Effects Of Oxycodone On Substance P, 5-HT And PCIA In Patients Undergoing Laparoscopic Cholecystectomy

Objective Laparoscopic cholecystectomy(LC) is the normal operation on gallbladder in present. The postoperation pain of LC is mainly involved. Incisional pain, visceralgia and the referred shoulder pain. The pain mechanism is complicated, and the clinical manifestation is various, Most need narcotic painkillers to alleviate pain. Clinical oral, intramuscular injection and other traditional analgesic method ignored the individual differences of patients, pain duration is not clear, multiple dosing with superposition of drug effect. So it is often difficult to achieve the expected analgesia effect. patientcontrolled intravenous analgesia PCIA method is widely used gradually. PCIA is a patient in individualized dosing method with the characteristics of steady blood drug concentration, high security, simple dosing methods and the patient easy to accept. In order to alleviate postoperative pain, the PCIA most common opioid drugs such as fentanyl family, joint or not combined with other drugs such as non-steroidal. Family of fentanyl analgesic effect is obvious, but used alone dose is larger, there exists the common adverse reactions of opioids such as respiratory depression. Oxycodone is the only double opioid receptor in clinically use(μ-receptor and), and with high affinity of visceral κ-receptors. It’s reducing visceral effect of postoperative pain is gradually confirmed. End of operation before giving painkillers as part of a multimodal analgesia, Affects the cycle stability and the incidence of postoperative agitation in recovery period(including before and after extubation). To investigate the safety in anesthesia recovery period and effectiveness of postoperative analgesic effect of oxycodone, this test is designed.(The stochastic indicator method)Methods According to the operation sequence numbered the patients who meet the conditions, and group the patients by the parity of the number in selected random number table. The experimental group is Oxycodone group(O group,twenty patients), the control group is fentanyl group(F group, twenty patients).Made a preoperative visit on patients before surgery and strict screen the admissions of patients. Carried out preoperative preparation in accordance with the lapa-roscopic cholecystectomy.1.Anaesthesia Method:Open venous pathways after into the operating room, connect the monitor. Regular monitoring of electrocardiogram(ECG), noninvasive arterial pressure and oxygen saturation. Using sufentanil, midazolam, propofol, and benzene sulfonic acid shun atracurium to anesthesia induction. After endotracheal intubation use the anesthesia machine to control breath. Intraoperative maintain using propofol, remifentanil- benzene sulfonic acid shun atracurium maintain enough depth of anesthesia. According to the monitor data, at the end of the respiratory CO2 partial pressure, the BIS value and the patient is given proper anesthesia depth. Strictly control the liquid supplement. Stop anesthetic drugs after the performer removed the gallbladder. Intravenous inject oxycodone injection and fentanyl citrate injection respectively. Made sputum suction for the patient before spontaneous breathing with regulate action, so as not to cause agitation. Pull out the endotracheal tube when meet the conditions of extubation. Put into the anesthesia recovery room when the patient awake up completely. 2.Data collection methods: Record the spontaneous breathing recovery time and extubation time. This test need to extract venous blood at three time points :before induction of anesthesia(t0), extubating immediate(t1), out of the recovery room(t2). Measure the value of 5-HT and substance P in serum with ELISA method.Record the value of he patient’s heart rate(HR), mean arterial pressure(MAP), pulse oxygen saturation(Sp O2) at three time points: t0、t1、t2. Record the patient agitation after regained consciousness. And SAS score. Classify the score according to the mild, moderate and severe. Record the VAS score and Ramsay score at seven time points: before anesthesia induction(T0), after extubation(T1), the recovery room(T2), postoperative 4h(T3), 12 h after surgery(T4), 24 h after surgery(T5), 48 h after surgery(T6).3.The statistical analysis of data: Using SPSS13.0 software for data analysis. Measurement data using two independent sample t test, The results were measured by(X2). Chisquare test for count data. The difference was statistically significant when p<0.05.Results 1 There was no significant difference between the two groups of patients(P>0.05). 2 Oxycodone group recover spontaneous breathing and wake up faster(P < 0.05). 3 Recovery period of oxycodone group the incidence of agitation rate is small, light degree, and have small affect on heart rate, and stability of mean arterial pressure meanwhile the oxygen saturation unaffected. 4 Substance P and serotonin in oxycodone group compared with fentanyl group is rising slowly before and after extubation, when out of the recovery room. 5 PCIA postoperative analgesia VAS and Ramsay score and fentanyl group was higher than that of oxycodone group, oxycodone analgesia effect is good, moderate sedation. Adverse reactions occurred rate of fentanyl group was higher than that of oxycodone group.Conclusion 1 laparoscopic gallbladder surgery patients before surgery applications oxycodone, do not delay the patient awake, does not affect extubation can reduce blood flow and reduce volatility dynamics incidence of agitation, there is high security, stable anesthesia period cycle. 2 Application of oxycodone in laparoscopic surgery in patients with postoperative PCIA, can effectively reduce postoperative pain in patients with analgesic, fentanyl is superior to conventional use.