OBJECTIVES:To determine the prevalence, distribution, and associated clinical factors of chronic neuropathic cancer pain (CNCP) among outpatients with chronic cancer pain (CCP) and to inform improved recognition and management. METHODS:In this cross-sectional study, consecutive outpatients with CCP diagnosed according to the International Association for the Study of Pain (IASP) criteria were recruited from the pain clinic at Peking Union Medical College Hospital between June and October 2025. CNCP was diagnosed based on the Neuropathic Pain Special Interest Group (NeuPSIG) criteria. Patients were classified into the CNCP group if they met at least one of the four NeuPSIG criteria, regardless of coexisting visceral or bone pain. Demographic, oncologic, and pain-related data were collected through standardized interviews. Between-group differences in baseline characteristics were assessed using absolute standardized differences and Chi-square or t-tests. Logistic regression analyses were conducted to identify clinical factors associated with CNCP. RESULTS:Of 138 eligible patients with CCP, 85 (61.6%) were classified into the CNCP group and 53 (38.4%) into the non-CNCP group. Multivariable logistic regression analysis revealed that bone metastasis (adjusted OR = 2.316, 95% CI: 1.074-5.178, P = 0.032), radiotherapy (adjusted OR = 2.489, 95% CI: 1.119-5.803, P = 0.025), and voiding dysfunction (adjusted OR = 5.470, 95% CI: 2.150-16.396, P < 0.001) were independently associated with CNCP. Pancreatic cancer was inversely associated with CNCP (OR = 0.371, P = 0.031). Only 5 (3.6%) patients in the CNCP group received neuropathic pain-specific interventions, indicating a predominant reliance on single-modality pain management. CONCLUSIONS:CNCP was present in nearly two-thirds of outpatients with CCP. The identified associations with bone metastasis, radiotherapy, and voiding dysfunction may aid in the early recognition of neuropathic pain components and support the adoption of mechanism-based multimodal pain management strategies.

Background Amino acids (AAs) are one of the primary metabolic substrates for cardiac work. The correlation between AAs and both atrial fibrillation (AF) and aging has been documented. However, the relationship between AAs and age-related AF remains unclear. Methods Initially, the plasma AA levels of persistent AF patients and control subjects were assessed, and the correlations between AA levels, age, and other clinical indicators were explored. Subsequently, the age-related AF mouse model was constructed and the untargeted myocardial metabolomics was conducted to detect the level of AAs and related metabolites. Additionally, the gut microbiota composition associated with age-related AF was detected by a 16S rDNA amplicon sequencing analysis on mouse fecal samples. Results Higher circulation levels of lysine (Student’s t-test, P = 0.001), tyrosine ( P = 0.002), glutamic acid ( P = 0.008), methionine ( P = 0.008), and isoleucine ( P = 0.014), while a lower level of glycine ( P = 0.003) were observed in persistent AF patients. The feature AAs identified by machine learning algorithms were glutamic acid and methionine. The association between AAs and age differs between AF and control subjects. Distinct patterns of AA metabolic profiles were observed in the myocardial metabolites of aged AF mice. Aged AF mice had lower levels of Betaine, L-histidine, L-alanine, L-arginine, L-Pyroglutamic acid, and L-Citrulline compared with adult AF mice. Aged AF mice also presented a different gut microbiota pattern, and its functional prediction analysis showed AA metabolism alteration. Conclusion This study provided a comprehensive network of AA disturbances in age-related AF from multiple dimensions, including plasma, myocardium, and gut microbiota. Disturbances of AAs may serve as AF biomarkers, and restoring their homeostasis may have potential benefits for the management of age-related AF.

Pain management, listed as the fifth vital sign, has gained increasing attention from clinicians. Conventional analgesics have limited duration, leading to intense monitor and frequent dosing during the early phase in order to prevent the progression of chronic pain. Thus, prolonging the duration of analgesics has become one focus of the pain research. Several strategies, such as adding adjuvants, producing derivatives, and applying extended-release carriers, make it possible for super long-acting analgesics to come into reality. This review briefly introduces the strategies and development of the super long-acting analgesics, including the successful translation and commercialization of the present products of super long-acting analgesics. It also summarizes the application and translation of extended-release drug carriers, providing invaluable reference for the future research on the field of super long-acting analgesics.

目的:系统性评价高功率短时程(HPSD)与传统低功率长时程(LPLD)导管射频消融治疗房颤的有效性与安全性差异.方法:在PubMed、Embase与Cochrane Library数据库中检索导管射频消融治疗房颤对比HPSD与传统LPLD策略的文献,经文献筛选、质量评价与数据提取后计算合并效应与安全性.结果:筛选后纳入24项原始研究、5 358例/次房颤患者,相比传统策略组,HPSD 组术中急性肺静脉电传导恢复发生率低(RR=0.56,P=0.000 4)、术后12个月房颤(RR=0.69,P=0.02)和房颤/房速(RR=0.72,P=0.002)复发率低、食道损伤无显著差异(P＞0.05)、手术时程(WMD=-38.89 min,P＜0.000 01)与肺静脉电隔离(PVI)消融时间(WMD=-14.95 min,P＜0.000 01)更短;亚组分析提示功率更高时PVI耗时更短(P=0.000 3).结论:导管射频消融房颤HPSD策略的有效性与手术效率优于传统LPLD消融策略,两种策略安全性类似.

Pain management plays an essential role in medical care. Previous studies showed that pain is a dynamic process involving multiple mechanisms, which inspired the concept of multimodal analgesia. Therefore, a drug delivery system loaded with a single analgesic may be insufficient for pain control. In this study, an implantable thermogel/electrospun fiber (Gel/Fiber) system loaded with bupivacaine hydrochloride (BUP-HCl) and acetaminophen (APAP) was synthesized. In the composite, BUP-HCl was preferentially released from the hydrophilic thermogel to relieve nociceptive pain, followed by the release of APAP in a more sustained manner from hydrophobic fibers to reduce the inflammatory reaction. Pain behavioral study and activation assay of spinal glial cells in the chronic constriction injury (CCI) model demonstrated the superior analgesic efficacy and chronic pain prevention property of the Gel/Fiber system. Furthermore, the composite exhibited satisfactory biocompatibility, as shown by histological and pharmacokinetic analysis. These results indicate that the successful sequential BUP-HCl/APAP release by a Gel/Fiber system alleviates chronic pain with good biocompatibility.Our study may pave the way for the future application of extended-delivery systems.

INTRODUCTION:Benzodiazepines such as midazolam are widely used to moderately sedate patients during impacted wisdom tooth extraction to reduce anxiety in outpatient surgery. This present protocol was designed to determine whether continuous intravenous remimazolam, a new ultrashort-acting benzodiazepine, produces superior postoperative recovery quality to that of midazolam in patients undergoing extraction of impacted wisdom teeth.METHODS AND ANALYSIS:This study is a multicentre randomised controlled trial conducted at Peking Union Medical College Hospital, Beijing Anzhen Hospital and Beijing Shijitan Hospital in China. Approximately 150 participants undergoing extraction of impacted mandibular wisdom teeth will be randomly allocated to two groups (remimazolam and midazolam). The participants will be administered standard interventions to ensure they achieve a sedation level of III on the Ramsay sedation scale during the treatment. Preoperative and anaesthesia management and surgical techniques will be standardised for all participants. The primary outcome is recovery time for complete alertness and the secondary outcomes are anterograde amnesia during and after surgery, and interruption during operation for poor compliance or safety concerns.ETHICS AND DISSEMINATION:This study has been approved by the Ethics Review Committee of Peking Union Medical College Hospital (approval number: ZS-3142), Beijing Anzhen Hospital (approval number: KS2022082) and Beijing Shijitan Hospital (approval number: 2023-4).TRIAL REGISTRATION NUMBER:NCT05350085.

Besides peripheral nerve injury, the acute inflammation is one of the pathological features of tissues after surgery, which exacerbates the postoperative pain, especially in the first 48 h after the surgery. Multimodal analgesia (MMA), such as the combination of non-steroidal anti-inflammatory drugs (NSAIDs) with local anesthetics, has shown enhanced potency compared with the usage of local anesthetics alone. However, rare formulations can provide long-term analgesia at a single dose. Herein, bupivacaine (BUP, a local anesthetic) loading poly(lactic-co-glycolic acid) (PLGA) nanoparticles (NPB) were coated with meloxicam (MLX, an NSAID) loading lipid bilayer (LPM), forming a core–shell nanosystem (NPB@LPM) to provide enhanced and long-term analgesia to treat postoperative pain. MLX was encapsulated in the lipid shell, which enabled high dose MLX to be released in the first 48 h after surgery to reduce the acute inflammation induced pain. BUP was encapsulated in the PLGA core to provide a long-term release for the nerve block. This nanosystem provided a 7-day (whole recovery cycle) effective analgesia in the Brennan’s plantar incision rat model. The tissue reactions of NPB@LPM are benign. This work will provide feasible strategies on designing drug delivery systems for postoperative pain management.

Background Perioperative acute kidney injury (AKI) has been one of the leading causes of morbidity and mortality for surgical patients. Pheochromocytoma is a rare, catecholamine-secreting neuroendocrine neoplasm characterized by typical long-term hypertension that needs surgical resection. Our objective was to determine whether intraoperative mean arterial pressures (MAPs) less than 65 mmHg are associated with postoperative AKI after elective adrenalectomy in patients with pheochromocytoma. Methods We performed a retrospective review of patients undergoing adrenalectomy for pheochromocytoma between 1991 and 2019 at Peking Union Medical College Hospital, Beijing, China. Two intraoperative phases, before and after tumor resection, were recognized based on distinctly different hemodynamic characteristics. The authors evaluated the association between AKI and each blood pressure exposure in these two phases. The association between the time spent under different absolute and relative MAP thresholds and AKI was then evaluated adjusting for potential confounding variables. Results We enrolled 560 cases with 48 patients who developed AKI postoperatively. The baseline and intraoperative characteristics were similar in both groups. Though time-weighted average MAP was not associated with postoperative AKI during the whole operation (OR 1.38; 95% CI, 0.95–2.00; P = 0.087) and before tumor resection phase (OR 0.83; 95% CI, 0.65–1.05; P = 0.12), both time-weighted MAP and time-weighted percentage changes from baseline were strongly associated with postoperative AKI after tumor resection, with OR 3.50, 95% CI (2.25, 5.46) and 2.03, 95% CI (1.56, 2.66) in the univariable logistic analysis respectively, and with OR 2.36, 95% CI (1.46, 3.80) and 1.63, 95% CI (1.23, 2.17) after adjusting sex, surgical type (open vs. laparoscopic) and estimated blood loss in the multiple logistic analysis. At any thresholds of MAP less than 85, 80, 75, 70, and 65 mmHg, prolonged exposure was associated with increased odds of AKI. Conclusions We found a significant association between hypotension and postoperative AKI in patients with pheochromocytoma undergoing adrenalectomy in the period after tumor resection. Optimizing hemodynamics, especially blood pressure after the adrenal vessel ligation and tumor is resected, is crucial for the prevention of postoperative AKI in patient with pheochromocytoma, which could be different from general populations.

The phosphorylation of 14-3-3 binding motif is involved in many cellular processes. A strategy that enables targeted degradation of 14-3-3-binding phosphoproteins (14-3-3-BPPs) for studying their functions is highly desirable for basic research. Here, we report a phosphorylation-induced, ubiquitin-proteasome-system-mediated targeted protein degradation (TPD) strategy that allows specific degradation of 14-3-3-BPPs. Specifically, by ligating a modified von Hippel-Lindau E3-ligase with an engineered 14-3-3 bait, we generated a protein chimera referred to as Targeted Degradation of 14-3-3-binding PhosphoProtein (TDPP). TDPP can serve as a universal degrader for 14-3-3-BPPs based on the specific recognition of the phosphorylation in 14-3-3 binding motifs. TDPP shows high efficiency and specificity to a difopein-EGFP reporter, general and specific 14-3-3-BPPs. TDPP can also be applied for the validation of 14-3-3-BPPs. These results strongly support TDPP as a powerful tool for 14-3-3 related research.

PurposeThis study aimed to develop prediction models for chronic postsurgical pain (CPSP) after breast cancer surgery using machine learning approaches and evaluate their performance.MethodsThe study was a secondary analysis based on a high-quality dataset from a randomized controlled trial (NCT00418457), including patients with primary breast cancer undergoing mastectomy. The primary outcome was CPSP at 12 months after surgery, defined as modified Brief Pain Inventory > 0. The dataset was randomly split into a training dataset (90%) and a testing dataset (10%). Variables were selected using recursive feature elimination combined with clinical experience, and potential predictors were then incorporated into three machine learning models, including random forest, gradient boosting decision tree and extreme gradient boosting models for outcome prediction, as well as logistic regression. The performances of these four models were tested and compared.Results1152 patients were finally included, of which 22.1% developed CPSP at 12 months after breast cancer surgery. The 6 leading predictors were higher numerical rating scale within 2 days after surgery, post-menopausal status, urban medical insurance, history of at least one operation, under fentanyl with sevoflurane general anesthesia, and received axillary lymph node dissection. Compared with the multivariable logistic regression model, machine learning models showed better specificity, positive likelihood ratio and positive predictive value, helping to identify high-risk patients more accurately and create opportunities for early clinical intervention.ConclusionsOur study developed prediction models for CPSP after breast cancer surgery based on machine learning approaches, which may help to identify high-risk patients and improve patients’ management after breast cancer.

BackgroundEffects of anesthetic interventions on cancer prognosis remain controversial. There is evidence that estrogen receptor (ER)-negative breast cancer patients have an early recurrence peak. We aimed to assess the potential benefit of regional anesthesia-analgesia versus general anesthesia regarding early recurrence in breast cancer according to ER expression.MethodsBased on a multicenter randomized controlled trial (clinicaltrials.gov, NCT00418457), we included all the patients from Peking Union Medical College Hospital research center in this study. The primary outcome was breast cancer recurrence after surgery. The Cox proportional hazard model was used to compare recurrence between groups.ResultsIn total, 1,253 breast cancer patients were included in this sub-study, among whom the median follow-up time was 53 months. In this sub-study, 320 patients were ER-negative, and 933 were ER-positive. As for ER-negative patients, the recurrence risk in the PPA (paravertebral blocks and propofol general anesthesia) group showed no statistical difference compared with the GA (sevoflurane and opioids general anesthesia) group (19.1% versus 23.4%; adjusted HR: 0.80, 95% CI: 0.50–1.30; P = 0.377). In the first 18 months after breast cancer surgery, which is considered as the classical early peak of recurrence, after adjustment for menstruation and the pathological stage of tumor, the decrease of early recurrence observed in the PPA group was not significant compared with the GA group (adjusted HR: 0.63, 95% CI: 0.34–1.14; P = 0.127).ConclusionsIn our study, the effects of early recurrence after breast cancer surgery in both ER-negative and ER-positive patients were similar between regional anesthesia-analgesia and general anesthesia. Large samples of ER-negative patients will be needed to clarify the effects of anesthetic interventions.

High-power short-duration (HPSD) setting during radiofrequency ablation has become an attempt to improve atrial fibrillation (AF) treatment outcomes. This study ought to compare the efficacy, safety, and effectiveness between HPSD and conventional settings. PubMed, Embase, and Cochrane Library were searched. Studies that compared HPSD and conventional radiofrequency ablation settings in AF patients were included while studies performed additional ablations on nonpulmonary vein targets without clear recording were excluded. Data were pooled with random-effect model. Efficacy endpoints include first-pass pulmonary vein isolation (PVI), acute pulmonary vein (PV) reconnection, free from AF, and free from atrial tachycardia (AT) during follow-up. Safety endpoints include esophagus injury rate and major complication rate. Effectiveness endpoints include complete PVI rate, total procedure time, PVI time, and PVI radiofrequency ablation (PVI RF) time. We included 22 studies with 3867 atrial fibrillation patients in total (2393 patients received HPSD radiofrequency ablation). Perioperatively, the HPSD group showed a higher first-pass PVI rate (risk ratio, RR = 1.10 , P = 0.0001 ) and less acute PV reconnection rate ( RR = 0.56 , P = 0.0004 ) than the conventional group. During follow-up, free from AF ( RR = 1.11 , P = 0.16 ) or AT ( RR = 1.06 , P = 0.24 ) rate did not differ between HPSD and conventional groups 6-month postsurgery. However, the HPSD group showed both higher free from AF ( RR = 1.17 , P = 0.0003 ) and AT ( RR = 1.11 , P < 0.0001 ) rate than the conventional group 12-month postsurgery. The esophagus injury ( RR = 0.99 , P = 0.98 ) and major complications ( RR = 0.76 , P = 0.70 ) rates did not differ between the two groups. The HPSD group took shorter total procedure time ( MD = − 33.71 95% CI: -43.10 to -24.33, P < 0.00001 ), PVI time ( MD = − 21.60 95% CI: -25.00 to -18.21, P < 0.00001 ), and PVI RF time ( MD = − 13.72 , 95% CI: -14.45 to -13.00, P < 0.00001 ) than conventional groups while complete procedure rate did not differ between two groups ( RR = 1.00 , P = 0.93 ). HPSD setting during AF radiofrequency ablation has better effectiveness, efficacy, and similar safety compared with the conventional setting.

Objective To evaluate the release characteristics and analgesic effect of extended-release composite polymers of local anesthetics. Methods Polymer extended-release film containing bupivacaine hydrochloride was prepared via electrospinning (nanomembrane, group M), and was furthermore loaded intoPLGA-PEG-PLGA thermo-sensitive gel forming composite extended-release carrier (group G). The in vitro release profile, analgesic effect and safety in vivo were evaluated. Results In vitro, the cumulative release of bupivacaine hydrochloride reached more than 5 d in the group M and 10 d in the group G. In vivo, the analgesic effect in the model of chronic compression injury of sciatic nerve lasted for 14 d in the group M and group G. There was no significant difference between the two groups (P > 0.05). The peak plasma concentration of bupivacaine hydrochloride in the group M was (0.294±0.029)μg/L one day after drug administration, while (0.192±0.064)μg/L in the group G three days after drug administration, which were far below the toxic plasma level of bupivacaine chloride. Meanwhile, there were no significant pathological changes in the heart, liver, spleen, lung and kidney of the two groups. Conclusions In this study, the composite extended-release drug delivery prepared by bupivacaine hydrochloride electrospinning film as the basis and PLGA-PEG-PLGA thermo-sensitive gel can further prolong the release time of bupivacaine chloride and exhibit long-term analgesic effect without toxicity.

Intraoperative anesthesia can be divided into general anesthesia and local anesthesia according to the distribution of anesthetic drugs, and local anesthesia has broad applications in plastic surgery. The short acting time and poor lipid solubility of local anesthetics on conventional dosage limit their application in transdermal delivery. In recent years, there has been rapid developments in the topical analgesic transdermal delivery system, through which a drug penetrates the cuticle of the skin and enters the dermis to block the introduction of nerve terminal pain, so as to achieve the analgesic effect. In addition, transdermal administration can significantly increase safety and patient comfort compared to injectable administration. In this review, the commonly used methods of promoting transdermal absorption and topical analgesics on the market were overviewed, and the application and future direction of anesthetics in plastic and cosmetic surgery were prospected based on the research progress.

Aim: To evaluate the genetic associations of visceral adipose tissue (VAT) mass with metabolic risk factors and cardiovascular disease (CVD) endpoints and to construct a network analysis about the underlying mechanism using Mendelian randomization (MR) analysis. Methods and Results: Using summary statistics from genome-wide association studies (GWAS), we conducted the two-sample MR to assess the effects of VAT mass on 10 metabolic risk factors and 53 CVD endpoints. Genetically predicted VAT mass was associated with metabolic risk factors, including triglyceride (odds ratio, OR, 1.263 [95% confidence interval, CI, 1.203-1.326]), high-density lipoprotein cholesterol (OR, 0.719 [95% CI, 0.678-0.763]), type 2 diabetes (OR, 2.397 [95% CI, 1.965-2.923]), fasting glucose (OR, 1.079 [95% CI, 1.046-1.113]), fasting insulin (OR, 1.194 [95% CI, 1.16-1.229]), and insulin resistance (OR, 1.204 [95% CI, 1.16-1.25]). Genetically predicted VAT mass was associated with CVD endpoints, including atrial fibrillation (OR, 1.414 [95% CI, 1.332 = 1.5]), coronary artery disease (OR, 1.573 [95% CI, 1.439 = 1.72]), myocardial infarction (OR, 1.633 [95% CI, 1.484 =1.796]), heart failure (OR, 1.711 [95% CI, 1.599-1.832]), any stroke (OR, 1.29 [1.193-1.394]), ischemic stroke (OR, 1.292 [1.189-1.404]), large artery stroke (OR, 1.483 [1.206-1.823]), cardioembolic stroke (OR, 1.261 [1.096-1.452]), and intracranial aneurysm (OR, 1.475 [1.235-1.762]). In the FinnGen study, the relevance of VAT mass to coronary heart disease, stroke, cardiac arrhythmia, vascular diseases, hypertensive heart disease, and cardiac death was found. In network analysis to identify the underlying mechanism between VAT and CVDs, VAT mass was positively associated with 23 cardiovascular-related proteins (e.g., Leptin, Hepatocyte growth factor, interleukin-16), and inversely with 6 proteins (e.g., Galanin peptides, Endothelial cell-specific molecule 1). These proteins were further associated with 32 CVD outcomes. Conclusion: Mendelian randomization analysis has shown that VAT mass was associated with a wide range of CVD outcomes including coronary heart disease, cardiac arrhythmia, vascular diseases, and stroke. A few circulating proteins may be the mediators between VAT and CVDs.

Objective:To compare the effects of different anesthetic methods on the prognosis in the patients with stage Ⅲ breast cancer.Methods:Based on a multicenter randomized controlled trial (NCT00418457), 274 patients with untreated stage Ⅲ breast cancer, aged 18-85 yr, of American Society of Anesthesiologists physical statusⅠ-Ⅲ, were enrolled in the study and assigned to thoracic paravertebral block (TPVB) combined with total intravenous anesthesia group (TPVB+ TIVA group, n=141) and general anesthesia group (GA group, n=133) by computer-generated randomization stratified by study site.The primary outcome parameter of this study was postoperative recurrence rate.The secondary outcome parameters were the degree of postoperative acute pain (assessed using visual analogue scale score), the incidence of postoperative nausea and vomiting (PONV), postoperative hospital stay time, and the incidence of persistent pain after breast cancer surgery (PPBCS) at 6 and 12 months after surgery (assessed using the modified Brief Pain Inventory). Results:Compared with group GA, no significant change was found in the postoperative recurrence rate ( HR=0.711, 95% confidence interval (CI) 0.418-1.210, P=0.209), the degree of postoperative acute pain and the incidence of PONV were decreased (mean difference ( MD) of visual analogue scale score -0.890, 95% CI -1.344--0.436, P<0.001; OR=0.236, 95% CI 0.083-0.674, P=0.007), and no significant change was found in postoperative hospital stay time and the incidence of PPBCS ( HR=1.000, 95% CI 0.778-1.286, P=1.000; OR=2.100, 95% CI 0.599-7.362, P=0.246) in group TPVB+ TIVA. Conclusion:Compared with general anesthesia alone, TPVB combined with total intravenous anesthesia can provide lower degree of postoperative acute pain and lower incidence of PONV, and exert no effects on postoperative recurrence, postoperative hospital stay time and PPBCS in patients with stage Ⅲ breast cancer.

Abstract Background The correlation between serum bilirubin level and multiple respiratory system diseases including lung cancer has been reported. We aimed to explore the relationship between serum bilirubin level and the prevalence of lung cancer among smokers in China. Methods We designed a retrospective case-control study and enrolled 266 lung cancer patients and 266 matched controls from The Third Xiangya Hospital of Central South University from February 2011 to May 2017. Data including diagnosis, serum bilirubin levels and smoking history were collected, which consistently showed significant differential in cases and controls. Results Lower total and indirect bilirubin level is correlated with smoking but they can be recuperating after cessation. The average bilirubin level in lung cancer patients was lower than matched controls. Low indirect bilirubin level within normal range is the risk factor of lung cancer in smokers (OR = 2.710). Of note, smokers whose serum bilirubin lower than 7.88 µmol / L has a higher risk of lung cancer in Chinese adults. Conclusions Serum indirect bilirubin level would be a screening predictor to identify higher risk smokers of lung cancer.

背景:良好的围手术期镇痛是加速康复外科(ERAS)理念的重要组成部分.前足截骨矫形手术是足踝外科常见手术,尚无针对此类手术的规范化围手术期镇痛方案.目的:比较喉罩全麻结合踝周神经阻滞与喉罩全麻结合术后患者自控镇痛(PCA)两种方法在前足截骨矫形术后镇痛方面的疗效.方法:本研究纳入2015年1月至2019年6月间收治的中重度外翻并接受单足前足截骨矫形患者86例,其中男8例,女78例,年龄53～83岁,平均(68.1±8.4)岁.术式采用收肌腱及外侧关节囊松解+改良Chevron截骨±Weil截骨±Akin截骨.患者随机分为两组,PCA组:采用喉罩全麻+术后PCA;踝周阻滞组:采用喉罩麻醉后、切开手术前行踝周神经阻滞.收集两组手术时间,术前及术后即刻、6 h、12 h、24 h、48 h及3 d、7 d时切口疼痛VAS评分等指标.结果:两组患者年龄、性别无统计学差异(P>0.05).PCA组的平均手术时间为(56±6)min,踝周阻滞组为(58±7)min,组间比较无统计学差异(P>0.05).PCA组术后即刻、6 h、12 h、24 h的VAS评分分别为(4.5±1.0)分、(5.1±1.5)分、(4.8±1.7)分、(4.0±1.4)分,踝周阻滞组分别为0分、(1.0±0.9)分、(3.5±1.1)分、(3.0±1.8)分,踝周阻滞组显著低于PCA组(P<0.05).术后48 h、3 d及7 d的VAS评分,两组比较无统计学差异(P>0.05).术后注射阿片类镇痛药物者,PCA组(10例,23.3％)明显多于踝周阻滞组(2例,4.7％).结论:踝周神经阻滞可有效控制前足截骨矫形术后疼痛,减少非PCA途径阿片类镇痛药物使用,提高患者手术体验,值得临床应用.