Acute pain differs in many aspects from chronic pain states and can arise from various etiologies. Recent years have seen advancements in postoperative acute pain management, which is a critical component of perioperative care. These strategies play a key role in enhancing recovery after surgery (ERAS) with goals of reducing postoperative opioid consumption and shortening hospital stay durations. To further standardize postoperative pain management for adult patients in China，the Guidelines Working Group has developed the Clinical Practice Guideline for Postoperative Pain Management in Adults (2024 Edition). These guidelines were formulated in accordance with World Health Organization handbook for guideline development and the Guidance Principles for Developing/Revising Clinical Guidelines in China (2022 Edition). These guidelines consist of 33 evidence-based recommendations for 17 clinical questions on postoperative pain management. We provide recommendations pertaining to preoperative education, risk assessment, selection of analgesic modalities, and management of adverse effects. We also provide some principles of analgesia strategy including: using preemptive or multimodal analgesia; foundation; regional blocks; patient-controlled intravenous analgesia; and opioid sparing. By enhancing the scientific rigor of postoperative pain management， the guidelines aim to provide healthcare professionals with a clear decision-making framework, ultimately improving patient outcomes.
Intrapartum fever is a common complication in parturients undergoing epidural analgesia (EA), significantly increasing the incidence of maternal and infant complications. This study aims to develop and validate a prediction model for intrapartum fever related to chorioamnionitis (IFTC) in parturients undergoing epidural analgesia. A total of 596 parturients with fever (axillary temperature ≥ 38℃) who received EA from January 2020 to December 2023 were included and randomly assigned to the training set (N = 417) and the validation set (N = 179) according to the ratio of 7:3. The independent risk factors were screened by univariate and multivariate logistic regression analysis to develop a nomogram model. Decision curve analysis (DCA) was used to evaluate the clinical effectiveness and discrimination of the model; calibration curve was used to assess the accuracy of the model. Maximum temperature, meconium-stained amniotic fluid, C-reactive protein (CRP), gestational age and BMI were independent risk factors for predicting IFTC, and the area under receiver operating characteristic curve (AUC) of the training set and the validation set were 0.744 (0.691-0.796) and 0.793 (0.714-0.872), respectively. The calibration curve showed good consistency between predicted and actual results. DCA curve showed that the model had clinical value throughout a broad threshold probability range. The nomogram prediction model based on CRP, meconium-stained amniotic fluid, maximum temperature, gestational age and BMI has good predictive performance for the risk of IFTC in EA parturients.
Recent data indicated a high incidence of inappropriate management of neuromuscular block, with a high rate of residual paralysis and relaxant-associated postoperative complications. These data are alarming in that the available neuromuscular monitoring, as well as myorelaxants and their antagonists basically allow well tolerated management of neuromuscular blockade. In this first European Society of Anaesthesiology and Intensive Care (ESAIC) guideline on peri-operative management of neuromuscular block, we aim to present aggregated and evidence-based recommendations to assist clinicians provide best medical care and ensure patient safety. We identified three main clinical questions: Are myorelaxants necessary to facilitate tracheal intubation in adults? Does the intensity of neuromuscular blockade influence a patient's outcome in abdominal surgery? What are the strategies for the diagnosis and treatment of residual paralysis? On the basis of this, PICO (patient, intervention, comparator, outcome) questions were derived that guided a structured literature search. A stepwise approach was used to reduce the number of trials of the initial research (n = 24 000) to the finally relevant clinical studies (n = 88). GRADE methodology (Grading of Recommendations, Assessment, Development and Evaluation) was used for formulating the recommendations based on the findings of the included studies in conjunction with their methodological quality. A two-step Delphi process was used to determine the agreement of the panel members with the recommendations: R1 We recommend using a muscle relaxant to facilitate tracheal intubation (1A). R2 We recommend the use of muscle relaxants to reduce pharyngeal and/or laryngeal injury following endotracheal intubation (1C). R3 We recommend the use of a fast-acting muscle relaxant for rapid sequence induction intubation (RSII) such as succinylcholine 1 mg kg-1 or rocuronium 0.9 to 1.2 mg kg-1 (1B). R4 We recommend deepening neuromuscular blockade if surgical conditions need to be improved (1B). R5 There is insufficient evidence to recommend deep neuromuscular blockade in general to reduce postoperative pain or decrease the incidence of peri-operative complications. (2C). R6 We recommend the use of ulnar nerve stimulation and quantitative neuromuscular monitoring at the adductor pollicis muscle to exclude residual paralysis (1B). R7 We recommend using sugammadex to antagonise deep, moderate and shallow neuromuscular blockade induced by aminosteroidal agents (rocuronium, vecuronium) (1A). R8 We recommend advanced spontaneous recovery (i.e. TOF ratio >0.2) before starting neostigmine-based reversal and to continue quantitative monitoring of neuromuscular blockade until a TOF ratio of more than 0.9 has been attained. (1C).
These practice guidelines provide evidence-based recommendations on the management of neuromuscular monitoring and antagonism of neuromuscular blocking agents during and after general anesthesia. The guidance focuses primarily on the type and site of monitoring and the process of antagonizing neuromuscular blockade to reduce residual neuromuscular blockade.
(1)一般情况：患者，女性，年龄66岁，身高152 cm，体质量52 kg。因"自觉眼睑无力3个月，胸闷、气短伴吞咽困难2月余"入院。患者3个月前无明显诱因突发眼睑下垂，未予重视，2个月余前出现平卧位后胸闷、气短，伴进食困难，1个月前症状较前加重，伴呼吸困难，给予无创辅助通气，收入ICU治疗，胸部CT示胸腺肿物。口服溴吡斯的明诊断性治疗后好转。为进一步诊治收入本院胸外科，拟在全身麻醉下行经剑突下胸腔镜纵隔肿物切除术。
