From a clinical perspective, local anesthetics have rather widespread application in regional blockade for surgery, postoperative analgesia, acute/chronic pain control, and even cancer treatments. However, a number of disadvantages are associated with traditional local anesthetic agents as well as routine drug delivery administration ways, such as neurotoxicity, short half-time, and non-sustained release, thereby limiting their application in clinical practice. Successful characterization of drug delivery systems (DDSs) for individual local anesthetic agents can support to achieve more efficient drug release and prolonged duration of action with reduced systemic toxicity. Different types of DDSs involving various carriers have been examined, including micromaterials, nanomaterials, and cyclodextrin. Among them, nanotechnology-based delivery approaches have significantly developed in the last decade due to the low systemic toxicity and the greater efficacy of non-conventional local anesthetics. Multiple nanosized materials, including polymeric, lipid (solid lipid nanoparticles, nanostructured lipid carriers, and nanoemulsions), metallic, inorganic non-metallic, and hybrid nanoparticles, offer a safe, localized, and long-acting solution for pain management and tumor therapy. This review provides a brief synopsis of different nano-based DDSs for local anesthetics with variable sizes and structural morphology, such as nanocapsules and nanospheres. Recent original research utilizing nanotechnology-based delivery systems is particularly discussed, and the progress and strengths of these DDSs are highlighted. A specific focus of this review is the comparison of various nano-based DDSs for local anesthetics, which can offer additional indications for their further improvement. All in all, nano-based DDSs with unique advantages provide a novel direction for the development of safer and more effective local anesthetic formulations.

ABSTRACT:Patients with chronic pain often experience exaggerated pain response and aversive emotion, such as anxiety and depression. Central plasticity in the anterior cingulate cortex (ACC) is assumed to be a critical interface for pain perception and emotion, which has been reported to involve activation of NMDA receptors. Numerous studies have documented the key significance of cGMP-dependent protein kinase I (PKG-I) as a crucial downstream target for the NMDA receptor-NO-cGMP signaling cascade in regulating neuronal plasticity and pain hypersensitivity in specific regions of pain pathway, ie, dorsal root ganglion or spinal dorsal horn. Despite this, whether and how PKG-I in the ACC contributes to cingulate plasticity and comorbidity of chronic pain and aversive emotion has remained elusive. Here, we uncovered a crucial role of cingulate PKG-I in chronic pain and comorbid anxiety and depression. Chronic pain caused by tissue inflammation or nerve injury led to upregulation of PKG-I expression at both mRNA and protein levels in the ACC. Knockdown of ACC-PKG-I relieved pain hypersensitivity as well as pain-associated anxiety and depression. Further mechanistic analysis revealed that PKG-I might act to phosphorylate TRPC3 and TRPC6, leading to enhancement of calcium influx and neuronal hyperexcitability as well as synaptic potentiation, which results in the exaggerated pain response and comorbid anxiety and depression. We believe this study sheds new light on the functional capability of ACC-PKG-I in modulating chronic pain as well as pain-associated anxiety and depression. Hence, cingulate PKG-I may represent a new therapeutic target against chronic pain and pain-related anxiety and depression.

Given that the incidence of cancer is dramatically increasing nowadays, cancer-related neuropathic pain including tumor-related and therapy-related pain gradually attracts more attention from researchers, which basically behaves as a metabolic-neuro-immune disorder with worse clinical outcomes and prognosis. Among various mechanisms of neuropathic pain, the common underlying one is the activation of inflammatory responses around the injured or affected nerve(s). Innate and adaptive immune reactions following nerve injury together contribute to the regulation of pain. On the other hand, the tumor immune microenvironment involving immune cells, as exemplified by lymphocytes, macrophages, neutrophils and dendritic cells, inflammatory mediators as well as tumor metastasis have added additional characteristics for studying the initiation and maintenance of cancer-related neuropathic pain. Of interest, these immune cells in tumor microenvironment exert potent functions in promoting neuropathic pain through different signaling pathways. To this end, this review mainly focuses on the contribution of different types of immune cells to cancer-related neuropathic pain, aims to provide a comprehensive summary of how these immune cells derived from the certain tumor microenvironment participate in the pathogenesis of neuropathic pain. Furthermore, the clarification of roles of various immune cells in different tumor immune microenvironments associated with certain cancers under neuropathic pain states constitutes innovative biology that takes the pain field in a different direction, and thereby provides more opportunities for novel approaches for the prevention and treatment of cancer-related neuropathic pain.

Objectives The erector spinae plane (ESP) block is a newly defined regional anesthesia technique first described in 2016. The aim of this meta-analysis is to assess the efficacy of ESP block in improving analgesia following lumbar surgery. Methods PubMed, EMBASE, Cochrane Library, and Web of Science were searched for randomized controlled trials (RCTs) that compared the analgesic efficacy of the ESP block with non-block care for lumbar surgery from inception 3 August 2021. The primary outcomes were postoperative opioid consumption and pain scores during the first 24 h. Postoperative pain was measured as pain at rest and on movement at postoperative 0, 4, 8, 12, and 24 h expressed on a visual analog scale (VAS), where 0 = no pain and 10 = the most severe pain. Results 11 studies involving 775 patients were included in our analysis. The use of ESP block significantly decreased 24-h opioid consumption (WMD, -8.70; 95% CI, -10.48 to -6.93; I 2 = 97.5%; P < 0.001) compared with the non-block. Moreover, ESP block reduced pain scores at postoperative time-points up to 24 h. ESP block also prolonged the time to first analgesic request (WMD = 6.93; 95% CI: 3.44 to 10.43, I 2 = 99.8%; P < 0.001). There was less PONV with ESP block versus non-block group (RR, 0.354; 95% CI, 0.23 to 0.56; I 2 = 25.2%; P < 0.001), but no difference in pruritus. Conclusions ESP block provides less opioid consumption and PONV, lower pain scores, and longer time to first analgesic request in patients undergoing lumbar surgery compared to general anesthesia alone.

临床常见的扁桃体肥大患儿多因张口呼吸、睡眠质量差或者通气障碍就诊,严重者甚至会出现呼吸暂停,危及生命[1].根据最新数据,扁桃体切除术是美国最常见的外科手术之一,每年将近 289000例 15 岁以下儿童接受此手术[2].扁桃体切除术本身会对患儿咽喉部产生强烈刺激,因此引发剧烈的术后疼痛.此外,术后疼痛亦会诱发一系列后续的不良反应,甚至会对患儿的生理、心理和行为产生长期的消极影响[3].为了减轻患儿术后疼痛并预防患儿术后躁动,吉林大学第二医院应用舒芬太尼术后镇痛泵对接受扁桃体切除术的患儿进行超前镇痛[4-5],报道如下.

Following the publication of the above article, the authors have requested that it be retracted. After having repeated some of the experiments, the authors were not able to reproduce certain of the results. Furthermore, following a further investigation in the Editorial Office, it came to light that some of the wstern blotting data shown in Fig. 3 and the tumor images in Fig. 5 were strikingly similar to those that had been submitted for publication prior to the receipt of present article. Therefore, this article has been retracted from the Journal; all the authors agree to this retraction. The Editor and the authors would like to apologize for any inconvenience caused. [the original article was published in Molecular Medicine Reports 12: 3951‑3957, 2015; DOI: 10.3892/mmr.2015.3820].

目前医学专业学位研究生培养目标是以培养研究生的临床胜任能力为重点,使其最终成为合格的临床医师.因此,临床思维能力、团队协作能力和在临床情景中运用所掌握的实践操作技术能力以及医患沟通技巧是目前医学专业学位研究生培养的重点.吉林大学第二医院麻醉科通过探索与研究,引入了临床实践情景模拟教学模式,形成了具有特色的医学专业学位研究生培养模式.

Background: Breast cancer is the most commonly diagnosed cancer in women, and more than half of breast surgery patients experience severe acute postoperative pain. This meta-analysis is designed to examine the clinical analgesic efficacy of Pecs block in patients undergoing breast cancer surgery. Methods: An electronic literature search of the Library of PubMed, EMBASE, Cochrane Library, and Web of Science databases was conducted to collect randomized controlled trials (RCTs) from inception to November 2018. These RCTs compared the effect of Pecs block in combination with general anesthesia (GA) to GA alone in mastectomy surgery. Pain scores, intraoperative and postoperative opioid consumption, time to first request for analgesia, and incidence of postoperative nausea and vomiting were analyzed. Results: Thirteen RCTs with 940 patients were included in our analysis. The use of Pecs block significantly reduced pain scores in the postanesthesia care unit (weighted mean difference [WMD] = -1.90; 95% confidence interval [CI], -2.90 to -0.91; P < .001) and at 24 hours after surgery (WMD = -1.01; 95% CI, -1.64 to -0.38; P < .001). Moreover, Pecs block decreased postoperative opioid consumption in the postanesthesia care unit (WMD = -1.93; 95% CI, -3.51 to -0.34; P = .017) and at 24 hours (WMD = -11.88; 95% CI, -15.50 to -8.26; P < .001). Pecs block also reduced intraoperative opioid consumption (WMD = -85.52; 95% CI, -121.47 to -49.56; P < .001) and prolonged the time to first analgesic request (WMD = 296.69; 95% CI, 139.91-453.48; P < .001). There were no statistically significant differences in postoperative nausea and vomiting and block-related complications. Conclusions: Adding Pecs block to GA procedure results in lower pain scores, less opioid consumption and longer time to first analgesic request in patients undergoing breast cancer surgery compared to GA procedure alone.

Abstract Background: Breast cancer is the most commonly diagnosed cancer in women, and more than half of breast surgery patients experience severe acute postoperative pain. This meta-analysis is designed to examine the clinical analgesic efficacy of Pecs block in patients undergoing breast cancer surgery. Methods: An electronic literature search of the Library of PubMed, EMBASE, Cochrane Library, and Web of Science databases was conducted to collect randomized controlled trials (RCTs) from inception to November 2018. These RCTs compared the effect of Pecs block in combination with general anesthesia (GA) to GA alone in mastectomy surgery. Pain scores, intraoperative and postoperative opioid consumption, time to first request for analgesia, and incidence of postoperative nausea and vomiting were analyzed. Results: Thirteen RCTs with 940 patients were included in our analysis. The use of Pecs block significantly reduced pain scores in the postanesthesia care unit (weighted mean difference [WMD] = −1.90; 95% confidence interval [CI], −2.90 to −0.91; P < .001) and at 24 hours after surgery (WMD = −1.01; 95% CI, −1.64 to −0.38; P < .001). Moreover, Pecs block decreased postoperative opioid consumption in the postanesthesia care unit (WMD = −1.93; 95% CI, −3.51 to −0.34; P = .017) and at 24 hours (WMD = −11.88; 95% CI, −15.50 to −8.26; P < .001). Pecs block also reduced intraoperative opioid consumption (WMD = −85.52; 95% CI, −121.47 to −49.56; P < .001) and prolonged the time to first analgesic request (WMD = 296.69; 95% CI, 139.91–453.48; P < .001). There were no statistically significant differences in postoperative nausea and vomiting and block-related complications. Conclusions: Adding Pecs block to GA procedure results in lower pain scores, less opioid consumption and longer time to first analgesic request in patients undergoing breast cancer surgery compared to GA procedure alone.

This article has been retracted. Please see the Retraction Notice for more detail: https://doi.org/10.1186/s12890-020-01365-7.

Background: Perioperative hypothermia is a common and serious complication during surgery. Different warming systems are used to prevent perioperative hypothermia. However, there have been no previous meta-analyses of the effectiveness of air-free warming systems on perioperative hypothermia in patients undergoing joint arthroplasty. Methods: We systematically searched PubMed, EMBASE, Cochrane Library, and China National Knowledge Infrastructure (CNKI) databases to collect randomized controlled trials (RCTs) from inception to August 2018. These RCTs compared the effects of air-free warming with forced-air (FA) warming system in patients undergoing joint arthroplasty. Postoperative temperature, core temperature during surgery, thermal comfort, blood loss and incidence of shivering and hypothermia were analyzed. Results: A total of 287 patients from 6 clinical studies were included in the analysis. In summary, there was no significant difference in the postoperative temperature (WMD -0.043, 95% CI -0.32 to 0.23, P=.758) between the air-free warming and FA warming groups. No statistical difference (WMD 0.058, 95% CI -0.10 to 0.22, P=.475) was found in core temperatures at 0minutes during surgery between the air-free warming and FA warming groups. Furthermore, there was no statistical difference in thermal comfort, blood loss or incidence of shivering and hypothermia between the air-free warming and FA warming groups. Conclusions: Air-free warming system was as effective as FA warming system in patients undergoing joint arthroplasty.

Objective Explore the effect of wake quality and adverse reactions of using an anesthetic desflurane that is quickly eluded, on the basis of combined use of propofol combined fentanyl to quality in elderly patients.Methods 82 cases of elderly patients with total anesthesia were selected.Patients were randomized to two different group, 42 in the control group and 40 in the experimental group.In P group (control group), propofol and remifentanil were used to maintain anesthesia.D group (test group) target controlled infusion of propofol, remifentanil and combined inhaled difluoroether.Results In D group (experimental group), the dosage of propofol, time of wake up, extubation time and the time of Aldrete score is greater than or equal to 9 minutes are less than pure propofol combined fentanyl patients (control group), the difference was statistically significant (P＜0.05).In group D, there were 6 patients with a restlessness score of 3 and above, accounting for 15％ of group D, and 5 cases of group P 3 and above, accounting for 11.9％ of group P.There was no significant difference between the two groups (P＞0.05).There was no statistically significant difference in the incidence of tachycardia, nausea, vomiting and respiratory depression between the two groups detected in the wake period (P＞0.05).Conclusion The target controlled infusion of propofol, remifentanil and combined inhalation of desflurane can improve the resuscitation quality of the patients, and the ideal anesthetic effect can be achieved for the elderly.

Objectives: The objective of this meta-analysis was to evaluate the analgesic effects of dexmedetomidine (DEX) in transversus abdominis plane (TAP) blocks for abdominal surgery. Methods: Electronic databases, including PubMed, EMBASE, Chinese National Knowledge Infrastructure (CNKI), Wan Fang, and the Cochrane Library, were conducted to collect the randomized controlled trials (RCTs) from inception to March 2018. RCTs investigating the impact of adding DEX to local anesthetics for TAP blocks were included in this analysis. Pain scores (at rest and movement), opioid consumption, the duration of the TAP block and the common adverse effects were analyzed. Results: Twenty published trials including 1212 patients met the inclusion criteria. The addition of DEX significantly reduced pain scores 8 hours postoperatively at rest (WMD, -0.78; 95% CI, -1.27 to -0.30; P=0.001), 4 hours postoperatively on movement (WMD, 1.13; 95% CI, -1.65 to -0.60; P < 0.001), and opioid consumption (WMD, 13.71; 95% CI, -17.83 to -9.60; P < 0.001) when compared with control group. Furthermore, perineural DEX significantly prolonged the duration of the TAP block (WMD, -3.33; 95% CI, -2.85 to -3.82; P < 0.001). It did not affect the incidence of postoperative nausea and vomiting, hypotension, bradycardia, somnolence, or pruritus. Conclusions: DEX is a potential anesthetic adjuvant that can facilitate better postoperative analgesia, reduce postoperative analgesic requirements, and prolong the local anesthetic effect when administered in TAP blocks.

在心脏外科手术中,临床常通过体外循环（CPB）时的血压,血氧饱和度等监测来判断患者脑部供血是否充足,但是效果不甚理想。近年来出现了颈静脉球血氧饱和度（SjvO2）这一检测项目,通过大量临床试验表明体外循环期间监测SjvO 2 能够降低患者脑部缺氧发生的风险,可以对临床工作

疼痛是困扰患者的主要问题之一,已被列为继体温、脉搏、呼吸、血压之后的第五大生命体征 [1] 。疼痛使得人们的生活质量显著降低。目前,阿片类药物是治疗疼痛最有效的药物,如芬太尼等。但长期使用会出现耐药性,成瘾性,戒断反应,呼吸抑制等不良反应。曲马多是一种人工合成的阿片类中枢系统镇痛剂,它是相对较弱的μ-阿片受体激动剂,并且可以抑制5-羟色胺和去甲肾上腺素的重吸收。

随着肥胖人口增长,肥胖病人外科手术接受全麻的数量增加。肥胖患者体内脂肪过多,脂溶性高的麻醉药物会蓄积在脂肪,导致药物代谢时间长,出现苏醒延迟。此外,肥胖患者围术期发生上呼吸道梗阻、支气管痉挛等气道并发症的风险显著增加,且这类患者耐受缺氧的能力减弱,易发生低氧血症。地氟烷的血气分配系数和脂肪/血分配系数在现有

This study aimed to compare the effects of moderate versus deep hypothermia anesthesia for Stanford A aortic dissection surgery on brain injury. A total of 82 patients who would undergo Stanford A aortic dissection surgery were randomized into two groups: moderate hypothermia group (MH, n = 40, nasopharyngeal temperature 25 °C, and rectal temperature 28 °C) and deep hypothermia group (DH, n = 42, nasopharyngeal temperature 20 °C, and rectal temperature 25 °C). Different vascular replacement techniques including aortic root replacement, Bentall, and Wheat were used. The intraoperative and postoperative indicators of these patients were recorded. There were no differences in intraoperative and postoperative measures between MH and DH groups. The concentrations of neuron-specific enolase and S-100β increased with operation time, and were significantly lower in MH group than those in the DH group (P < 0.05). The occurrence rates of complications including chenosis, postoperative agitation, and neurological complications in MH group were significantly lower than in DH group. The recovery time, postoperative tube, and ICU intubation stay were significantly shorter in MH group than those in DH group (P < 0.05). There were no significant differences revealed in hospital stay and death rate. MH exhibited better cerebral protective effects, less complications, and shorter tube time than DH in surgery for Stanford A aortic dissection.

Objective To evaluate the influence of moderate hypothermia anesthesia on brain injury in the operation of repairing Stanford type A aortic operation. Methods A total of 82 patients underwent Stanford type A aortic operation were divided into two groups:deep hypothermia (anus temperature 25 ℃, nasopharyngeal temperature 20 ℃) (DH group) 40 cases and moderate hypothermia anesthesia group (anus temperature 28 ℃, nasopharyngeal temperature 25 ℃) (MH group) 42 cases respectively. Two groups of patients were anesthetized in the same manner. MH group was cooled to nasopharyngeal temperature 25 ℃, circulation was stopped when anal temperature reached 28 ℃. DH group was cooled to nasal cavity temperature 20 ℃, circulation was stopped when anal temperature reached 25 ℃. Surgery were conducted by the same set of performer. S-100β and neuron specific enolase (NSE) blood concentration were measured from blood taken from bottom of jugular vein ball at time points prior to the cut lesion (T 0), before stop the circulation (T1), after circulation restored (T2), postoperative 4 h (T3), 24 h after surgery (T4) and 72 h after surgery (T5). In addition, the time of general anesthesia, the time of cooling, the time of reheating, the time of the operation, the changes of the pupil during the perfusion, the blood loss after the shutdown, the blood flow of the blood cells and the amount of blood plasma were recorded. Postoperative period of waking time, conjunctival edema, surgical restlessness, neurological complications, postoperative management time, duration of ICU, duration of hospital stay were also recorded and analyzed. Results Compared with DH group, MH group in general anesthesia time, cooling time, thawing time, operation time, awake time, chemosis, restlessness, neurological complications, postoperative with tube time, ICU stay time, total days in hospital were decreased (P<0.05). Blood bleeding volume after the machine shutting down, blood transfusion and blood plasma volume were decreased (P<0.05). The blood concentration of S-100βand NSE was significantly reduced at T1, T2 and T3 (P<0.05). Conclusions Moderate hypothermia anesthesia in Stanford type A aortic operation can help reduce brain injury and can be used as a preferred scheme.

Neural plasticity, a fundamental mechanism of neuronal adaptation, is disrupted in depression. The changes in neural plasticity induced by stress and other negative stimuli play a significant role in the onset and development of depression. Antidepressant treatments have also been found to exert their antidepressant effects through regulatory effects on neural plasticity. However, the detailed mechanisms of neural plasticity in depression still remain unclear. Therefore, in this review, we summarize the recent literature to elaborate the possible mechanistic role of neural plasticity in depression. Taken together, these findings may pave the way for future progress in neural plasticity studies.