Study On The Optimal Background Dose Of PCIA After Gynecological Laparoscopic Surgery Under Multimodal Analgesia

Objective:Under the multimodal analgesic strategy,to investigate the optimal background infusion dose of PCIA based on sufentanil in patients undergoing gynecological laparoscopic hysterectomy,and the smallest dose of sufentanil that can adequately control postoperative pain in this type of surgery.Provide a reference for postoperative analgesia pump configuration in clinical pratice.Methods:After the approval of the Ethics Committee of our hospital,90 patients aged 35-65 who underwent elective laparoscopic hysterectomy under general anesthesia in Yan’an University Affiliated Hospital from April 2021 to June 2021 and met the inclusion and exclusion criteria were selected.The patients were divided into 3 groups using a random table,with 30 cases in each group.The 3 groups were:background dose of 2 ml/h group(group A),background dose of 1 ml/h group(group B),no background dose group(group C).All patients were given intravenous injection of parecoxib sodium 40 mg,dexamethasone 0.2 mg/kg,dezocine 1 mg/kg,and granisetron 3 mg 10 minutes before induction of anesthesia,and all received the same general anesthesia induction and maintenance protocol.All patients were treated with the pulmonary recruitment maneuver(PRM)when releasing pneumoperitoneum.After the operation,they were immediately connected to an intravenous analgesia pump for PCIA until 48 hours.The analgesic pump formula of the 3 groups of patients was sufentanil 1 ug/kg+dexmedetomidine 0.03ug/kg/h(group A,group B)or 0.05 ug/kg/ml(group C)+0.9%normal saline to 100 ml.The analgesic pump parameters of the three groups of patients were all set as the first dose of 2 ml,the PCA dose of 2 ml/time,the locking time of 15 min,and the limit volume of 16ml/h.The setting of background infusion dose is different,group A is 2 ml/h,group B is1 ml/h,group C is 0 ml/h.The resting and active NRS scores,the Ramsay sedation scores,the Bruggrmann comfort scores,PCA times,and the PONV verbal description scores were recorded at 4 h(T1),8 h(T2),12 h(T3),24 h(T4),48 h(T5)after surgery.The total times of PCA,the total consumption of sufentanil in the analgesic pump,and the occurrence of other adverse reactions except PONV within 48 hours after operation were also recorded.The above observation indicators of the three groups of patients were compared.Results:(1)The comparison of general conditions before and during operation between the three groups of patients,including age,height,weight,BMI,ASA grade,main diagnosis,the times of surgery and anesthesia,intraoperative consumption of sufentanil and remifentanil,whether or not pelvic adhesion release was performed during operation,had no statistical significance(P>0.05);(2)The comparison of the rest and activity NRS score between the three groups of patients at T1,T2,T3,T4 and T5 had no statistical significance(P>0.05),and the postoperative analgesic effects of the three groups were all satisfactory;(3)The comparison of the Ramsay sedation scores between the three groups at T1,T2,T3,T4 and T5 had no statistical significance(P>0.05).The sedation effect of the three groups of patients was satisfactory,and the scores were in the range of2 to 4;(4)The comparison of the Bruggrmann comfort score between the three groups at T1,T2,T3,T4 and T5 had no statistical significance(P>0.05);(5)The comparison results of PCA times at T1,T2,T3,T4 and T5 between the three groups had no statistical significance(P>0.05);(6)The comparison results of the total times of PCA after surgery between the three groups had no statistical significance(P>0.05);(7)The comparison of the PONV scores at T1,T2,T3,T4,T5 and the incidence of PONV after surgery between the three groups all had no statistical significance(P>0.05).The incidence of PONV in the group A,Band C were 37.9%,20.7%,and 20.0%,respectively,and the incidence of PONV in the overall patient was 26.1%;(8)The comparison of the incidence of other adverse reactions between the three groups had no statistical significance(P>0.05);(9)Comparing the total consumption of sufentanil in the three groups after surgery,the difference was statistically significant(P<0.01),the A group,B group,and C group were58.93(56.40-61.46)ug,32.16(30.39-33.92)ug,and 16.68(15.74-17.61)ug,respectively,and the C group was the least.Conclusion:(1)The analgesic,sedative effects and the incidence of PONV were similar when the background infusion dose of the analgesic pump was set to 2ml/h,1ml/h and 0ml/h,but the postoperative sufentanil consumption was lower at 0ml/h,which was only 16.68(15.74-17.61)ug.Therefore,the optimal background infusion dose of sufentanil for PCIA after gynecological laparoscopic hysterectomy under MA is 0 ml/h,that is,no background infusion dose,which reduced the abuse of opioids and the occurrence of related adverse reactions on the basis of ensuring adequate analgesia;(2)For laparoscopic hysterectomy patients aged 35-65 years,BMI 20.0-28.0kg/m~2,and ASA I-Ⅱgrades,if MA strategy is adopted in the perioperative period,the postoperative PCIA use0.01ug/kg/ml Sufentanil,the total amount of sufentanil is 16～18ug,compounded with0.05ug/kg/ml dexmedetomidine,and the analgesic pump parameters are set to the first dose of 2ml,the background infusion dose of 0ml/h,the PCA dose of 2ml,in this way,the analgesic and sedative effects are satisfactory and the incidence of PONV is low,which is a good and reliable analgesic scheme.