Clinical Trial Of Oxycodone Intravenous Patient-controlled Analgesia With Different Background Doses For Thoracoscopic Lobectomy

Objective:An ideal effect of perioperative analgesia can not only significantly reduce the severe pain caused by surgical trauma,but also accelerate the recovery of patients and improve their prognosis.In view of the high incidence of pain after thoracic surgery,oxycodone combined with sufentanil will be applied to intravenous patient-controlled analgesia pumps for patients after video-assisted thoracoscopic lobectomy of thoracic surgery in this study,and with different background doses.Compared with sufentanil,which is widely used in clinical postoperative intravenous analgesia,oxycodone can be used individually and the parameters of intravenous patient-controlled analgesia pump should be optimized,so as to explore the overall satisfaction of patients with medicines,safety and effectiveness,and the value of clinical promotion.Methods:In this study,a prospective,randomized,controlled,double-blind clinical trial,a total of 60 patients undergoing elective thoracoscopic lobectomy from December 2019 to December 2020 were randomly divided into three groups:sufentanil group（S group）,low background dose of oxycodone+sufentanil group（OS₁ group）and high background dose of oxycodone+sufentanil group（OS₂ group）with 20 cases in each group.Patients in S group were treated with sufentanil citrate（100μg）as opioid medication of postoperative analgesia pump,and added dexmetomidine（200μg）and ramosetron（0.6mg）mixed with 0.9%normal saline to 100ml,analgesic pump parameters were set to 2ml/h of continuous infusion dose,0.5ml per times of self-controlled infusion dose,and 15min of lock-up time.Patients in OS₁ group and OS₂ group were treated with oxycodone hydrochloride（50mg）and sufentanil（50μg）as opioids for postoperative analgesia pump,and added dexmedetomidine（200μg）and ramosetron（0.6mg）mixed with 0.9%normal saline to 100ml.The analgesic pump parameters of OS₁ group were set as follows:1ml/h of continuous infusion dose,0.5ml per times of self-controlled infusion dose,and 15min of lock-up time.The analgesic pump parameters of OS₂ group were set as follows:2ml/h of continuous infusion dose,0.5ml per times of self-controlled infusion dose,and 15min of lock-up time.Sedation,analgesia and adverse reactions were evaluated at 1^sth（T₁）,8^thh（T₂）,24^thh（T₃）and 48^thh（T₄）after operation.The number of invalid compression of analgesic pump was counted at 48^thh（T₄）after operation.The indwelling time of thoracic drainage tube and the hospitalization days were calculated after discharge.And IBM SPSS Statistics 23.0 statistical software was used for statistical analysis.Results:（1）In this study,60 patients undergoing thoracoscopic lobectomy were treated with analgesia pump after operation,with a good compliance.They cooperated with anesthesiologists to complete perioperative management,and received postoperative follow-up and clinical observation.There was no statistical difference in baseline data among the three groups of subjects,including gender,age,height,weight,BMI and other population baseline data,as well as ASA grade of preoperative evaluation,surgical incision grade,the number of incisions and operation duration.（2）The Ramsay score within 48hours after operation in OS group was generally higher than that in S group.At24^thh after operation,there was statistical difference between OS₂ group and S group.（3）The median postoperative NRS score of the three groups was less than4,and the NRS score of the OS group was generally lower than that of the S group within 48 hours after operation.In the resting state,there was statistical difference between OS₂ group and S group at 48^thh after operation.In the state of exercise,there was significantly statistical difference among the three groups at 8^thh after operation,the difference between OS₂ group and S group was highly statistically significant,and the difference between OS₁ group and S group was statistically significant.There was significantly statistical difference among the three groups at 24^thh after operation,and the differences between OS₂ group and S group/OS₁ group were highly statistically significant.（4）There was no statistical difference in postoperative adverse reactions among the three groups.（5）There was no statistical difference in the number of invalid compression of analgesia pump among the three groups.（6）There was no statistical difference in indwelling time of thoracic drainage tube among the three groups.While there was statistical difference in postoperative hospital stay among the three groups,among which the difference between OS₂ group and S group was statistically significant.Conclusion:Low background dose of oxycodone combined with sufentanil for intravenous patient-controlled analgesia after thoracoscopic lobectomy has a good analgesic effect,while the incidence of adverse reactions does not increase,which is worthy of clinical promotion and further study.