Application Of Single Injection Of Hydromorphone Hydrochloride In Epidural Space Combined With PCIA After Prostatectomy

Objective: To investigate the effect of hydromorphone hydrochloride(HM)epidural space single injection combined with patient-controlled intravenous analgesia(PCIA)on postoperative analgesia after prostatectomy.Methods: A total of sixty patients with transurethral resection of the prostate(TURP)admitted in our hospital were randomly divided into PCIA group(only PCIA)and HM group(Single injection of hydrophone in epidural space + PCIA),Morphine(MI)group(Single injection of morphine in epidural space + PCIA).The hemodynamic data was recorded at 4 h(T1),12 h(T2),24 h(T3)and 48 h(T4)after surgery,including heart rate(HR),mean arteries pressure(MAP),Oxygen saturation(Sp O2).Analgesic and sedative effects were evaluated using resting state visual analogue scale(R-VAS),moving state visual analogue scale(M-VAS),as well as Ramsay sedation score(Ramsay)at T1 to T4 time points.The number of effective PCIA compressions and analgesic recovery rates for each regimen were counted in postoperative 48 h.The analgesic satisfaction score of the patients was recorded 3 days after operation.Postoperative complications such as nausea and vomiting,skin itching,respiratory inhibition and catheter-related bladder irritation sign(CRBD)were recorded.Postoperative ground movement and postoperative time were also recorded.Results: The MAP、HR of postoperative T1～T4 in HM group and MI group was lower compared to that in PCIA group(P<0.05 respectively).There was no significant difference in hemodynamic data between HM group and MI group(P>0.05).No significant difference was found in hypotension and bradycardia in three groups.The R-VAS and M-VAS scores in HM group and MI group were significantly lower than those in PCIA group at postoperative T1～T4 time points(P<0.05 respectively).The R-VAS 、 M-VAS scores of HM group at T1 time point was significantly decreased compared to those in MI group(P<0.05 respectively).The number of compressions in PCIA group was significantly higher than that in HM and MI group(P<0.05 respectively).There was no significant difference between HM and MI group(P>0.05).The analgesic satisfaction of HM and MI groups was significantly higher than that of PCIA group(P<0.05).The level of sedation by Ramsay score was less than 4 points in three groups at T1-T4 time points.The incidence of nausea,vomiting and itching in MI group were significantly higher than PCIA and HM group(P<0.05 respectively).The incidence of CRBD in PCIA group was significantly higher than that in HM and MI group(P<0.05respectively).The time of postoperative ground movement and exhaust of PCIA group was significantly longer than the other two groups(P<0.05 respectively).Conclusion: A single injection of HM epidural combined with PCIA provide adequate analgesic and sedative effect in analgesia of prostatectomy.