Clinical Effect of Small-Dose Dexmedetomidine Combined with Oxycodone for Patient-Controlled Analgesia After Colon Cancer Surgery

2020 ◽  
Vol 10 (2) ◽  
pp. 435-443
Author(s):  
Xi Zhan ◽  
Chang-Cheng Lei ◽  
Hai-Xia Jiang ◽  
Fei Qiao

This study aimed to elucidate the efficacy and safety of oxycodone combined with dexmedetomidine for patientcontrolled analgesia after colon cancer. Sixty patients were randomly divided into the experimental and control groups (n = 30 each). The control group received 0.5 mg/kg oxycodone. The experimental group received 0.5 mg/kg oxycodone and 2 μg/kg dexmedetomidine. Both groups were administered normal saline (NS) up to 100 mL (via background infusion at 2 mL/h with a 0.5-mL bolus dose and 15-min lockout interval). Both groups received oxycodone 0.1 mg/kg and tropisetron 5 mg, 20 min before the end of surgery. The MAP and HR of T1, T2, T3, and T4 were recorded in three groups. After the operation, a blinded observer assessed pain using the visual analogue scale (VAS) score, level of sedation (Ramsay score), and postoperative nausea and vomiting score at 2, 6, 24, 48 h. Side effects included dizziness, shivering, headache, and pruritus. The results showed that, in the experimental group, the T2∼T5 activity pain and T2∼T4 visceral pain VAS scores of patients were obviously lower than those in the control group (activity pain P T2∼T5 = 0.000, visceral pain P T2 = 0.018, P T3 = 0.001, P T4 = 0.010). The dosage of analgesic pump and number of rescue analgesia occurrences in the experimental group were far lower than those in the control group (P = 0.000 and P = 0.029, respectively). The time of first anus exhaust of the patients in the experimental group was obviously earlier than that of the control group (P = 0.030), and the number of vomiting occurrences of the patients in the experiment group was obviously lower than that in the control group (P = 0.023). No significant differences in the incidence of other adverse reactions were observed between the two groups within 48 h post-operation (P >0.05). In summary, oxycodone combined with dexmedetomidine can be safely and effectively used for analgesia after laparoscopic radical resection of colon cancer.

2022 ◽  
Vol 20 (4) ◽  
pp. 25-31
Author(s):  
A. A. Parshina ◽  
N. N. Tsybikov ◽  
P. P. Tereshkov ◽  
T. M. Karavaeva ◽  
M. V. Maksimenya

Aim. To investigate formation of neutrophil extracellular traps (NETs) and their impact on fibrinolysis in patients with colon cancer.Materials and methods. The study was performed in two groups. The experimental group consisted of patients with stage 2–3 non-metastatic colon cancer (n = 17, average age – 67 years). The control group included healthy volunteers matched by sex and age (n = 30, average age – 68 years). An experimental model was created from the whole blood. It included platelet-poor plasma and an isolated culture of neutrophils, previously induced to NETosis by adding 100 nmol PMA. The samples were incubated for 4 hours, then the test tubes were centrifuged to pellet cells and their remnants, and the plasma was transferred for subsequent examination. The plasma incubated with intact neutrophils was used as a control. The levels of interleukin-8 (IL-8) and P-selectin glycoprotein ligand-1 (PSGL-1) were used to determine the degree of cell activation. NETosis was confirmed by enzyme-linked immunosorbent assay (ELISA) and fluorescent microscopy. Fibrinolysis was assessed using the thrombodynamics test. The results were compared with the levels of fibrinolytic system components measured by flow cytometry.Results. In the control group, NETosis induction contributed to pronounced neutrophil activation that was accompanied by an increase in the IL-8, PSGL-1, and plasminogen levels, a decrease in PAI-1, and enhancement of fibrinolysis, compared with the intact samples. Higher levels of IL-8, PSGL-1, plasminogen, and PAI-1 and intensified fibrinolysis were detected in the intact samples. However, PMA-induced NETosis did not result in an increase in the degree of activation and significant changes in the given parameters.Conclusion. NETosis promotes both formation and lysis of fibrin clots. However, in cancer patients, suicidal NETosis does not contribute to fibrinolysis due to intracellular protease depletion, which may be one of the mechanisms causing hypercoagulation and insufficient fibrinolysis in cancer. 


2018 ◽  
Vol 2 (6) ◽  
Author(s):  
Ke Du ◽  
Zhenxing Wang

【Abstract】Objective: To compare the clinical effects of minimally invasive esophageal cancer radical resection and traditional esophageal cancer radical resection.Methods: 200 cases of esophageal cancer radical resection were performed from July 2014 to July 2017 in our hospital.The cases were divided into experimental group and control group, 82 cases in the experimental group and 118 cases in the control group.The experimental group was treated with minimally invasive esophageal cancer radical surgery, and the control group was treated with conventional thoracotomy.Record the comparison between the two groups (1) surgical conditions, including the time of surgery, intraoperative blood loss, hospitalization time; (2) the number of lymph nodes cleaned; (3) the postoperative control group used conventional thoracotomy, including lung lesions, anastomotic fistula / narrow.RESULTS: The parameters of operation time, intraoperative blood loss, hospitalization time, and number of lymph nodes cleaned in the experimental group were lower than those in the control group, and the difference was statistically significant (p<0.05). In addition to pulmonary infection (p<0.05), There was no significant difference in the incidence of other complications between the experimental group and the control group (p>0.05).Conclusion: Minimally invasive esophageal cancer radical resection and conventional thoracotomy have good clinical effects in the treatment of esophageal cancer. Minimally invasive esophageal cancer radical surgery can effectively reduce intraoperative trauma and postoperative reaction, which is worthy of popularization and application.


2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Huajia Dai ◽  
Yuhao Bian ◽  
Libin Wang ◽  
Junfeng Yang

This study was to analyze the diagnostic value of magnetic resonance imaging (MRI) for gastric cancer (GC) lesions and the treatment effect of complete laparoscopic radical resection (CLSRR). A malignant tumor recognition algorithm was constructed in this study based on the backprojection (BP) and support vector machine (SVM), which was named BPS. 78 GC patients were divided into an experimental group (received CLSRR) and a control group (received assisted laparoscopic radical resection (ALSRR)), with 39 cases in each group. It was found that the BPS algorithm showed lower relative mean square error (MSE) in axle x (OMSE, x) and axle y (OMSE, x), but the classification accuracy (CA) was the opposite ( P < 0.05 ). The postoperative hospital stay, analgesia duration, first exhaust time (FET), and first off-bed activity time (FOBA) for patients in the experimental group were less ( P < 0.05 ). The operation time of the experimental group (270.56 ± 90.55 min) was significantly longer than that of the control group (228.07 ± 75.26 min) ( P < 0.05 ). There were 3 cases of anastomotic fistula, 1 case of acute peritonitis, and 2 cases of lung infections in the experimental group, which were greatly less than those in the control group (7 cases, 4 cases, and 3 cases) ( P < 0.05 ). In short, the BPS algorithm was superior in processing MRI images and could improve the diagnostic effect of MRI images. The CLSRR could reduce the length of hospital stay and the probability of complications in GC patients, so it could be used as a surgical plan for the clinical treatment of advanced GC.


2021 ◽  
Vol 5 (3) ◽  
Author(s):  
Wei Zheng ◽  
Xiang Yan ◽  
Xiaoxue Song

Objective: To study and analyze the clinical efficacy of gemcitabine combined with Tegafur chemotherapy after radical resection of pancreatic cancer. Methods: The subjects of the study were 200 patients who were admitted to the hospital from January 2018 to February 2021 requiring chemotherapy after radical resection of pancreatic cancer. According to the different treatment methods, they were divided into a experimental group (gemcitabine combined with Tegafur chemotherapy) and a control group (single gemcitabine chemotherapy), and the treatment efficacy of the two groups of patients was observed and compared. Results: Compared with the control group, patients in the experimental group had significantly better treatment efficacy, quality of life scores and post-treatment anxiety and depression scores. The difference between the groups was significant (p<0.05). Conclusion: Gemcitabine combined with Tegafur chemotherapy for patients requiring chemotherapy after radical resection of pancreatic cancer can significantly improve the treatment efficacy for the disease, improve the patient's quality of life, and ensure that the patient's emotional state during treatment is more positive.


2019 ◽  
Author(s):  
Manhua Zhu ◽  
Yong Qi ◽  
Huijuan He ◽  
Jinfeng Lou ◽  
Qingqing Pei ◽  
...  

Abstract Background: Quadratus lumborum block (QLB) is an effective analgesia that lowers opioid consumption after lower abdominal and hip surgeries. The subcostal approach to transmuscular QLB is a novel technique that can provide postoperative analgesia by blocking more dermatomes. The aim of this study is to evaluate the efficacy and viability of subcostal approach to QLB after laparoscopic nephrectomy. Methods: Sixty patients who underwent laparoscopic nephrectomy were randomly divided into the subcostal approach to QLB group (QLB group, n=30) and the control group (C group, n=30). All patients underwent ultrasound-guided subcostal approach to QLB in an ipsilateral parasagittal oblique plane at the L1–L2 level. The QLB group received 0.4 cc/kg of 0.3% ropivacaine, and the C group received 0.4 cc/kg of 0.9% saline. Postoperatively, a patient-controlled intravenous analgesic pump with sufentanil was attached to all the patients. The primary outcome was sufentanil consumption within the first 24 h after surgery. The secondary outcomes included the Ramsey sedation scale (RSS) scores and Bruggemann comfort scale (BCS) scores 6 h (T1), 12 h (T2), and 24 h (T3) after surgery, intraoperative remifentanil consumption, number of patients requiring rescue analgesia, time to recovery of intestinal function, mobilization time after surgery, and presence of side effects. Results: Sufentanil consumption within the first 24 h after surgery was significantly lower in the QLB group than in the C group (mean [standard deviation]: 34.1 [9.9] μg vs 42.1 [11.6] μg, P=.006). The RSS scores did not differ between the two groups, and the BCS scores of the QLB group at T1 and T2 time points was significantly higher than those of the C group(P<0.05). The consumption of remifentanil intraoperatively and the number of patients requiring rescue analgesia were significantly lower in the QLB group (P<0.05). Time to recovery of intestinal function and mobilization time after surgery were significantly earlier in the QLB group (P<0.05). The incidence of postoperative nausea and vomiting was significantly lower in the QLB group (P<0.05). Conclusions: The ultrasound-guided subcostal approach to QLB is an effective analgesic technique in patients undergoing laparoscopic nephrectomy as it reduces the consumption of sufentanil postoperatively.


2005 ◽  
Vol 23 (19) ◽  
pp. 4414-4423 ◽  
Author(s):  
Isabelle Ray-Coquard ◽  
Thierry Philip ◽  
Guy de Laroche ◽  
Xavier Froger ◽  
Jean-Philippe Suchaud ◽  
...  

Purpose A cancer network of general or private hospitals of a French region was started in 1995 for improving quality of care and rationalizing medical prescriptions. The impact of implementing a clinical practice guidelines (CPG) project assessed conformity with guidelines in medical practice; significant changes were observed within the network, whereas no changes were observed in a control region without cancer network. In the present study, we evaluated the persistence of conformity to guidelines through a new medical audit. Patients and Methods In 1999, the hospitals of the previously compared experimental and control groups accepted to reassess the impact of CPG. A controlled transversal study was performed in the experimental group (cancer network) and in the control group (no regional cancer network). In 1996 (first audit) and in 1999 (present audit), all new patients with colon cancer (177 and 200 in experimental group and 118 and 100 in control group, respectively) and early breast cancer (444 and 381 in experimental group and 172 and 204 in control group, respectively) were selected. Results In the experimental group, the compliance of medical decisions with CPG was significantly higher in 1999 than in 1996 for colon cancer (73%; 95% CI, 67% to 79% v 56%; 95% CI, 49% to 63%, respectively; P = .003) and similar for the two periods for breast cancer (36%; 95% CI, 31% to 41% v 40%; 95% CI, 35% to 44%, respectively; P = .24). In the control group, compliance was significantly higher in 1999 than in 1996 for colon cancer (67%; 95% CI, 58% to 76% v 38%; 95% CI, 29% to 47%, respectively; P < .001) and identical for the two periods for breast cancer (4%; 95% CI, 1% to 7% v 7%; 95% CI, 3% to 11%, respectively; P = .19). Conclusion The CPG program for cancer management produced persistent changes in medical practice in our cancer network in terms of conformity with CPG.


2020 ◽  
Author(s):  
Yulong Tian ◽  
Shougen Cao ◽  
Leping Li ◽  
Qingsi He ◽  
Lijian Xia ◽  
...  

Abstract Background: As well known, the incidence of gastric cancer in East Asian countries is much higher than the international average. Therefore, improving the prognosis of patients and establishing effective clinical pathways are important topics for the prevention and treatment of gastric cancer. At present, the enhanced recovery after surgery (ERAS) pathway is widely used in the field of gastric surgery. Many RCT studies have proven that the ERAS regimen can not improve the short-term clinical outcomes of gastric cancer patients. However, a prospective study on the effect of the ERAS pathway on the prognosis of gastric cancer patients has not been reported. This trial aims to confirm whether ERAS pathway can improve disease-free survival (DFS) and overall survival (OS) in patients undergoing laparoscopic-assisted radical resection for distal gastric cancer.Methods/design: This study is a prospective, multicenter, randomized controlled trial (RCT). This experiment will include randomly divided groups, the experimental group and the control group, according to a proportion of 1:1. The perioperative period of the experimental group will be managed according to the ERAS pathway, and the control group will be managed according to the traditional management mode. An estimated 400 patients will be enrolled. The main endpoint is to compare the 3-year OS and PFS between the two groups.Discussion: This RCT should demonstrate whether ERAS pathway is superior to traditional treatment on inflammatory indexes, short-term clinical outcome and survival for laparoscopic assisted radical resection of distal gastric cancer.Our data can provide evidence that the ERAS pathway improves survival in patients with gastric cancer.Trial registration: Chinese Clinical Trial Registry, CHiCTR1900022438. Registered on 11 April 2019


2021 ◽  
Author(s):  
Rong Chen ◽  
Hong Cao ◽  
Zhibo Sun ◽  
Liangbo Jiang ◽  
Xiangwei Li ◽  
...  

Abstract Objective: The patellar inferior pole fracture is typically comminuted. Hence, achieving firm fixation and early activity is highly challenging. In this article, we employed the method of wire cerclage through a generated bone hole to reduce the fracture. Our objective was to compare the clinical efficacy of patellar concentrator alone with a combination of cerclage and patellar concentrator in the treatment of patellar inferior pole fracture.Methods: We conducted a retrospective review of patients with patellar inferior pole fractures, who underwent patellar concentrator fixation only (the control group) or cerclage combined with patellar concentrator fixation (the experimental group), performed by a single surgeon, between July 2015 and October 2019. Our analysis included surgical indexes like7 aspects (fracture gap after operation, operation time, intra-operative blood loss,intra-operative number of C-arm fluoroscopies conducted, Insall-Salvati ratio calculated immediately after operation, initial range of motion on the 7th day after operation, and fracture healing time), as well as the Bostman score and complications recorded on 1-, 3-, 6-, and 12-month follow up post operation.Results:A total of 94 patients with patellar inferior pole fracture and a minimum 1-year followup were recruited. Following operation, the control group had 33(71.74%) patients with a fracture gap of 0-2 mm and 13(28.26%)patients with a fracture gapgreater than 2 mm(P=0.002). Conversely,the experimental grouphad46(95.83%)patients with a fracture gap of 0-2 mm and 2(4.17%) patients with a fracture gapgreater than 2 mm(P=0.002). Compared to the control group, the experimental group did not experience enhanced operation time or intra-operative blood loss (P=0.811, P=0.823). The Insall-Salvati ratio and initial range of motion in the experimental group were larger than the control group (P=0.037, P=0.000). Alternately, the number of intra-operative C-arm fluoroscopies conductedand fracture healing time of the experimental group were considerably less than the control group (P=0.003,P=0.000).Moreover, at 1-, 3-, 6-, and 12-month follow ups after operation, the Bostman scores of the experimental group were remarkably higher than the control group (P< 0.05).At 12 months post operation, 23 cases (50%) were classified as excellent, 22 cases (47.83%) were good, and 1 case (2.17%) was poor in the control group(P=0.005). In the meantime, in the experimental group, 38 cases (79.17%) were deemed as excellent and 10 cases (20.83%) were good (P=0.005).Lastly, complications were detected in 3 cases (6.52%;1 case of internal fixation loss,2 cases of hematoma) within the control group, and in 1 case(2.08%; marginal wound necrosis) within the experimental group. There was no wound infection, implant discomfort, or broken fixation in eithergroup.Conclusion: Managingthe patellar inferior pole fracture with wire cerclage through a generated bone hole is both simple and effective. Moreover, an additional step of patellar concentrator fixation facilitates early functional exercise, with satisfactory clinical outcome.


2017 ◽  
Vol 2017 ◽  
pp. 1-6 ◽  
Author(s):  
Sultan Keles ◽  
Ozlem Kocaturk

Background. The aim of this retrospective study was to compare immediate postoperative pain scores and need for rescue analgesia in children who underwent pulpotomies and restorative treatment and those who underwent restorative treatment only, all under general anaesthesia.Methods. Ninety patients aged between 3 and 7 years who underwent full mouth dental rehabilitation under general anaesthesia were enrolled in the study and reviewed. The experimental group included patients who were treated with at least one pulpotomy, and the control group was treated with dental fillings only. The Wong-Baker FACES scale was used to evaluate self-reported pain and need for rescue analgesia. The data were analysed using the Kruskal-Wallis test, two samplet-tests, chi-square tests, and Pearson’s correlation analysis.Results. Ninety percent of the children experienced postoperative pain in varying degrees of severity. Immediate postoperative pain scores in experimental group were found to be significantly higher than in control group (x2=24.82,p<0.01). In the experimental group, 48% of the children needed rescue analgesia, compared with only 13% of the children in the control group (x2=13.27,p<0.05).Conclusion. Children who underwent pulpotomy treatment had higher postoperative pain scores and greater need for rescue analgesia than control group who underwent only dental fillings.


2019 ◽  
Author(s):  
Manhua Zhu ◽  
Yong Qi ◽  
Huijuan He ◽  
Jinfeng Lou ◽  
Qingqing Pei ◽  
...  

Abstract Background: Quadratus lumborum block (QLB) is an effective analgesia that lowers opioid consumption after lower abdominal and hip surgeries. The subcostal approach to transmuscular QLB is a novel technique that can provide postoperative analgesia by blocking more dermatomes. The aim of this study is to evaluate the efficacy and viability of subcostal approach to QLB after laparoscopic nephrectomy. Methods: Sixty patients who underwent laparoscopic nephrectomy were randomly divided into the subcostal approach to QLB group (QLB group, n=30) and the control group (C group, n=30). All patients underwent ultrasound-guided subcostal approach to QLB in an ipsilateral parasagittal oblique plane at the L1–L2 level. The QLB group received 0.4 cc/kg of 0.3% ropivacaine, and the C group received 0.4 cc/kg of 0.9% saline. Postoperatively, a patient-controlled intravenous analgesic pump with sufentanil was attached to all the patients. The primary outcome was sufentanil consumption within the first 24 h after surgery. The secondary outcomes included the Ramsey sedation scale (RSS) scores and Bruggemann comfort scale (BCS) scores 6 h (T1), 12 h (T2), and 24 h (T3) after surgery, intraoperative remifentanil consumption, number of patients requiring rescue analgesia, time to recovery of intestinal function, mobilization time after surgery, and presence of side effects. Results: Sufentanil consumption within the first 24 h after surgery was significantly lower in the QLB group than in the C group (mean [standard deviation]: 34.1 [9.9] μg vs 42.1 [11.6] μg, P=.006). The RSS scores did not differ between the two groups, and the BCS scores of the QLB group at T1 and T2 time points was significantly higher than those of the C group(P<0.05). The consumption of remifentanil intraoperatively and the number of patients requiring rescue analgesia were significantly lower in the QLB group (P<0.05). Time to recovery of intestinal function and mobilization time after surgery were significantly earlier in the QLB group (P<0.05). The incidence of postoperative nausea and vomiting was significantly lower in the QLB group (P<0.05). Conclusions: The ultrasound-guided subcostal approach to QLB is an effective analgesic technique in patients undergoing laparoscopic nephrectomy as it reduces the consumption of sufentanil postoperatively.


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