Perineural administration of dexmedetomidine in combination with Bupivacaine Enhances Sensory
post-test
CME Post-TestThis CME Post-Test contains questions for you to answer after you have reviewed all of the material on this CD-ROM. To receive CME credit, please PRINT THIS DOCUMENT and complete all of the information below and return it to the Spasticity CD-ROM Home Study Program, PPS Attn: D. Frontin, 400 Plaza Drive, Secaucus, NJ 07094-1505. Certificates will be mailed to you within 6-8 weeks of receiving this test and your evaluation form.1. Manifestations of damage to the UMN region include:a. Increased stretch reflexesb. Released flexor reflexes in the lower extremityc. Loss of dexterity in the fingers and limb weaknessd. All of the above2. Which of the following is not a clinical manifestation of UMN syndrome that resultsfrom dynamic contraction of the affected muscles:a. Clonusb. Loss of passive range of motionc. Slow, effortful movementd. Exaggerated stretch reflexes3. Symptomatic manifestations of UMN dysfunction includes all of the following except:a. Painb. Flexor and extensor spasmsc. Motor impersistenced. Disfigurement4. The following are passive problems of UMN dysfunction except:a. Difficulty toileting and caring for the perineal regionb. Reaching to graspc. Difficulty dressing the involved armd. Problems with skin integrity5. Which of the following is not an immediate consequence of UMN impairment:a. Rearrangement of spinal activityb. Paralysisc. Immobilization in shortened positiond. All of the above6. Early manifestations of muscle overactivity in the UMN does not include:a. Hyperreflexiab. Co-contractionc. Joint and capsular stiffnessd. Spastic dystonia7. Muscle tone in patients who have chronic UMN symptoms often reflects combineddynamic and static forces.a. Trueb. False8. The objectives of treating spasticity and muscle overactivity are to:a. Reduce symptomsb. Improve passive functionc. Improve active functiond. All of the above9. An assessment tool for evaluating stiffness, a symptomatic problem, is:a. Global pain scaleb. Spasm frequency scalec. Modified Ashworth scaled. All of the above10. Focal problems may be treated with chemodenervation, neurolysis, surgery, andphysical modalities to targeted muscles.a. Trueb. False11. Which of the following is not an oral/systemic agent used in the treatment ofspasticity:a. Tizanidineb. Phenytoinc. Diazepamd. Baclofen12. Implantation of the intrathecal baclofen system is an option under which of thefollowing conditions:a. If infection is presentb. If the patient has a history of allergy or hypersensitivity to baclofenc. If the patient has the potential for pregnancy or is currently breastfeedingd. When oral agents have failed or have resulted in excessive sedation13. The following agents can be used for long-duration nerve blocks except:a. Bupivacaineb. Phenolc. Botulinum toxind. Alcohol14. Phenol blocks can be which of the following?a. Perineuralb. Intramuscular with motor point targetingc. Open nerved. All of the above15. Which of the following statements is incorrect regarding the use of BoTX-A?a. It is useful to treat UMN manifestations of the upper and lower extremitiesb. EMG or electrical stimulation are commonly used to confirm needle location priorto BoTX-A injectionc. Under current clinical guidelines, a maximum dose of 1000 Units of BoTX-A maybe injected monthly as neededd. The smallest possible dose of BoTX-A should be used for optimal muscleoveractivity control16. The exact site of an injection of BoTX-A cannot be confirmed prior to injectionthrough the use of electrical stimulation.a. Trueb. False17. Which of the following techniques are under investigation to enhance the efficacy ofBoTX-A in patients with spasticity?a. Electrical stimulation of target musclesb. Stretching of the musclesc. Higher dilutions of BoTX-Ad. All of the above18. Which neuro-orthopaedic technique does not require surgery to treat theconsequences of UMN syndrome?a. Lengthening muscles with spasticityb. Serial casting to stretch soft tissuesc. Transferring tendons to redirect muscle forcesd. Releasing muscles and/or joints that are contractured and without function19. Which of the following is not a technique used to correct static forces:a. Release of soft tissue or capsule contracturesb. Tendon transferc. Lengthening of contractured muscled. Excision of heterotopic bone20. Neurosurgical interventions in patients with spasticity may include:a. Rhizotomyb. Peripheral neurectomyc. Dorsal column electrical stimulationd. All of the above21. Which of the following statements is not true regarding the rehabilitation of patientswith UMN syndrome?a. It relieves muscle overactivity after medical and surgical interventionsb. Relief of muscle overactivity frequently improves motor controlc. It allows the patient to become totally independentd. It improves the patient’s self-care and mobilitye. All of the above22. Severe spasticity is best treated with a combination of approaches that may includeoral/systemic medications, intrathecal baclofen, phenol, or chemodenervation with BoTX-A.a. Trueb. FalseCME Post-Test Answers1. d2. b3. c4. b5. a6. c7. a8. d9. c 10. a 11. b 12. d 13. a 14. d 15. c 16. b 17. d 18. b 19. b 20. d 21. e 22. a。
219526437_通督醒脑针刺法联合盐酸哌甲酯缓释片治疗儿童注意缺陷多动障碍的效果
通督醒脑针刺法联合盐酸哌甲酯缓释片治疗儿童注意缺陷多动障碍的效果卢燕彬① 陈丽琴① 吴霞① 【摘要】 目的：分析通督醒脑针刺法联合盐酸哌甲酯缓释片治疗儿童注意缺陷多动障碍（attention deficit hyperactivity disorder，ADHD）的效果。
方法：选取2021年1月—2022年7月玉林市妇幼保健院收治的80例ADHD患儿为研究对象。
根据随机数表法将其分为对照组和观察组，各40例。
对照组给予盐酸哌甲酯缓释片，观察组给予通督醒脑针刺法联合盐酸哌甲酯缓释片治疗。
比较两组临床疗效，治疗前后中医症候积分、症状、注意力及治疗安全性。
结果：观察组总有效率为92.50%（37/40），高于对照组的75.00%（30/40），差异有统计学意义（P<0.05）。
治疗后，观察组神思涣散积分、冲动多动积分均低于对照组，差异有统计学意义（P<0.05）。
治疗后，观察组多动冲动评分、注意力不集中评分、对立违抗评分均低于对照组，差异有统计学意义（P<0.05）。
治疗后，观察组注意力商数评分、控制商数评分、视觉注意评分、听觉注意评分均高于对照组，差异有统计学意义（P<0.05）。
两组不良反应发生率比较，差异无统计学意义（P>0.05）。
结论：通督醒脑针刺法联合盐酸哌甲酯缓释片治疗儿童ADHD效果良好，可改善患儿中医症候及临床症状，提高注意力，治疗安全性良好。
【关键词】 儿童注意缺陷多动障碍 盐酸哌甲酯缓释片 通督醒脑针刺法 中医症候 doi：10.14033/ki.cfmr.2023.18.012 文献标识码 B 文章编号 1674-6805（2023）18-0045-05 Effect of Tongdu Xingnao Acupuncture Combined with Methylphenidate Hydrochloride Sustained Release Tablets in the Treatment of Attention Deficit Hyperactivity Disorder in Children/LU Yanbin, CHEN Liqin, WU Xia. //Chinese and Foreign Medical Research, 2023, 21(18): 45-49 [Abstract] Objective: To analyze effect of Tongdu Xingnao acupuncture combined with Methylphenidate Hydrochloride Sustained Release Tablets in the treatment of attention deficit hyperactivity disorder (ADHD) in children. Method: A total of 80 children with ADHD admitted to Yulin Maternal and Child Health Care Hospital from January 2021 to July 2022 were selected as the study objects. They were divided into control group and observation group according to random number table method, with 40 cases in each group. The control group was given Methylphenidate Hydrochloride Sustained Release Tablets, and the observation group was given Tongdu Xingnao acupuncture combined with Methylphenidate Hydrochloride Sustained Release Tablets treatment. The clinical efficacy, traditional Chinese medicine (TCM) symptom scores, symptom, attention before and after treatment and treatment safety were compared between the two groups. Result: The total effective rate of the observation group was 92.50% (37/40), which was higher than 75.00% (30/40) of the control group, and the difference was statistically significant (P<0.05). After treatment, the scores of disorganized mind, impulse and hyperactivity in the observation group were lower than those in the control group, and the differences were statistically significant (P<0.05). After treatment, hyperactivity impulsivity score, inattention score and oppositional defiance score in the observation group were lower than those in the control group, and the differences were statistically significant (P<0.05). After treatment, the attention quotient score, control quotient score, visual attention score and auditory attention scores of the observation group were higher than those of the control group, and the differences were statistically significant (P<0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P>0.05). Conclusion: Tongdu Xingnao acupuncture combined with Methylphenidate Hydrochloride Sustained Release Tablets has a good effect in the treatment of children with ADHD, which can improve the symptoms of traditional Chinese medicine and clinical symptoms, improve attention, and the treatment safety is good. [Key words] Attention deficit hyperactivity disorder in children Methylphenidate Hydrochloride Sustained Release Tablets Tongdu Xingnao acupuncture TCM symptoms First-author's address: Yulin Maternal and Child Health Care Hospital, Yulin 537000, China 注意缺陷多动障碍（attention deficit hyperactivity disorder，ADHD）即临床俗称的多动症，是出现在儿童中的一种精神行为障碍性疾病，通常是由患儿的神经功能发育异常导致[1]。
三叉神经药物治疗英文全文
M. A. E.-M. Oomens and T. ForouzanfarAbstractClassical trigeminal neuralgia (CTN) is a severe neuropathic pain in the distribution of one or more branches of the trigeminal nerve, which occurs in recurrent episodes, causing deterioration in quality of life, affecting everyday habits and inducing severe disability. The aim of this review is to give an overview of the current literature on pharmaceutical treatment options for CTN in the elderly. The first-line treatment for the management of CTN in adults is an antiepileptic—carbamazepine or oxcarbazepine. There is a lack of research on the use of antiepileptics in the elderly. This is a deficiency, as the use of antiepileptics raises a number of problems due to the polypharmacotherapy common in older patients. This can induce drug interactions due to co-morbidities and changes in pharmacokinetics and pharmacodynamics. Furthermore, the side effects of carbamazepine include central nervous system disturbances, such as a lack of balance, dizziness, somnolence, renal dysfunction and cardiac arrhythmias, which are poorly tolerated by the elderly. Unfortunately, the efficacy and safety of alternative treatment options have not been systematically evaluated. On the basis of the current literature, it is not possible to give an evidence-based recommendation for first-line pharmaceutical management of CTN specifically for the elderly.Key PointsIn the primary care sector, diagnosis and initial management of orofacial pain are often performed by family doctors and dentists [1]. Trigeminal neuralgia (TN) is a specific diagnosis based on clinical findings, a thorough clinical history and an examination [2]. A multidisciplinary team should manage patients with complicated facial pain [1]. According to the International classification of headache disorders,third edition (ICHD-3), TN is defined as a disorder characterized by recurrent, unilateral, brief, electric shock-like pains, abrupt in onset and termination, limited to the distribution of one or more divisions of the trigeminal nerve and triggered by innocuous stimuli [3]. The annual overall incidence of TN ranges from 12.6/100,000 to 27/100,000 people per year, with an increase in the incidence with advancing age [4]. The mechanism of TN is described as hyperexcitability of trigeminal root fibres near the entry zone into the pons because of mechanical compression (vascular or tumorous) or inflammatory demyelination (multiple sclerosis). Empirical evidence has indicated that vascular compression of the trigeminal nerve root is associated with TN in about 95 % of patients [5]. Magnetic resonance imaging (MRI) studies have given more insights into the pathogenesis of TN. Trigeminal nerve microstructure abnormalities can be identified with new MRI techniques together with trigeminal tractography. Demyelination without significant axonal injury seems to be an important factor in the pathogenesis of TN. Furthermore, there seems to be a state of maintained sensitization of trigeminal nociceptive systems in the brain. Antiepileptic drugs are thought to work in the treatment of TN by blocking voltage-sensitive sodium channels, making brain cells less excitable [6]. Also, grey-matter volume reduction has been found in the primary and secondary somatosensory cortices of TN patients [4, 7].TN can be divided into symptomatic TN (STN) and classical (idiopathic) TN (CTN) [3]. STN can be classified by causative or contributing factors, as proposed by Eller et al. [8]—for example, trigeminal neuropathic pain resulting from multiple sclerosis plaques or tumours. Unfortunately, most TN is idiopathic, and the aetiology is not clear.The guidelines on pharmaceutical TN management published by the American Academy of Neurology (AAN) and the European Federation of Neurological Societies (EFNS) recommend carbamazepine (CBZ; 200–1200 mg/day) or oxcarbazepine (OXC; 600–1800 mg/day) as first-line therapy [9]. Patients unresponsive to CBZ or OXC should be referred for add-on therapy with l amotrigine or surgery. Elderly patients (defined as persons aged 60 years or older) often present with a number of co-morbid and age-related conditions, which often require polypharmacy. Antiepileptics have well-known interactions with other drugs. Therefore, it is a challenge to establish a medical treatment for CTN in the elderly without inducing changes in pharmacodynamics and pharmacokinetics, and without causing safety problems.The aim of this review is to give an overview of the currently available literature on the pharmaceutical management of CTN patients, with a focus on the elderly.Go to:Inclusion and Exclusion CriteriaThe studies included in this review were all double-blind, randomized, controlled trials (RCTs) involving non-surgical treatment of CTN. The review excluded articles on STN, articles not available in English and non-RCT study designs.Outcome MeasuresPain relief, defined as decreased frequency and decreased intensity of painful paroxysms, was regarded as the primary outcome. Secondary outcome measures were side effects.Literature SearchesTo identify eligible studies, Medline, Embase and were searched with the MeSH term ‘trigeminal neuralgia’. The search was restricted to RCTs, clinical trials and English-language articles.Data Collection and AnalysisThe titles and abstracts of the articles were screened, and the two authors of the review (MO and TF) decided which articles were eligible for inclusion. Information on the numbers of participants, length of follow-up and outcome measures was extracted from each article, using a data extraction form.Assessment of Risks of BiasThe risks of bias in each trial were assessed by scoring the security of randomization, allocation concealment, comparability of groups at baseline, double blinding and handling of dropouts. In cases of uncertainty, the authors of the relevant article were contacted whenever possible.Go to:Literature SearchesThe literature search resulted in 171 relevant studies. After review of the abstracts, 18 articles involving non-surgical treatment of CTN were identified. Of these, six articles assessed antiepileptic drugs and 12 investigated non-antiepileptic drugs (Fig. 1).Fig. 1Flowchart of article selection. i.n. intranasal application, m. mucosalapplication, s.c. subcutaneous applicationStudy DescriptionsAn overview of all included studies is given in Table 1. The four studies investigating the effectiveness of CBZ, all published before 1970, showed that CBZ reduced both the frequency and the intensity of painful paroxysms in 76 % of included patients [10–13]. A total of 165 patients were included [mean age 58 years (range 34–84)], and there was a mean follow-up of 23 months (range 1–46). CBZ dosages ranged from 100 to 2400 mg/day. Side effects of drowsiness, constipation, vertigo, nausea and vomiting, and a rash were described.Table 1Characteristics of the included studiesLamotrigine 200–400 mg as add-on therapy was shown to be an effective and safe treatment, in comparison with CBZ alone, for management of TN [14, 15] in 67 % of included patients with a mean age of 63 years (range 44–84). The reported side effects were headache, dizziness and a skin rash.Some non-antiepileptics, administered orally, have been studied in single trials. Tizanidine 12–18 mg showed no greater effectiveness than CBZ or placebo in 22 patients, with response rates of 56 % for tizanidine, 66 % for CBZ and 40 % for placebo [16, 17]. Baclofen was superior to placebo in reducing the number of painful paroxysms, with a 70 % response rate in 10 patients with a mean age of 64 years (range 36–77) [18]. In a small group of 12 patients, tocainide was as effective as CBZ in reducing the frequency and severity of pain attacks on a Visual Analogue Scale (VAS), with a response rate of 75 % [19]. Pimozide was even more effective than CBZ in a single trial including 48 patients, with a response rate of 100 % for pimozide versus 56 % for CBZ [20]. The reported side effects were physical and mental retardation, hand tremors and memory impairment in 83 % of the pimozide group. Drugs with local administration have been studied in single trials as well. Topical ophthalmic anaesthesia (proparacaine) was not effective in a single placebo-controlled trial in 47 patients [21]. Botulinum toxin (BTX) type A, administered subcutaneously, proved to be effective (with a 50 % response rate, defined as a decrease in the VAS score of >50 %) in three placebo-controlled trials, which included a total of 102 patients with a mean age of 57 years (range 30–88) [22–24]. The reported side effects were transient, such as facial asymmetry, haematoma or oedema. Sumatriptan(舒马曲坦）,administered subcutaneously, was more effective than placebo (response rate83 %) in a single trial in a small group of 24 patients [25]. Lidocaine 8 % applied on the mucosa or administered via the intranasal route was e ffective in 85 % of 49 patients in two placebo-controlled trials, but the effect diminished after approximately 3 h [26, 27].The studies included in this review included a total of 521 patients with a mean age of 60 years (range 20–88). None of the studies included more than 100 patients.Follow-up periods ranged from 1 week to 46 months.Quality AssessmentAll articles were assessed for risks of bias on the basis of the criteria shown in Table 2. The method of randomization was not clear in many of the included studies. In over half of the included studies, the method of allocation concealment was not clear. All articles, except for one, described handling of dropouts and the reasons for dropout.Table 2Risks of bias in the included studiesStatistical AnalysisBecause of the non-homogeneity of the studies’ interventions, no pooling of data was possible.Go to:The aim of this review was to give an overview of the current pharmaceutical management of CTN patients, with a focus on the elderly. Overall, the mean age of the patients included in the trials was 60 years. In general, clinical trials tend to exclude patients with co-morbidities and concomitant therapies. Unfortunately, there were no statements on inclusion or exclusion of elderly patients with co-morbidities in the included studies. Therefore, the results of the trials cannot be extrapolated to the elderly population. Data concerning the efficacy/safety ratios of treatments for TN in the elderly are lacking in the literature.According to the evidence in this review, the general first-line drug used in medical management of TN is still CBZ. If there are unacceptable side effects, which are mostly dose related and are more common in older patients, the patient should be switched to OXC [9]. Second-line treatment can be a combination of CBZ and lamotrigine or baclofen, but the evidence for the use of either combination is still weak. BTX type A a dministered subcutaneously could be effective, but the evidence for its use is weak as well. Local application of anaesthetics seems to be effective but only for a few hours. The authors of the current review propose an algorithm of evidence-based medical management of CTN (Fig. 2).Fig. 2Algorithm for medical management of classical trigeminal neuralgia (CTN) in the elderly. AV atrioventricular, CBZ carbamazepine,CT computedtomography, HLA human leukocyte antigen,MRI magnetic resonance imaging, ...Diagnostics in Trigeminal NeuralgiaThe diagnosis of CTN is mostly made on the basis of a clinical history and clinical examination. The diagnostic criteria suggested in the ICHD-3 [3] are at least three attacks occurring in one or more divisions of the trigeminal nerve, with no radiation beyond the trigeminal distribution. The pain has at least three of the following four characteristics:1.Recurring in paroxysmal attacks lasting from a fraction of a second to 2 min.2.Severe intensity.3.Electric shock-like, shooting, stabbing or sharp in quality.4.Precipitated by innocuous stimuli to the affected side of the face.Furthermore, there is no clinically evident neurological deficit, and the pain cannot be attributed to another disorder.Diagnosis of CTN in the elderly does not differ from that in younger patients, except that taking a clinical history from an elderly patient may be more challenging. TN caused by compression (vascular) is regarded as CTN. Vascular contact with cranial nerves is a normal variant found in many patients without TN [6]. Depending on the quality of imaging, MRI cannot be recommended for routine use, as it is currently too insensitive for detection of vascular compression of the trigeminal nerve [6, 9].Trigeminal sensory deficits, bilateral involvement of the trigeminal nerve, an age at onset of <40 years, ophthalmic division only, deafness or other ear problems, and abnormal trigeminal reflexes are associated with an increased risk of STN and should be considered useful in distinguishing STN from CTN [6, 9]. In patients with TN, routine head imaging identifies structural causes in up to 15 % of patients and may be considered useful when STN is suspected.Adverse Events and Side Effects of AntiepilepticsCBZ is the first choice for non-surgical management of TN. Side effects of CBZ include central nervous system (CNS) disturbances, such as a lack of balance, dizziness and somnolence, skin rash, renal dysfunction, leukopenia, elevation in liver transaminases, hyponatraemia, thrombocytopenia, accommodation disorders, ataxia, nausea and vomiting, cardiac arrhythmias and, in long-term use, osteoporosis and folate deficiency [28]. In a recent retrospective study in 200 patients treated with CBZ or OXC, 27 % of patients treated with CBZ and 18 % of patients treated with OXC incurred an adverse event that directly caused interruption of treatment [29]. The onset of side effects occurred with mean dosages of 600 mg for CBZ and 1200 mg for OXC.Most side effects occurred within the first month.CBZ treatment is usually initiated at 200 mg. After auto-induction, the dose often needs to be increased and titrated according to the clinical response. In the elderly, a starting dose of 100 mg is advisable, especially because during auto-induction, the concentrations will go up fast even with lower doses [30]. Kutluay et al. [31] compared the safety and tolerability of OXC in a cohort of 52 pati ents aged ≥65 years and a cohort of 1574 patients ranging in age between 18 and 64 years, and found that the tolerability in the older age group was similar to that in younger adults. Some important pre-treatment precautions should be taken when CBZ or OXC is being prescribed, such as baseline measurements of haematology, electrolytes and liver function [32]. During treatment, careful clinical observation is necessary to minimize the risks of interactions and adverse events, especially in the elderly. The UK National Institute for Health and Care Excellence (NICE) recommends a full blood count; measurement of electrolytes, liver enzymes and vitamin D levels; and other tests of bone metabolism (serum calcium and alkaline phosphatase) every 2–5 years in patients takingenzyme-inducing drugs [33].Interactions of Carbamazepine and OxcarbazepineCBZ is an inducer of cytochrome P450 (CYP) 3A4, which results in acceleration of the metabolism of concurrently prescribed antiepileptics, tricyclic antidepressants, antipsychotics, steroid oral contraceptives, glucocorticoids, oral anticoagulants, cyclosporine, theophylline, chemotherapeutic agents and cardiovascular drugs. Elevation of plasma CBZ concentrations to potentially toxic levels can be caused bymacrolide antibiotics, metronidazole, some antidepressants, calcium-channel blockers and valproic acid [34]. In 0.01–0.06 % of Caucasian patients, CBZ-induced Stevens–Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN) can occur. This percentage is approximately ten times higher in East Asian and South-East Asian populations because of their higher prevalence of the human leukocyte antigen (HLA)-B 1502 allele. Routine testing for this allele seems cost effective only in patients from a population with a high prevalence of the allele [35]. A positive test for the allele still demands appropriate clinical vigilance and patient management because of the test’s sensitivity of 92 % and negative predictive value of 98 %. The chemical structure of OXC is similar to that of CBZ. Although the evidence of efficacy is stronger for CBZ than for OXC, the latter may pose fewer safety concerns [9, 36]. CBZ is contra-indicated in patients with atrioventricular (AV) block.Special Recommendations for Antiepileptics in the ElderlyOlder people, in particular, are sensitive to CNS disturbances and the sedative effects of medications [37]. A lack of balance, dizziness, somnolence, ataxia and blurred vision are all risk factors for falling. Elderly patients often have co-morbidities, such as diseases of the kidneys, liver, heart and blood vessels. On top of theseco-morbidities, there are physiological modifications associated with aging, which all make the serum concentrations of antiepileptics unpredictable. Furthermore, the effectiveness of other medications often used by older patients (e.g. anticoagulants, antidepressants and antipsychotics) can be reduced, and some medication often prescribed in the elderly (e.g. calcium-channel blockers and macrolide antibiotics大环内酯类抗生素) can elevate the plasma concentration of CBZ to a toxic level [37].A quarter of patients taking more than one drug have been found to be candidates for drug–drug interactions [38]. To complicate prevention of drug–drug interactions even more, there is often a discrepancy in reported and true drug use [39]. As OXC is associated with fewer adverse events and fewer drug interactions than CBZ, and it seems to be as effective as CBZ, one could consider prescribing OXC in the elderly [36]. While switching from CBZ to OXC, phase out the CBZ to preventCBZ-associated withdrawal reaction [40]. As mentioned before, it is advisable to lower the initial doses of CBZ and OXC in the elderly to 100 mg and 150 mg, respectively. A baseline complete blood count, electrolytes and liver function should be repeatedly measured during treatment.Agreements and Disagreements with Other StudiesCruccu and Truini [41] suggest following the AAN/EFNS guidelines on TN management, i.e. if a patient reaches the therapeutic dosage with either CBZ or OXC and does not have satisfactory pain relief, then t he patient should be referred for surgery. For patients who are not eligible to undergo surgery, lamotrigine as add-ontherapy or BTX injections should be tried. Lamotrigine and BTX type A injections may straightforwardly be regarded as an alternative to surgery, but the evidence is not yet strong enough [42]. Surgery is not always an option in elderly patients, particularly if they are not medically fit. If surgery is not contra-indicated, palliative destructive trigeminal nerve root procedures, such as radiofrequency lesioning, chemical destruction, balloon compression or stereotactic radiosurgery (Gamma Knife), should be considered over microvascular decompression because of the less invasive nature of these techniques. These palliative destructive trigeminal nerve root procedures tend to result in sensory side effects [43, 44]. A Cochrane review [45] assessed the effects of non-antiepileptic drugs in TN and concluded that there was insufficient evidence from the four included RCTs to show a significant benefit from non-antiepileptic drugs in TN. Another Cochrane review [6] investigating the efficacy of CBZ for acute and chronic pain concluded that CBZ was effective in chronic neuropathic pain, but 66 % of participants experienced at least one adverse event, with somnolence and dizziness ratios of 40–60 %. Conversely, a Cochrane review on antiepileptic drugs for neuropathic pain from 2013 concluded that there was insufficient evidence of an effect for the use of CBZ [46].Go to:For first-line treatment of TN, use of the algorithm presented in Fig. 2 is advised. Prescribe antiepileptics in the elderly with extreme caution, and pay attention todrug–drug interactions and side effects. In the literature, there is a deficiency of research on CTN in the elderly. Further research should focus on the efficacy and safety of the alternative non-surgical treatment options. Older patients and patients with co-morbidities and concomitant therapies should be included in the researchp opulation as well to allow generalization of research conclusions to ‘real life’.Go to:Conflicts of interestBoth authors (M. A. E.-M. Oomens and T. Forouzanfar) declare that they have no conflicts of interest.FundingBoth authors (M. Oomens and T. Forouzanfar) declare that they received no funding to support this manuscript.。
布瑞亭的临床使用
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超声引导下收肌管联合ipAck神经阻滞在膝关节置换术后镇痛中的应用研究
•论著•超声引导下收肌管联合ipAck神经阻滞在膝关节置换术后镇痛中的应用研究*刘宇权，乌卩文伟，王军，曾志文，廖亿舞（梅州市人民医院麻醉科，广东梅州514031）［摘要］目的探讨超'引导下收肌管联合ipAck神经阻滞用于膝关节置换术后镇痛的临床效果$方法选取该院2018年2月至2019年12月该院收治的行膝关节置换术患者90例，随机分为对照组（45例）和观察组（45例），分别采用超'引导下收肌管阻滞和超'引导下收肌管联合ipAck神经阻滞方案行术后镇痛$比较两组术后48h疼痛数字评分法11（NRS）静态/动态评分曲线下面积（AUC）、麻醉药物使用情况［舒芬太尼使用量、静脉自控镇痛泵（PCIA）按压率）下床最多活动步数及主动屈膝最大角度$结果观察组术后48h NRS静态/动态评分AUC均显著低于对照组；舒芬太尼用量显著少于对照组，差异均有统计学意义（P<0.05）两组PCIA按压率比较，差异无统计学意义（P>0.05）观察组术后48h下床最多活动步数和主动屈膝最大角度均显著多于对照组，差异均有统计学意义（P<0.05）结论超'引导下收肌管联合ipAck神经阻滞用于膝关节置换术后镇痛可有效缓解患者术后疼痛程度，减少麻醉药物用量，并有助于改善患者早期活动功能$［关键词］超'&收肌管阻滞；ipAck神经阻滞；膝关节置换术；镇痛DOI：10.3969/j.issn.1009-5519.202109.008中图法分类号：R614.3；R614.4文章编号:1009-5519（2021）09-1465-03文献标识码:AStudy on the application of adductor tube combined with ipAck nerve block under ultrasoundguidance in analgesia after knee arthroplasty*LIU Yuquan,WU Wenzvei,WANG Jun ZENG Zhixven LIAO Yiling(.Department of Anesthesiology^Meizhou People'Hospital■,Meizhou,Guangdong514031China') [Abstract]Objective To explore the clinical effect of adductor tube combined with ipAck nerve block under ultrasound guidance in analgesia after knee arthroplasty.Methods A total of90patients undergoing knee arthroplasty in the hospital from February2018to December2019were selected and randomly divided into control group(45cases)and observation group(45cases). AdduGtortubebloGkunderultrasoundguidanGeandadduGtortubeGombinedwithipAGknervebloGkultrasound-guidedwereadopt-ed for postoperative analgesia respectively.The Area under the curve(AUC)of static/dynamic score of numerical pain score11 (NRS),the use of anesthetics[the usage of sufentanil,the compression rate of intravenous patient-controlled analgesia pump(PICA)],the maximum number of steps to get out of bed,and the maximum angle of active knee flexion at48hours after the operation were compared between the two groups.Results The AUC of static/dynamic score of NRS at48h after operation in the observation group was significantly lower than that in the control group；the dosage of sufentanil in the observation group was significantly less than that in the control group,and the differences were statistically significant(P<0.05).There was no significant di f erence in the compression rate of PCIA between the two groups(P>005)/The maximum number of steps to get out of bed and the maximum angle of active knee flexion in the observation group were significantly more than those in the control group at 48h after operation,and the differences were statistically significant(P<0.05).Conclusion The use of adductor tube combined wihipAcknerveblockunderulrasoundguidanceforposDoperaDiveanalgesiaafDerkneearDhroplasDycane f ecivelyrelieveposDop-eraDivepainreduceDheamounDofanesDheicsandhelpimproveDhepaDienD'searly mobiliDy.[Key words]Ultrasound；Adductor tube block；ipAck nerve block；Knee replacement；Analgesia既往研究表明，股神经联合坐骨神经阻滞的术后镇痛效果良好，但对股四头肌肌力影响显著）12&收肌管阻滞尽管可提供与上述方法相似镇痛效果且不影响股四头肌肌力，但无法满足膝关节后方镇痛需求3&近年来，ipAck神经阻滞开始被用于解决膝关节后方疼痛，主要针对支配膝关节后方终末感觉支,主要包括腓总神经、胫神经和闭孔神经关节支，不影响腓总神经功能［45］&本研究以本院收治的行膝关节基金项目：广东省梅州市科技局科技计划项目（2018B017）&作者简介：刘宇权（1985—）,本科，主治医师，主要从事心脏麻醉、区域神经阻滞等方面研究&置换术患者90例作为研究对象，分别采用超声引导下收肌管阻滞和超声引导下收肌管联合ipAck神经阻滞方案行术后镇痛，探讨超声引导下收肌管联合ipAck神经阻滞用于膝关节置换术后镇痛的临床效果，现报道如下&1资料与方法1.1一般资料选取本院2018年2月至2019年12月收治的行膝关节置换术患者90例，随机分为对照组和观察组，每组45例&纳入标准：（1）符合膝关节置换术指征［6］;（2）美国麻醉医师协会（ASA）分级1〜/级；（3）单侧膝关节病变；（4）首次手术。
超声引导下前锯肌平面阻滞预防乳腺癌术后疼痛综合征
CHINA MEDICINE AND PHARMACY Vol.11 No.9 May 2021183超声引导下前锯肌平面阻滞预防乳腺癌术后疼痛综合征刘远辉 庄彩屏 钟国城广东省惠州市中心人民医院麻醉科，广东惠州 516001[摘要] 目的 观察超声引导下前锯肌平面阻滞（SPB）超前镇痛预防乳腺癌根治术后疼痛综合征（PMPS），其原理是否与降低炎症反应有关。
方法 选择2019年4月至2020年4月在我院择期拟行乳腺癌根治术的女性患者120例，采用随机数字表法分为全身麻醉组（G 组）和前锯肌平面阻滞组（SPB 组），每组各60例。
SPB 组在术前采用超声引导下0.33%罗哌卡因行前锯肌平面阻滞，G 组不给予神经阻滞。
记录术中患者丙泊酚及瑞芬太尼的用量；比较两组在麻醉前20 min（t 0）、手术开始（t 1）、手术结束（t 2）、术后6 h（t 3）及术后24 h （t 4）血清中炎症因子表达水平的变化；评估患者术后6 h （T 1）、24 h （T 2）、48 h （T 3）、l 周（T 4）、1个月（T 5）、3个月（T 6）的视觉模拟评分（VAS）；记录两组术后1、3个月慢性疼痛发生率。
结果 SPB 组术中丙泊酚和瑞芬太尼的用量低于G 组（P ＜0.05）；在t 2～t 4时刻，SPB 组白细胞介素6（IL-6）、白细胞介素10（IL-10）水平明显低于G 组（P ＜0.05）；SPB 组T 1～T 6的VAS 评分明显低于G 组（P ＜0.05）。
SPB 组术后1、3个月慢性疼痛发生率分别为42.3%、23.0%，低于G 组的62.5%、46.4%（P ＜0.05）。
结论 超声引导前锯肌平面阻滞在麻醉期间降低术后炎症因子水平，可为乳腺癌根治术提供良好的术后镇痛，有效预防乳腺癌术后疼痛综合征，且安全性较高。
[关键词] 乳腺癌；乳腺癌术后疼痛综合征；前锯肌平面阻滞；炎症因子[中图分类号] R614；R737.9 [文献标识码] A [文章编号] 2095-0616（2021）09-0183-04Ultrasound-guided serratus anterior plane block in prevention ofpost-mastectomy pain syndromeLIU Yuanhui ZHUANG Caiping ZHONG GuochengDepartment of Anesthesiology, Huizhou Municipal Central Hospital, Guangdong, Huizhou 516001, China[Abstract] Objective To observe whether ultrasound-guided anterior serratus muscle block (SPB) can prevent pain syndrome (PMPS) after radical mastectomy, and whether its principle is related to reducing inflammatory reaction. Methods A total of 120 female patients scheduled for radical mastectomy in our hospital from April 2019 to April 2020 were selected. They were randomly divided into the general anesthesia group (group G) and the serratus anterior plane block group (group SPB), with 60 cases in each group. In group SPB, 0.33% ropivacaine was used in ultrasound-guided SPB before operation, while in group G, no nerve block was given. The dosage of propofol and remifentanil used in patients during operation were recorded. The levels of serum inflammatory factors in the two groups were compared at 20 min before anesthesia (t 0), at the beginning of operation (t 1), at the end of operation (t 2), 6 h after operation (t 3) and 24 h after operation (t 4). The score of visual analogue scale (VAS) was evaluated at 6 h (T 1), 24 h (T 2), 48 h (T 3), 1 week (T 4), 1 month (T 5), 3 months (T 6) after operation. The incidence of chronic pain at 1 month and 3 months after operation was recorded in the two groups. Results The dosages of propofol and remifentanil were lower in group SPB than that in group G (P ＜0.05). The levels of IL-6 and IL-10 were significantly lower in group SPB than those in group G at t 2-t 4 (P ＜0.05). The VAS scores were significantly lower in group SPB than those in group G at t 1-t 6 (P ＜0.05). The incidence of chronic pain was 42.3% and 23.0% in group SPB, lower than 62.5% and 46.4% in group G at 1 and 3 months after operation (P ＜0.05). Conclusion Ultrasound-guided SPB can reduce the level of postoperative inflammatory factors during anesthesia, which can provide a good postoperative analgesia for radical mastectomy, and effectively prevent PMPS, with higher safety.[Key words] Breast cancer; Post-mastectomy pain syndrome; Serratus anterior plane block; Inflammatory factor[基金项目] 广东省惠州市医疗卫生类科技计划项目（2019Y023）乳腺癌是女性最常见的癌症之一，手术治疗是目前乳腺癌治疗的主要手段[1]。
利多卡因复合阿托品治疗麻醉恢复室导尿管相关膀胱刺激症的效果
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评价髂筋膜间隙阻滞（FICB）联合单侧腰麻用于老年患者髋部骨折手术麻醉的优化效应
评价髂筋膜间隙阻滞（FICB）联合单侧腰麻用于老年患者髋部骨折手术麻醉的优化效应发布时间：2021-07-01T07:20:19.553Z 来源：《中国医学人文》(学术版)2021年第3期作者：严平丽[导读] 目的评价髂筋膜间隙阻滞（FICB）联合单侧腰麻用于老年患者髋部骨折手术麻醉的优化效应。
方法纳入本院2019年10月-2020年12月的72例老年髋部骨折患者展开研究并分成两组，实行髂筋膜间隙阻滞联合单侧腰麻的为观察组，实行单侧腰麻的为参照组，观察应用效果。
结果观察组血浆皮质醇浓度和褪黑素浓度优于参照组；其观察组的并发症发生率较低，差异明显（P<0.05）。
结论通过对老年髋部骨折手术患者实行联合麻醉，可以有效改善患者的血浆皮质醇浓度和褪黑素浓度，并发症发生率显著降低，有利于改善患者的睡眠质量。
严平丽黑龙江省七台河市七煤医院 154600【摘要】目的评价髂筋膜间隙阻滞（FICB）联合单侧腰麻用于老年患者髋部骨折手术麻醉的优化效应。
方法纳入本院2019年10月-2020年12月的72例老年髋部骨折患者展开研究并分成两组，实行髂筋膜间隙阻滞联合单侧腰麻的为观察组，实行单侧腰麻的为参照组，观察应用效果。
结果观察组血浆皮质醇浓度和褪黑素浓度优于参照组；其观察组的并发症发生率较低，差异明显（P<0.05）。
结论通过对老年髋部骨折手术患者实行联合麻醉，可以有效改善患者的血浆皮质醇浓度和褪黑素浓度，并发症发生率显著降低，有利于改善患者的睡眠质量。
【关键词】髂筋膜间隙阻滞；单侧腰麻；老年髋部骨折[Abstract]Objective To evaluate the optimal effect of iliac fascia space block（ficb）combined with unilateral spinal anesthesia for hip fracture surgery in elderly patients. Methods 72 elderly patients with hip fracture in our hospital from October 2019 to December 2020 were included and divided into two groups. The observation group was treated with iliac fascia space block combined with unilateral spinal anesthesia，and the control group was treated with unilateral spinal anesthesia. Results the plasma cortisol concentration and melatonin concentration of the observation group were better than those of the control group；the complication rate of the observation group was lower，and the difference was significant（P < 0.05）. Conclusion combined anesthesia can effectively improve the plasma cortisol concentration and melatonin concentration of elderly patients with hip fracture surgery，reduce the incidence of complications，and improve the sleep quality of patients.[Key words]iliac fascia space block；unilateral spinal anesthesia；elderly hip fracture对于老年髋部骨折手术患者，全身麻醉以及椎管内麻醉都是较为常见的麻醉方式，其能够确保患者术中无痛，但是单一椎管内麻醉并不能缓解由于体位变化所引发的疼痛，而对于全身麻醉，因为围术期应激反应显著，麻醉管理困难，手术后很容易产生各种并发症【1】。
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Perineural Administration of Dexmedetomidine in Combinationwith Bupivacaine Enhances Sensory and Motor Blockade inSciatic Nerve Block without Inducing Neurotoxicity in the Rat
Chad M. Brummett, M.D.*, Mary A. Norat, B.S.**, John M. Palmisano, B.S.#, and Ralph Lydic,Ph.D.†
Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
AbstractBackground—The present study was designed to test the hypothesis that high-dosedexmedetomidine added to local anesthetic would increase the duration of sensory and motorblockade in a rat model of sciatic nerve blockade without causing nerve damage.
Methods—Thirty-one adult Sprague Dawley rats received bilateral sciatic nerve blocks with either0.2 ml of 0.5% bupivacaine and 0.5% bupivacaine plus 0.005% dexmedetomidine in the contralateralleg, or 0.2 ml of 0.005% dexmedetomidine and normal saline in the contralateral leg. Sensory andmotor function were assessed by a blinded investigator every 30 minutes until the return of normalsensory and motor function. Sciatic nerves were harvested at either 24 hours or 14 days after injectionand analyzed for perineural inflammation and nerve damage.
Results—High-dose dexmedetomidine added to bupivacaine significantly enhanced the durationof sensory and motor blockade. Dexmedetomidine alone did not cause significant motor or sensoryblock. All of the nerves analyzed had normal axons and myelin at 24 hours and 14 days. Bupivacaineplus dexmedetomidine showed less perineural inflammation at 24 hours than the bupivacaine groupwhen compared with the saline control.
Conclusion—The finding that high-dose dexmedetomidine can safely improve the duration ofbupivacaine-induced antinociception following sciatic nerve blockade in rats is an essential first stepencouraging future studies in humans. The dose of dexmedetomidine used in this study may exceedthe sedative safety threshold in humans and could cause prolonged motor blockade, therefore futurework with clinically relevant doses is necessary.
IntroductionAlthough the use of peripheral nerve catheters has increased in recent years, the majority ofanesthesiologists still perform single injection peripheral nerve blocks. Long acting localanesthetics alone can provide excellent analgesia for up to 9-14 hours.1-4 This often leaves
Corresponding Author: Chad Brummett, M.D. Department of Anesthesiology Division of Pain Medicine The University of MichiganHealth System 7433 Medical Sciences Bldg 1 1150 W. Medical Center Drive Ann Arbor, MI 48109-5615 Phone: 734-647-7831 FAX:734-764-9332 E-MAIL: E-mail: cbrummet@umich.edu.*Clinical Lecturer
**Laboratory Manager
#Research Technician Assistant
†Professor
Preliminary data presented at the Association of University Anesthesiologists Annual Meeting, Chicago, Illnois, April 26-29, 2007.Summary Statement: High dose dexmedetomidine added to bupivacaine significantly increased the duration of sensory and motorblockade in rat. Histopathology at 24 hours and 14 days revealed normal nerves.
NIH Public AccessAuthor ManuscriptAnesthesiology. Author manuscript; available in PMC 2009 September 1.Published in final edited form as:Anesthesiology. 2008 September ; 109(3): 502–511. doi:10.1097/ALN.0b013e318182c26b.NIH-PA Author Manuscript
NIH-PA Author ManuscriptNIH-PA Author Manuscriptpatients feeling their first pain during the nighttime hours, however, thereby interruptingpatients' sleep on the first postoperative night. The goal for anesthesiologists then becomesfinding ways to prolong the duration of single shot regional techniques in an effort to keeppatients comfortable longer.
The efficacy of clonidine, an □2-adrenoceptor agonist, in a variety of regional anesthesiatechniques has been established.5 Clonidine has been shown in many clinical studies to prolongthe duration of anesthesia and analgesia in peripheral nerve blocks, although results with longacting local anesthetics have been somewhat less impressive.6-15 A few studies have foundno beneficial effect with the addition of clonidine.16-18
Dexmedetomidine (trade name Precedex®, Hospira, Inc., Lake Forest, IL) is a selective □2-adrenoceptor agonist Food and Drug Administration approved for continuous intravenoussedation in the intensive care setting. A pilot study performed by our group (data not presented)showed that perineural dexmedetomidine added to 0.25% bupivacaine in rat sciatic nerveinjections enhanced the duration of sensory and motor blockade. Other studies have founddexmedetomidine to be safe and effective in various neuraxial and regional anesthetics inhumans, including intrathecal19 and intravenous regional anesthesia.20