Pain Management and Prevention Surgical incisions, no matter how large or small, are injuries. With injury, there will be different degrees of pain response, which is the body’s normal response to injury. Different degrees of pain should be analyzed, treated differently, and handled differently. Slight pain] Reason The vast majority of patients after needle knife surgery only have a slight pain in the needle knife opening, which has no effect on the activities. Because the treatment point is less, loosening, peeling surface is small, the sensitivity of the tissue is low, so the pain is very mild. The pain is mostly generated in the parts that are not sensitive to pain, such as the neck and lower back. There is no redness or heat in the painful area, i.e. no inflammation. Handle this kind of pain not more than three days, three days later should be basically back to normal. For this kind of pain, there is no need to deal with it naturally. [Heavier pain] The reason a few people are more sensitive to pain, some parts of the needle knife surgery to stimulate a greater response, or surgical stripping surface is large, more damage to the tissue, and thus the pain reaction is strong. Performance of such pain occurs in the more sensitive parts of the pain, such as the knee, hands and feet and other parts. This pain from the disappearance of local anesthetic drugs, generally up to 3-5 days, and even some up to 7 days. Check the localization of no redness, swelling, heat and other manifestations. Treatment for patients after needle knife surgery in the limb area can be given general painkillers, tablets, injections can be, without the application of narcotic drugs. The pain should gradually decrease after three days. If there is weight gain, other complications should be considered. [Inflammatory pain] The causes are mostly due to a weak concept of asepsis, not following the requirements of asepsis, not strictly sterilizing, contaminating the operation, or not talking about aseptic technique at all. The root cause here is the poor quality of medical personnel. The first sign of manifest inflammation is pain. This pain should occur after 2-3 days after the operation and gradually aggravate without any tendency to relieve, and local redness, swelling, heat and other signs can be found. The body temperature should rise accordingly and the blood picture should also be responsive. See Infection section for management of this pain. Treatment and prevention of dizziness and weakness [Causes and manifestations] Application of local infiltration anesthesia This symptom should be treated as follows: 1. If it is caused by nervousness, more explanation should be given. Explain that the operation of the needle knife surgery is relatively simple, will not cause adverse effects, etc., to lift the ideological concerns, it can eliminate the discomfort symptoms. 2, in order to avoid dizziness, fatigue, and then fainting to fall events, be sure to rest or bed observation after the needle knife surgery for 15 minutes, after measuring blood pressure, pulse rate is normal before leaving the hospital. Generally, traction is required after needle-knife surgery for cervical spondylosis and lumbar disc herniation, so the patient cannot leave the hospital within 15 minutes. Therefore, we have not encountered any patients who fainted as a result. 3, a small number of people with longer duration of symptoms, the patient should be asked to rest for one or two days, heavy symptoms should be bed rest, generally without the need to give medication. Treatment of hemorrhage and hematoma 【Causes of hemorrhage and hematoma】 1. Hemophiliacs and undiagnosed hemophiliacs should pay special attention to this kind of patients, and should never miss the diagnosis. This is the patient who is most prone to bleeding, and once bleeding occurs, it will be more difficult to deal with. 2, coagulation time, platelet normal preoperative should be done routinely, can not be ignored. 3, female menstruation, the whole body blood vessels are in a mild expansion of congestion, should be avoided to do needle knife operation. This point, as long as attention to ask will not be missed. 4, unfamiliar with the anatomy of the larger blood vessels at the site of the needle knife operation, the needle knife cuts through the larger blood vessels, resulting in bleeding or hematoma; a larger range of needle knife laxation, especially large scar, adhesion, and extensive arthrocentesis (the use of type II, III needle knife), often more blood seepage from the incision. Even if the extravasation is not much, the swelling of the surgical site, in addition to edema, there are also causes of hematoma. 5, needle knife operation rough cutting, peeling too much, damage to the small blood vessels of a tissue resulting in hematoma; listen to the patient’s response, a hospital to do lumbar disc herniation needle knife treatment, even in the buttocks of a point on the repeated cutting for 15 minutes; and then, let the patient’s family members to press the point for half an hour; and told not to be lazy, or it will bleed. This kind of rough operation, how can not bleed! 6, the needle knife operation is not in place especially in the muscle belly of the operation is larger and more. Needle knife operations, the vast majority of which are in the tendons, ligaments, joint capsules and other parts of the body. These parts, especially those with adhesions and scarring have fewer blood vessels and should have poorer blood circulation status. If there is abundant circulation in these areas, it shouldn’t have lesions such as scarring. When a doctor (and trainee) treated a gluteus medius injury, he did a sparing peel before the needle and knife reached the bony surface because the site was deep, and as a result, the ecchymotic spot reached the knee. Clinical manifestations of hemorrhage and hematoma] 1, blood seepage from the incision to the outside, but never arterial jet bleeding, usually seepage of a few drops of blood, which is normal; 2, seepage of more blood, such as seepage from the incision of the needle knife to the outside in less than 30 ml; 3, there is a swelling or mass at the site of the needle knife debridement. The degree of swelling and the size of the mass vary depending on the amount of internal bleeding. The swollen area is hard and tough, the limbs can be thickened, and the mass can be detected in the abdomen, dorsum and lumbar region with pressure pain; 4. Pay attention to the blood pressure, pulse and hemoglobin checking, and there should not be any major changes in general, but for those with large amount of hemorrhage, the vital signs can be affected; 5. 1-2 days later, if the hemorrhage is superficial, it may be manifested as subcutaneous petechiae, and in some cases, it may flow down the muscular space, and petechiae may appear in the adjacent areas. [Treatment and prevention] 1, general bleeding (oozing), can be compressed to stop bleeding, should be no problem. 2, more bleeding in the limbs, the affected limbs can be elevated, and the limbs can be cushioned with pillows up to at least 30 °, that is, to reach a level higher than the heart. 3.Flexion immobilization of the joint should be done well for patients after needle-knife release of joint ankylosis. If the joint release is relatively adequate and the angle of fixation is sufficient, as long as a few hours are spent, then the swelling of the internally bleeding limb will be greatly reduced and will greatly promote the recovery of limb function. When immobilizing, care must be taken not to loop the limb to ensure that the blood supply and nerve function of the limb are not affected. Special attention should be paid to the distal end of the limb capillary recovery time, the degree of pain, with or without numbness sensation, foot dorsiflexion, toe movement disorders and other symptoms of observation, if there is any change should be dealt with in a timely manner. 4, for the limb has occurred serious swelling, poor blood circulation or numbness and other neurological dysfunction, we should lose no time to timely release the limb fixation, including bandages, splints and so on. If you wait until serious paralysis symptoms (such as foot drop, etc.) to find and deal with, it will be too late. 5, for major needle knife release surgery after the operation, medical personnel must closely observe the wound oozing blood, swelling and any abnormal sensation and so on. The postoperative medical advice should indicate the observation items, and measure the blood pressure, pulse rate and other vital characteristics on time to avoid accidents. For patients who have more blood seepage and hematoma, they should be given timely treatment such as hemostasis, fluid supplementation and blood transfusion. 6. For those who have considered the possibility of bleeding beforehand, hemostatic agent can be given before operation and continue to be given after operation. However, please note that the effect of hemostatic drugs is limited, and it is often unreliable to rely solely on hemostatic drugs to stop bleeding. 7, the most important way to prevent and reduce bleeding is that the needle knife operation should be gentle, should be done to the normal tissue damage is minimized, not to damage the larger blood vessels, bleeding, hematoma can be avoided naturally. This must have an in-depth understanding of the vascular course of the needle knife surgical site, body surface projection, etc., to make a reasonable design of the needle knife approach to avoid damage to blood vessels, resulting in bleeding. 8, not in the muscle belly, especially in the muscle door to do the invalid peeling operation of the needle knife.