Application Of Different Doses Of Sufentanil Combined With Tramadol In Patient-controlled Intravenous Analgesia After Pediatric Digestive Surgery

ObjectiveTo evaluate the effect of different doses of sufentanil combined with tramadol in patient-controlled intravenous analgesia after pediatric digestive surgery,and to determine the optimum dose of sufentanil.MethodsThe study was approved by the Ethics Committee of The Children’s Hospital affiliated to Nanjing Medical University.Eighty-four pediatric patients,ASA grade of Ⅰ or Ⅱ,age of 2-8 years,weight of 10-30 kg,scheduled for digestive surgery,were randomly divided into three groups(group L,group M and group H)with 28 patients in each group using a computer-generated randomization list.All children were given general anesthesia,patients in Group L received sulfentanil 0.03 μg·kg-1·h-1 +tramadol 0.3 mg·kg-1·h-1 for PCIA,in Group M sulfentanil 0.04μg·kg-1·h-1 + tramadol 0.3 mg kg-1·h-1 for PCIA,and in Group H sulfentanil 0.05 μg·kg-1·h-1 + tramadol 0.3 mg·kg-1·h-1 for PCIA.The PC A model for all groups was loading dose of sulfentanil 0.2 μg/kg 30 min before the end of operation,bolus of 0.5 ml with lock time 15min and background 2 ml/h.PCA was performed by the parents of the children.CHIPPS pain scores and Ramsay sedation scores were recorded at 2 h、4 h、8 h、12 h、24 hand 48 h after the end of surgery.Recording the PCA press times and effective press times.Monitoring mean arterial pressure,heart rates and pulse oximetry at 2 h、12 h and 24 h after the end of surgery.The incidence of adverse reactions in children was recorded and satisfaction evaluation was performed by the parents of the children.ResultsThere were no statistics differences in MAP and HR among the groups at 2 h and 12 h after surgery(P>0.05).The MAP of Group L and Group M were higher than Group H[(98.3±5.7)versus.(88.9±5.7),(94.8±4.7)versus.(88.9±5.7)](P<0.05),The HR of Group L was higher than Group H[(90.8±4.6)versus.(82.7±2.5)](P<0.05)at 24 h after the end of surgery.And statistics differences in SpO2 was saw among the groups at 24 h after surgery(P<0.05).The trend of CHIPPS pain scores was similar to the trend of Ramsay sedation scores,those reached to peak values at 2 h after surgery,and then gradually declined.Compared with the Group M and Group L,CHIPPS pain scores were lower and Ramsay sedation scores were higher in Group H(P<0.05).The PCA press times and effective press times in Group L were more than those in Group M and Group H.The incidence of adverse reactions in Group H was 32.1%,which was higher than that in Group L(7.1%)and in Group M(7.1%).The satisfaction rate of Group M was(92.9%),which was significantly better than that of Group L(89.3%)and of Group H(71.4%)(P<0.01).ConclusionSufentanil 0.04 μg·kg-1·h-1 combined with tramadol 0.3 mg·kg-1·h-1 for patient-controlled intravenous analgesia after pediatric digestive surgery can provide good analgesic effect,less adverse reaction and higher satisfaction.