The Effects Of Butorphanol Combined With Dexmedetomidine For Patient Controlled Intravenous Analgesic On Analgesic Effect And Inflammatory Reaction In Elderly Patients With Colorectal Cancer Undergoing Laparoscopic Surgery

Objective:To observe and evaluate the effects of butorphanol combined with dexmedetomidine for patient controlled intravenous analgesic on analgesic effect and inflammatory reaction in elderly patients with colorectal cancer undergoing laparoscopic surgery.Methods:80 elderly patients(ASA I-II),aged 65-80 years,who recieved elective laparoscopic colorectal cancer surgery at Baoding First Central Hospital from November 2018 to June 2019,according to the random number table method,the patients were divided into control group and experimental group(n=40).Both groups of patients were given intravenous injection of 1mg butorphinol and 5mg tropanetron at 30 minutes before the end of surgery.The surgeon gave 0.5% ropivacaine 20 ml for local infiltration of the incision at the time of suture.At the end of the operation,the analgesia pump was connected and started.Butorphanol 0.15mg/kg(not more than 10mg)for the control group,Butorphinol 0.15mg/kg(not more than 10mg)combined with dexmedetomidine 100 ug for the experimental group.They were diluted to 100 ml with 0.9% physiological saline,and continuous pump injection for 48 h after the operation.(pump speed: 2ml/h,the additional dose: 0.5ml,the lock time: 15min).Patients were followed up after surgery,the VAS scores and Ramsay scores were recorded at the time of leaving the resuscitation room,2h,4h,6h,12 h,24h,48 h after surgery.If the VAS scores>4,the patients can press the analgesic pump.If the pain is still not relieved,100 mg tramadol deliverd by intramuscular injection is used for remedy analgesia,and the number of analgesia pump compressions and tramadol doses were recorded.The number of adverse reactions such as nausea,vomiting,bradycardia,and drowsiness were recorded within 48 hours after surgery.All the patients were perfomed with collecting vein blood sample 30 minutes before anesthesia,the end of the operation,24 h and 72 h after the operation respectively.The vein blood sample was contrifugede and supernate was taken,then the TNF-a and IL-6 concentration were detectd by enzyme linked immunosorbent assay.The first time to get out of bed and the first time to anal exhaust were recorded in the two groups to evaluate the recovery of gastrointestinal function.Results:1.general date:The differences of sex,age,ASA,BMI,operation time,surgical site in the two groups were not statistically significant(P> 0.05).2.the effects of pain and sedation: At 2h,4h,and 6h after operation,the VAS scores in the experimental groups were less than the control group,and the difference was statistically significant(P<0.05).There was no significant difference in the VAS scores between the two groups at other time points(P>0.05),and both of the two groups did not press the analgesic pump and no tramadol was used during postoperative analgesia.There was no significant difference in Ramsay scores between the two groups(P> 0.05).3.adverse reactions: 2 patients in the experimental group experienced nausea and vomiting,and 5 patients in the control group experienced nausea and vomiting(χ2=1.409,P=0.235),the difference was not statistically significant(P>0.05).No serious complications such as respiratory depression,drowsiness,bradycardia occurred after operation in both groups.4.inflammatory factors: The concentrations of TNF-a and IL-6 in the experimental groups at 24 hours and 72 hours after operation were lower than those in the control group,and the difference was statistically significant(P<0.05).5.the recovery of gastrointestinal function: the first time to anal exhaust in the experimental group was earlier than the control group after operation,and the difference was statistically significant(P<0.05),there was no statistical difference between the two groups in the first time to get out of bed after surgery(P>0.05).Conclusion:0.15mg/kg butorphanol combined with 100 ug dexmedetomidine is used in elderly patients with postoperative analgesia for laparoscopic colorectal cancer.It has significant analgesic and sedative effects,reduces adverse reactions,and effectively reduces the serum TNF-a and IL-6 concentration in the postoperative period.Relieving patients’ inflammatory reaction and promoting the recovery of gastrointestinal function to achieve rapid recovery of patients.