Clinical Observation On Patient-controlled Intravenous Analgesic Effects Of Dezocine For Patients Undergoing Elective Thoracotomy

Objective To observe and evaluate the clinical efficacy of patient-controlled intravenous analgesia (PCIA) with dezocine after elective thoracotomy.Methods Sixty ASA(Ⅰ～Ⅱ)patients(20-70 years) undergoing general anesthesia for elective thoracotomy were randomly divided into two groups:①experimental group (dezocine PCIA group) (n=30),0.9 mg·kg-1 dezocine plus 5 mg dexamethasone was diluted to 100 ml with normal saline (NS),②control group (fentanyl PCIA group) (n=30),0.02 mg·kg-1 fentanyl plus 5 mg dexamethasone was diluted to 100 ml with normal saline (NS). Exclusion criteria included known allergy,sensitivity or contra-indications to dezocine or fentanyl; hepatic or renal Insufficiency;a history of chronic pain, long-term use analgesics; a history of bronchial asthma;and pregnancy; long-term useβ-blockers, calcium channel blockers or alcohol addiction.The sustained infusion was 2 ml/h plus PCIA 0.5 ml for each time, whereas the lockout time of safety was 15 min.Blood samples were obtained for analysis of TNF-a and IL-6 levels at 5 intervals:before induction of anesthesia, immediately after the pleural cavity is opened,the 2nd,24 th,48 th h after surgery. TNF-a and IL-6 were measured by using the TNF-a ELISA kit, IL-6 ELISA kit according to the manufacturer's protocol. The efficacy of analgesia was assessed by Visual Analogue Scale (VAS) and Bruggrmann Comfort Scale at the 2nd,12 th,24 th,36 th and 48th hours after surgery respectively. The side effects of analgesia was assessed by Ramsay Scale,incidence of nausea and vomiting, dizziness, somnolence and pruritus at the 2nd,12 th,24 th,36 th and 48th hours after surgery respectively. the stress response was assessed by levels of TNF-a and IL-6. patients'overall satisfaction with analgesia were assessed at the end of analgesia.Results No statistical difference in the pain visual analogue scale was found between experimental and control group within 48 hours after surgery(P>0.05). Postoperative follow-up period,there were not significant difference (P>0.05) (VAS) between experimental and control group in respiratory and circulatory function.The incidence of nausea, vomiting, excessive sedation in the experimental group was significantly lower than control group(P< 0.05).No statistical difference in the the incidence of dizziness and pruritus between experimental and control group within 48 hours after surgery(P>0.05). No significant difference was found in plasma levels of TNF-a and IL-6 between the two groups(P>0.05). patient's overall satisfaction with analgesia was not statistically significant between experimental and control group.Conclusions Dezocine PCIA could effectively relieve or eliminate post-operative pain of patients undergoing elective thoracic surgery, provides similar analgesia with fentanyl PCIA, but a lower incidence of the untoward reactions.