Cirurgia de bloqueig nerviós?

1. The goal of postoperative pain treatment is to reduce postoperative complications, promote patient recovery, and improve surgical treatment effects through analgesia. PCA technology is a kind of microcomputer analgesia produced by the close integration of computer technology and medicine. It is pre-set by the anesthesiologist with a program and a safe limit of analgesics. The patient himself uses an easy-to-operate compression twist to intermittently control the required analgesia. Pain medicine to quickly relieve or relieve pain after surgery. Entered China in the mid to late 1990s. The route of administration can be selected according to the patient's condition via intravenous (PCIA), epidural (PCEA) or subcutaneous (PCSA). The main advantage of PCA is that the administration conforms to the pharmacokinetic principle of analgesics, and it is easier to maintain the lowest effective analgesic concentration; the use of analgesics can be truly timely and rapid, which basically solves the individual needs of patients for analgesics Differences; it is beneficial for patients to obtain the best analgesic effect at any time and under different pain intensity; it reduces the adverse reactions caused by pain, such as stress, myocardial ischemia, atelectasis and delayed functional exercise. The drugs used in PCA are mainly opioids and local anesthetics. Clinically, it is mostly low-concentration local anesthetics (such as 0.125 percent bupivacaine) combined with low-dose opioids (such as fentanyl, morphine, and sufentanil). The new local anesthetic, ropivacaine, exhibits obvious characteristics of separation of sensory and motor nerve blocks at low concentrations (0.1 percent to 0.2 percent ), and has special significance in postoperative analgesia. In recent years, the concept of "walkable epidural analgesia" has been proposed so that patients can get out of bed early without affecting the movement of the lower limbs while obtaining satisfactory analgesia. The commonly used formula is 0.1 percent ropivacaine plus morphine or fentanyl. It is worth mentioning the problem of postoperative analgesia in children. The severe postoperative pain has a greater impact on children's mental health and is not conducive to their mental health development, especially for children who have undergone repeated orthopedic operations. Some experts believe that all children over 5 years of age can consider postoperative analgesia.

2 The pain during childbirth comes from the contraction of the uterus and the expansion of the vagina. Analgesia requirements neither affect the maternal contractions nor prolong the birth process, but also ensure the safety of the fetus's life. The PCEA method meets the above requirements. The specific methods are as follows: ① The parturient enters into regular contractions (the opening of the uterus is about 3 to 5 cm), and the routine epidural puncture is performed, with a gap of 2 to 3 or 3 to 4 at the waist, and a tube 3.5 cm from the head. ② After successful puncture, give 2 to 3 ml of 1 percent lidocaine. After observing the phenomenon of no spinal anesthesia for 5 minutes, continue the administration to control the level of anesthesia below T10. Then turn on the analgesic pump. The commonly used formula is 0.125 percent bupivacaine (or 0.1 percent bupivacaine plus 0.0016 percent fentanyl for a total of 60Ml. ③ When you see the fetal head in the second stage of labor, raise the head of the delivery bed by 30· and give it another first time. The dosage is 8ml. The purpose is to concentrate the medicine on the perineum so that there is no pain during the suture. No more medicine is given after the fetus is delivered.

3 Cancer pain can reduce the dosage of systemic analgesics or adjuvant drugs, reduce the tendency of daytime sleepiness, and self-administer medication when analgesia is needed, shorten the time from pain to analgesia, and improve the quality of life of patients with pain. Reduce the burden on the patient's family. When necessary, catheters and other devices can be embedded under the skin. There are reports of 351 days of epidural catheterization in China2. In terms of drugs, in addition to commonly used opioids, ketamine and N-type calcium channel blocker ziconotide can also be used.

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