Nerve block?

Patient-controlled analgesia (PCA) is used for acute postoperative pain, labor analgesia and cancer pain.

1. The goal of postoperative pain treatment is to reduce postoperative complications, promote patients' rehabilitation and improve the effect of surgical treatment through analgesia. PCA technology is a microcomputer analgesia technology which is produced by the close combination of computer technology and medicine. The anesthesiologist sets the procedure and the safety limit of painkillers in advance, and the patient himself intermittently controls the needed painkillers through the easy-to-operate buttons, so as to quickly achieve the purpose of relieving or alleviating pain after operation. He entered China in the middle and late 1990s. According to the patient's condition, the route of administration can be PCIA, PCEA or PCSA. The main advantage of PCA is that the administration conforms to the pharmacokinetic principle of analgesic drugs and it is easier to maintain the lowest effective analgesic concentration; The use of painkillers can be timely and fast, which basically solves the individual differences of patients' demand for painkillers; It is beneficial for patients to obtain the best analgesic effect at any time and under different pain intensities; Relieve 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, most of them are low-concentration local anesthetics (such as 0. 1.25% bupivacaine) combined with low-dose opioids (such as fentanyl, morphine and sufentanil). Ropivacaine is a new local anesthetic. At low concentration (0. 1% ~ 0.2%), sensory nerve block and motor nerve block are obviously separated, which has special significance in postoperative analgesia. In recent years, the concept of "walking epidural analgesia" has been put forward, so that patients can obtain satisfactory analgesic effect without affecting the movement of lower limbs and get out of bed as soon as possible. The commonly used formula is 0. 1% ropivacaine plus morphine or fentanyl. It is worth mentioning the problem of postoperative analgesia in children. Severe postoperative pain has a great influence on children's mental health, which is not conducive to their mental health development, especially for children who have undergone orthopedic surgery repeatedly. Some experts believe that children over 5 years old can consider postoperative analgesia.

The pain during childbirth comes from the contraction of uterus and the expansion of vagina. Analgesia requirements will not affect maternal contractions, prolong the labor process, and ensure the safety of the fetus. PCEA method meets the above requirements. The specific methods are as follows: ① The parturient enters the regular uterine contraction (the cervix is about 3~5cm) and carries out routine epidural puncture with a gap of 2 ~ 3 or 3 ~ 4 waist, and the tube is placed 3 ~ 5 cm in the direction of the head. ② 2 ~ 3ml 1% lidocaine was given after successful puncture. After observing for 5 minutes without spinal anesthesia, continue to give drugs to control the anesthesia level below T 10. Then turn on the analgesic pump. Commonly used formula is 0. 125% bupivacaine (or 0. 1% bupivacaine plus 0.00 16% fentanyl * * 60ml. ③ When you see the fetal head in the second stage of labor, raise the bedside by 30, and give the first dose of 8ml again. The purpose is to concentrate the medicine on the perineum, so that there will be no pain when sewing. No more drugs are given after the fetus is delivered.

Cancer pain can reduce the dosage of systemic painkillers or auxiliary drugs, reduce the tendency of drowsiness during the day, take medicine by oneself when it is necessary to relieve pain, shorten the time from pain to analgesia, improve the quality of life of patients with pain, and reduce the burden on their families. If necessary, devices such as catheters can be buried under the skin. It has been reported in China that the epidural space has a tube 35 1 day 2. In terms of drugs, besides commonly used opioids, ketamine and N-type calcium channel blocker ziconotide can also be used.