroidal anti-inflammatory drug group, can be within the primary treatment options for renal colic because of better analgesic efficacy, being well tolerated by patients compared with meperidine hydrochloride.

Ultrasound guided single injection caudal epidural anesthesia of isobaric bupivacaine with/without dexamethasone for geriatric patients undergoing total hip replacement surgery

BackgroundDexamethasone has anti-inflammatory properties that can affect postoperative analgesia when added to caudal bupivacaine.MethodsSeventy-two geriatric patients scheduled for elective total hip replacement under ultrasound guided caudal anesthesia were randomized blindly into two groups: Group BD received caudal isobaric bupivacaine 0.25% (20 ml) and dexamethasone 8 mg (2 ml) and Group BS received caudal isobaric bupivacaine 0.25% (20 ml) and normal saline (2 ml). Postoperative analgesia was assessed by recording time to first rescue analgesia and the analgesic doses (paracetamol and meperidine hydrochloride) required during the first 24 h postoperatively as a primary outcome. Secondary outcomes were the time taken to the onset of sensory analgesia at T10, time to the onset of complete motor block, VAS pain score at rest and on movement at 1, 2, 4, 6, 8, 12 and 24 h, and postoperative adverse events.ResultsGroup BD had a significantly longer time to first rescue analgesia [402 (63) vs 213 (53)] min and significantly lower doses of paracetamol [3389 (728) vs 2833 (697)] mg meperidine hydrochloride [78 (30) vs 142 (28)] mg than Group BS. VAS scores were significantly lower in Group BD than Group BS both at rest and on movement respectively at 4, 6, 8, 12 and 24 h.ConclusionAdding dexamethasone with isobaric bupivacaine caudal anesthesia prolongs the duration of postoperative analgesia and decreased postoperative analgesic requirement in geriatric patients undergoing total hip replacement surgery in comparison isobaric bupivacaine alone.

Observation on the analgesic effect of intercostal nerve block after thoracotomy

Objective Observe the analgesic effect of intercostals never block using ropivacaine after thoracotomy.Methods Divide the 36 cases who would be performed operation into two groups randomly and there are 18 cases in each group.Every patient got pethidine intramuscular injections to relieve pain in group A and ropivacaine (0.375％ 20 ml) to perform intercostal nerve block instead in group B.Record the VAS mark in different time point after anesthesia recovery and pulmonary complications performance of each group.Results The analgesic effect in group B is much better than group A and which has lower rate of postoperative complications.Conclusion It has a satisfactory analgesic effect to use ropivacaine to perform intercastal never block.And it is simple to use which proved a better analgesic method after thoracotomy. Key words: Ropivacaine; Intercostal nerve block; Analgesic

Efficacy of intramuscular meperidine hydrochloride versus placebo in experimental foot lameness in horses

There are no peer reviewed, blinded controlled studies regarding the skeletal analgesic efficacy of intramuscularly administered meperidine in horses. Using an adjustable heart bar shoe model of equine foot pain, the objective of this study was to test the hypothesis that meperidine (pethidine) administered intramuscularly would prove more efficacious in alleviating lameness than a saline placebo. Crossover pharmacodynamic experiment. Eight healthy adult Thoroughbred horses randomly underwent weekly i.m. treatments 1 h after lameness induction: saline placebo (1 ml/45 kg bwt) or meperidine hydrochloride (1 mg/kg bwt i.m.). Heart rate (HR) and lameness score (LS) responses were assessed by a blinded observer every 20 min for 5 h after lameness induction and then hourly through 12 h after treatment. Jugular venous blood samples were obtained at -1, 0, 0:05, 1, 2, 4, 6, 8, 10 and 12 h and were subsequently analysed for drug concentrations (lower limit of detection, 1 ng/ml). Repeated measures ANOVA and post hoc Tukey's test were used to identify analgesic effects at a significance level of P<0.05. Mean (± s.e.) HR were lower in meperidine trials at 2.3, 3.3 and 3.7 h post administration (P<0.05). Mean LS were lower in meperidine trials at 2.0, 2.3 and 3.3 h post administration (P<0.05). Mean plasma (meperidine) peaked at 227 ± 52 ng/ml at 1 h post administration and decreased to 2.7 ± 0.3 ng/ml at 12 h post administration. In 3 of 8 subjects, plasma (meperidine) was below the lower limit of detection at 12 h after administration. Intramuscular meperidine was more effective than the saline placebo but only for 2.0-3.7 h post administration compared with the 8-12 h durations of efficacy reported previously using this same model when horses were treated with nonsteroidal anti-inflammatory drugs (NSAIDs). Meperidine may be a suitable nonNSAID alternative analgesic for acute foot pain with efficacy lasting from 2-3 h after a single i.m. dose.

Anaesthesia and orphan disease

Anaesthesia and orphan disease

The Efficacy of Bupivacaine Infiltration on the Nephrostomy Tract in Tubeless and Standard Percutaneous Nephrolithotomy: A Prospective, Randomized, Multicenter Study

To assess the analgesic efficacy of bupivacaine infiltrations into the nephrostomy tract in tubeless and standard percutaneous nephrolithotomy (PCNL). This prospective, randomized controlled study enrolled 121 patients. Patients were randomized to receive a 20-mL infiltration of 0.25% bupivacaine into the nephrostomy tract after PCNL. Patients were divided into 2 groups. The group 1 patients received bupivacaine infiltrations, whereas group 2 did not. Patients' visual analog scale (VAS) pain scores were evaluated at 6, 12, and 24 hours postoperatively. Pain in the postoperative period was managed with intramuscular diclofenac sodium (75 mg) or meperidine (pethidine) hydrochloride (50 mg), as requested by the patients. The patients were a mean age of 43.2 ± 12.7 years (range, 18-74 years). The VAS pain scores at 6, 12, and 24 hours postoperatively and the amount of diclofenac sodium needed were significantly less in the group with bupivacaine infiltration than in those that did not receive the infiltration (P<.05). The VAS pain scores in patients with tubeless PCNL were significantly lower than those in patients with standard PCNL (P<.05). The pain after tubeless and standard PCNL may be decreased by bupivacaine infiltration into the nephrostomy tract. The findings of the present study reveal that a tubeless procedure and local analgesic infiltration into the nephrostomy tract after the PCNL is the more comfortable procedure for the patients.

Effect of preemptive analgesia with parecoxib sodium on interleukin-6 and C-reactive protein level in patients undergoing radical excision of breast cancer

Objective To investigate the preemptive analgesia of parecoxib sodium on interleukin-6 (IL-6) and C-reactive protein (CRP)level in patients undergoing radical excision of breast cancer,and to evaluate its analgesic effect.Methods Sixty ASA Ⅰ-Ⅱ patients undergoing radical excision of breast cancer were randomly divided into three groups(n=20):preemptive analgesia group(group A),blank control group(group B) and postoperative analgesia group(group C).Patients received intravenous parecoxib sodium 40 mg before 10 min(group A) or at the end of surgery(group C) or normal saline(group B).Blood samples were collected from all patients before anesthesia(T1) and at 1 h (T2),6 h (T3),24 h (T4) after surgery for assaying the plasma levels of interleukin-6 and C-reactive protein.Postoperative analgesic efficacy was assessed with visual analog scales (VAS).Results Compared with T1,the plasma levels of IL-6 and CRP were significantly higher at T2,T3 and T4 in all the three groups (P＜0.01).In group B,IL-6 and CRP levels were increased along with time progress,and were higher at T4 than at T2 (P＜0.01).The plasma levels of interleukin-6 in preemptive analgesia group at T2,T3,T4 time points were [(16.6±2.4),(27.0±3.7),(24.5 ±3.6) ng/L],lower than control group [(24.2±2.6),(32.9±4.2),(36.2±5.1) ng/L] and postoperative analgesia group [(20.8±2.7),(29.4±3.9),(31.9±4.4) ng/L] (P＜0.05).The plasma levels of C-reactive protein in preemptive analgesia group at T2,T3,T4 time points were [(10.6±2.4),(18.4±3.5),(40.7±4.3) mg/L],lower than control group [(14.9±3.2),(24.3±4.4),(54.6±5.4) mg/L] and postoperative analgesia group [12.3±2.6),(21.7±4.2),(45.6±4.8) mg/L] (P＜0.05).The VAS scores at both group A and C at 1,2,4,6 h,were [(2.1±1.0),(2.4±1.2),(2.9±1.3),(3.3±1.2)points],[(2.9±1.2),(3.2±1.2),(3.4±1.3),(3.6±1.2)points] lower than at the same time point of group B (P＜0.05).Pethidine consumption at 24 h after operation were higher in group B than in group A and group C (P＜0.05).The VAS scores were no significant differences at 12,24 h in three groups.Conclusions Preemptive analgesia with parecoxib can be achieved good analgesic effect and can effectively inhibit the postoperative of IL-6 and C-reactive protein level increased,regulate the body's inflammatory and stress response,possess immunization protection.,promote postoperative recovery. Key words: Parecoxib; Breast cancer; Preemptive analgesia; Interleukin-6; C-reactive protein

Study on modified anesthesia in the bronchoalveolar lavage of pneumoconiosis

To observe the anesthetic effect of modified anesthesia in the bronchoalveolar lavage. 118 cases randomly fell in two groups: traditional group: intramuscular injection of 10 mg diazepam prior to routine anesthesia; modified group: preoperative intramuscular injection of 50 mg dolantin,and venous injection of 2 ml physiological saline, 10 mg dexamethasone, 5 mg ephedrine; observe the anesthetic effect, satisfaction and lavage quantity in patients. The excellence rate and satisfaction of anesthetic effect are both 100% in modified group while 82.76% and 76.2% in the tradition group. The result indicates the excellence rate and satisfaction of anesthetic effect in modified group are better than the traditional group with a significant difference (P<0.05); the lavage quantity in the modified group is significantly higher than that in the traditional group with a significant difference (P<0.01 ). Dolantin, dexamethasone and ephedrine preoperatively used with a good anesthetic effect can improve the cooperation of patients in bronchoalveolar lavage with less pain and increased lavage quantity, thereby worthy of clinical application.

Meperidine: A Continuing Problem

Letter to the Editor regarding meperidine prescriptions in Queensland, Australia, 1999 to 2010.

Comparison of effects of sevoflurane versus propofol on tourniquet-induced lower extremity ischemia-reperfusion injury in patients undergoing orthopedic operation

Objective To compare the effects of sevoflurane versus propofol on a tourniquet-induced lower extremity ischemia-reperfusion (I/R) injury in patients undergoing orthopedic operation.Methods Fifty-four ASA Ⅰ or Ⅱ patients,aged 18-64 yr,weighing 44-85 kg,scheduled for elective orthopedic operation,were randomly assigned into 3 groups (n =18 each)∶ control group (group C),propofol group (group P) and sevoflurane group (group S).After lumbar plexus-sciatic nerve block,the laryngeal mask airway insertion was facilitated with propofol 2-4 mg/kg and anesthesia was maintained with infusion of propofol at 2-4 mg· kg-1 · h-1 during operation in group P.In group S,8 ％ sevoflurane was inhaled,the laryngeal mask airway was inserted and anesthesia was maintained with inhalation of 2％ sevoflurane during operation.A tourniquet was applied and inflated (300 mm Hg)during 15-20 min after administration of propofol or sevoflurane in groups P and S,and a tourniquet was also applied at the same time point in group C.The tourniquet was released at the end of operation.Postoperative analgesia was performed with oral meloxicam or intramuscular pethidine and VAS score was maintained ＜ 3.Blood samples were taken after admission to the operating room (T1) and 30 min after tourniquet release (T2) to determine the plasma concentrations of MDA and TNF-α.The changing rate of MDA and TNF-α concentrations was calculated.The tourniquet-related adverse events and amount of analgesics consumed within 24 h after operation were recorded.Results No tourniquet-related adverse events occurred in all the patients.Compared with group C,the plasma concentrations of MDA and TNF-α and changing rate were significantly decreased at T2 in groups P and S (P ＜ 0.05).There were no significant differences in the plasma concentrations of MDA and TNF-α and changing rate between group S and group P (P ＞ 0.05).Compared with the baseline value at T1,no significant change was found in the plasma concentrations of MDA and TNF-α at T2 in groups P and S (P ＞ 0.05),and the plasma concentrations of MDA and TNF-α were significantly increased at T2 in group C (P ＜ 0.05).There was no significant difference in the amount of analgesics consumed within 24 h after operation between the three groups (P ＞ 0.05).Conclusion Both sevoflurane and propofol can reduce a tourniquet-induced lower extremity I/R injury in patients undergoing orthopedic operation and the efficacy is comparable. Key words: Anesthetics, inhalation ; Propofol ; Tourniquets ; Reperfusion injury ; Lower extremity

The prospective study of emergency therapeutic methods for renal colic

Objective To analyze and compare the emergency therapeutic methods for renal colic,and to explore the preferable way of emergency therapies for renal colic.Methods A total of 340 cases of renal colic in emergency department were randomly divided into groups A (pethidine),B (diclofenac sodium),C (phloroglucinol),and D (diclofenac sodium + phloroglucino).The average time of therapeutic effect after given 30 min in different groups was observed.Results The average time of effect in group A [(9.53 ±3.34) min],group D[(10.49 ±2.54) min],and group B[(10.51 ±2.27)min] and they were much shorter than group C [(18.51 ±4.86) min] (P ＜0.01).There was no significant difference in the effective rate among the 4 groups(P ＞ 0.05).The relapse rate of group C (11.43％) and group D (9.00％) were much lower than group A (24.59％) and group B(23.75％).There was no adverse reaction in group C.The rates of adverse reactions in group B (2.27％) and group D (2.78％) were much lower than group A (27.27％).Conclusions Diclofenac sodium combined with phloroglucinol was preferable emergency treatment for renal colic. Key words: Emergency treatment; Colic/therapy; Kidney diseases/therapy; Prospective studies

Efficacy of preemptive analgesia with parecoxib sodium combined with local infiltration anesthesia with ropivacaine for postoperative pain after laparoscopic cholecystectomy

Objective To investigate the efficacy of preemptive analgesia with parecoxib sodium combined with local infiltration anesthesia with ropivacaine for postoperative pain after laparoscopic cholecystectomy.Methods One hundred and fifty ASA Ⅰ or Ⅱ patients,aged 41-63 yr,weighing 55-87 kg,scheduled for laparoscopic cholecystectomy under the general anesthesia,were randomly divided into 3 groups (n=50 each): parecoxib sodium+0.9％ normal saline (group A),parecoxib sodium + 0.5％ ropivacaine (group B) and parecoxib sodium + 0.75 ％ ropivacaine (group C).Parecoxib sodium 40 mg was injected intravenously 30 min before induction of anesthesia.Anesthesia was induced and maintained with remifentanil and propofol given by TCI.Immediately before skin closure,0.9％ normal saline 12 ml was given in group A,and 0.5％ and 0.75％ ropivacaine 12 ml were injected for local infiltration anesthesia in groups B and C,respectively.VAS scores were maintained ≤ 3after operation.When VAS scores ＞ 3,pethidine 75 mg was injected intramuscularly.Ramsay sedation scores were recorded at the end of operation and 2,4,8,12 and 24 h after operation.The side effects (nausea and vomiting,allergy,respiratory depression,etc.),requirement for pethidine,algesic sites (incisional pain,upper abdominal pain,referred pain in right shoulder),and condition of the wound healing were all recorded within 24 h after opcration.Results Compared with group A,Ramsay sedation scores,the incidence of nausea and vomiting,the requirement for pethidine and total amount of pethidine,and the incidence of incisional pain were significantly decreased in groups B and C (P ＜ 0.05 or 0.01).Compared with group B,the requirement for pethidine and total amount of pethidine,and the incidence of incisional pain were significantly decreased in group C (P ＜ 0.05 or 0.01).There was no significant difference in Ramsay sedation scores between groups B and C (P ＞ 0.05).There was no significant difference in the condition of the wound healing,upper abdominal pain and referred pain in right shoulder between groups A,B and C (P ＞ 0.05).Conclusion For the patients scheduled for laparoscopic cholecystectomy,local infiltration anesthesia with ropivacaine can improve the efficacy of preemptive analgesia with parecoxib sodium,and it provides better postoperative analgesia when 0.75 ％ ropivacaine is used. Key words: Cyclooxygenase 2 inhibitors; Amides; Analgesia; Laparoscopy

Effects of postoperative epidural analgesia on prolactin level and neonatal neurobehavioral scores after caesarean section

Objective To investigate the effect of postoperative epidural analgesia on prolactin level and neonatal neurological and adaptive capacity scores(NACS) after caesarean section.Methods Sixty healthy primipara after caesarean section under combined spinal epidural anesthesia were randomly divided into three groups(n=20).Received epidural analgesia with complex of butorphanol (0.006％) and 1evobupivacaine(0.15％) in group B,those with morphine(0.004％) and levobupivacaine(0.15％) in group M.Group C was given conventional postoperative analgesia with meperidine injection.The visual analog scales (VAS) and the adverse effects were observed at 4,8,12,24 and 48 h after operation.Detect the prolactin (PRL) level in serum before operation,after operation 24 h and 48 h separately by electrochemiluminescence immunoassay.Keep note of the first lactation time.NACS was recorded at 24,48 and 72 h.Results The VAS was significantly lower in group B [4 h:( 1.1±0.7),8 h:(1.2±1.2),12 h:( 1.7±1.1),24 h:(1.4±1.5),48 h:(1.0±0.9)] and group M [4 h:(1.1±0.9),8 h:(1.3±1.9),12 h:(1.6±1.2),24h:(1.3±1.3),48 h:(1.0±0.7)] than that in group C [4 h:(2.2±1.3),8 h:(4.3±1.7),12 h:(4.7±1.5),24 h:(3.6±1.3),48 h:(2.4±1.1)] at all time points (P＜0.05).The adverse effects of pruritus,nausea and vomiting were significantly more in group M (25％,30％,respectively)than that in group B (5％,0％,respectively)(P＜0.05).The first lactation time of the group B (26±8) h and M (26±9) h were distinctively earlier than that of the group C (35±10) h (P＜0.05).The PRL concentration in serum of the group B [(357±62),(387±63) μg/L,respectively] and group M [(367±64),(392±61) μg/L,respectively] at 24,48 h after operation were higher than that of the group C [(299±93),(327±74) μg/L,respectively](P＜0.05).There was no significant difference NACS among the 3 groups.Conclusions Combined with butorphanol levobupivacaine,epidural analgesia in parturient after cesarean section can provide effective analgesia,with less pruritus,nausea and vomiting,and promoting lactation without untoward reaction on NACS. Key words: Butorphanol ; Caesarean section; Epidural analgesia; Prolactin; Neonatal

The effect of pethidine combined with unarmed cervical expansion on stages of labor

Objective To study the effect and side - effect of pethidine intramuscular injection combined with unarmed cervical expansion on stages of labor.Methods A total of 120 normal primiparas were divided randomly into two groups.60 primiparas served as the experimental group ( Group A) and received pethidine intramuscular injection and unarmed cervical expansion ; 60 primiparas were measured as the control group ( Group B ) ,treated with normal care.There was no statistical significance in primiparas in two groups with age,weight,gestational weeks and fetal head size ( P ＞ 0.05 ).Stages of labor,pain rating scales of puerperas,fetal distress and postpartum hemorrhage were observed.Results Both of active phase and second stage of labor were shorten ed in group A.The cases of normal delivery increased in group A than that in group B.There were significant differences between two groups.Conclusions Pethidine intramuscular injection combined with unarmed cervical expansion can shorten active phase and second stage of labor,reduce postpartum hemorrhage,abate pain of puerperas,decrease fetal distress and asphyxia neonatorum and decrease rate of caesarean section. Key words: Pethidine; Unarmed cervical expansion; Stages of labor; Caesarean section

Application of therapeutic touch in post-operation pain control for old patients undergoing total hip joint replacement

Objective To evaluate the effect of therapeutic touch in post-operation pain control for old patients undergoing total hip joint replacement.Methods Seventy-one older patients undergoing total hip joint replacement were randomly divided into control group ( n =35 ) that received the conventional demulcent method (intermittent injection of pethidine hydrochloride)and experimental group (n =36) that received the therapeutic touch and pethidine hydrochloride was added if therapeutic touch had no effect.Then,the pain level,sleep quality score,compliance score to doctors' prescription within 3 days after operation of two groups were observed.Results The pain level,sleep quality,and compliance to doctors' prescription of experimental group were significantly better than that of the control group [( 1.76 ± 1.08 ) vs (2.94 ± 1.23 ),(2.25 ± 0.67 ) vs ( 1.36 ± 1.23 ),(2.42 ± 0.66) vs ( 1.56 ± 0.58 )],with statistically significant differences ( t =4.299,3.801,5.826,respectively; P ＜ 0.01).The injection times and the dosage of the medicine within 3 days after operation of experimental group were significantly less than that of the control group(6 vs 98,x2 =32.28,P ＜0.05 ;300 mg vs 4 900 mg,U =236.00,P ＜ 0.01 ).Conclusions Therapeutic touch is helpful for the pain control of older patients undergoing total hip joint replacement,and it can significantly reduce the dosage of the medicine. Key words: Arthroplasty, replacement, hip; Therapeutic touch; Analgesia

Research in influence of patient-controlled analgesia on incidence of postpartum depression after cesarean section

Objective To explore the influence of patient-controlled epidural analgesia(PCEA) on incidence of postpartum depression after cesarean section. Methods 256 cases of singleton term primary cesarean delivery were randomly divided into the study group( 130 cases)and the control group( 126 cases).The study group retained analgesia pump connected with epidural catheter,analgesic liquid was injected.In the control group,epidural catheter was removed,and was given intramuscular injection of pethidine hydrochloride 100 mg 4～6 h after operation,repeated 6 h later,total dosage was 200 mg.Postoperative observation time was 48h.Plasma prolactin(PRL) concentration was determined by radioimmunoassay in prenatal,postnatal 24 h and 48 h.Edinburgh postnatal depression scale (EPDS) was used to assess depression state 6 weeks postpartum in the two groups.The incidence of postpartum depression was compared between two groups. Results The plasma PRL level in the study group was significantly higher than the control group 24 h,48 h postpartum.The incidence rate of depression in the study group was 6.15％,while was 16.67％ in the control group,the differences were statistically significant. Conclusions The application of PCEA after cesarean section can significantly reduce the incidence of postpartum depression,and has very important practical significance in preventing the incidence of postpartum depression. Key words: Patient-controlled analgesia; Cesarean section; Postpartum; Depression