BACKGROUND:This study aims to evaluate the onset, maintenance, side effects s and the effect on newborns of dural puncture epidural (DPE) technique combined with programmed intermittent epidural bolus (PIEB) mode for labor analgesia as compared to conventional epidural (EP) technique combined with continuous epidural infusion (CEI) mode.METHODS:All patients were randomly assigned to receive EP + CEI (Group EC), EP + PIEB (Group EP), DPE + CEI (Group DC) and DPE + PIEB (Group DP). Record the time to reach Numerical Rating Scale (NRS) ≤ 1, ropivacaine consumption, the NRS when the uterine neck whole opened (NRS2), the incidence of bilateral sensory block level to S2, asymmetric block, incomplete analgesia, replacement of catheter, intrapartum fever, as well as the occurrence of neonatal Apgar score ≤ 7 at 1 minute and 5 minutes.RESULTS:A total of 455 women were included (111 in Group EC, 116 in Group EP, 114 in Group DC and 114 in Group DP). The time to reach NRS ≤ 1 in Group DP and Group DC was shorter than that in Group EP and Group EC (P < .05); the consumption of ropivacaine in Group DP was less than that in 3 other groups (P < .05); the incidence of incomplete analgesia and intrapartum fever in Group DP was lower than that in other 3 groups (P < .05).CONCLUSIONS:DPE technique can provide faster analgesia than conventional EP technique, combined with PIEB mode maybe superior to traditional methods as a labor analgesia regimen.

Obstructive sleep apnea (OSA) is defined by intermittent and recurrent episodes of partial or complete obstruction of the upper airway during sleep. Intermittent and recurrent hypoxia/reoxygenation is the main pathophysiological mechanism of OSA. Its consequences include systemic inflammation, activation of the sympathetic nervous system, and release of oxygen free radicals.Infusion of intravenous (IV) lidocaine has anti-inflammatory, antihyperalgesic, and analgesic properties, supporting its use as an anesthetic adjuvant. Lidocaine can reduce nociception and/or cardiovascular responses to surgical stress, as well as postoperative pain and/or analgesic requirements. Because of the high prevalence of OSA in obese patients, the use of opioids to manage postoperative pain in that population is often accompanied by the development of adverse respiratory events, such as hypoventilation and hypoxemia. IV infusion of lidocaine has been shown to enhance the quality of early recovery after laparoscopic bariatric and upper airway surgery. However, limited evidence exists regarding its use in patients undergoing surgery for OSA. In addition, whether IV infusion of lidocaine can improve postoperative early recovery in patients undergoing surgery for OSA remains unknown. Therefore, we hypothesized that IV infusion of lidocaine can improve postoperative early recovery in patients undergoing surgery for OSA. Perioperative infusion also may be a promising analgesic adjunct to enhanced recovery after surgery (ERAS) protocols.

Objectives/HypothesisSystemic infusions of lidocaine have been widely used as perioperative analgesic adjuvants. The aim of this randomized, double‐blinded, controlled trial was to investigate the effect of perioperative lidocaine infusion on postoperative early recovery quality in upper airway surgery.Study DesignProspective, randomized, double‐blinded, placebo‐controlled trial.MethodsA total of 99 patients were randomly assigned to the lidocaine group (group L) or the control group (group C). The patients received 2 mg/kg lidocaine completed within 10 minutes before the induction of anesthesia followed by continuous infusions of 2 mg/kg/hr lidocaine (group L) or the same volume of 0.9% normal saline (group C) intravenously during anesthesia. The Quality of Recovery‐40 (QoR‐40) survey was administered on the preoperative day (Pre) and postoperative days 1 (POD1) and 2 (POD2). The primary endpoint was QoR‐40 score on POD1 and POD2.ResultsCompared with Pre, global QoR‐40 scores on POD1 and POD2 were significantly lower (P < .05). Compared with group C, global QoR‐40 scores were significantly higher in group L on POD1 and POD2 (P < .05). Among the five dimensions of QoR‐40, the scores for physical comfort, emotional state, and pain were superior in group L compared to group C (P < .05). Compared with group C, the consumption of remifentanil and diclofenac as well as the incidence of postoperative nausea and vomiting (PONV) and postoperative 48‐hour numeric rating scale (NRS) scores in group L were significantly lower (P < .05).ConclusionsSystemic lidocaine infusion can improve QoR‐40 scores in patients with upper airway surgery, reduce the dosage of intraoperative opioids, decrease the incidence of PONV and NRS scores 2 days after surgery, thus improving postoperative early recovery quality.Level of Evidence1b Laryngoscope, 131:E63–E69, 2021

围术期使用阿片类药物的诸多不良反应促使研究者们对非阿片类镇痛辅助用药作越来越深入的研究,其中一种潜在的有效的药物是利多卡因.围术期使用利多卡因可以减少术中阿片类药物的用量,减轻术后疼痛,加快术后胃肠道功能恢复,缩短住院时间,促进术后康复.该文对围术期静脉应用利多卡因的效果和可能作用机制进行综述.