Effect Of Different Doses Of Butorphanol Tartrate For Preventive Analgesia On Postoperative Pain After Gynecological Laparoscopic Surgery

Background:The incidence of female reproductive system tumors in the reproductive age population is increasing year by year.Laparoscopic surgery has become the mainstream surgical method for these diseases.Compared with traditional open surgery,laparoscopic surgery has the advantages of small incision,less trauma,less pain for patients and faster recovery.However,it can still cause serious stress reactions due to intraoperative pneumoperitoneum,such as postoperative pain,nausea,vomiting and post-anesthesia shivering.The main pain complications of gynecological laparoscopic surgery include postoperative incision pain and visceral pain.Visceral pain is often difficult to manage effectively due to its complexity,resulting in many adverse effects on patients.preemptive analgesia promotes postoperative recovery by preventing peripheral and central traumatic sensitization,reducing the degree of pain after trauma,reducing the dosage of analgesic drugs,and making patients more stable and comfortable during anesthesia.Butorphanol tartrate,as a synthetic opioid receptor mixed agonist,can relieve visceral pain of patients with activator κ receptor and relieve respiratory depression,addiction,itching,postoperative nausea and vomiting with antagonistic μ receptor.Objective:In this study,three different doses of butorphanol were preinjected intravenously in patients undergoing laparoscopic surgery at an selected time in gynecology to explore the effect of different doses of butorphanol on postoperative pain for preemptive analgesia,and to explore the appropriate dose for postoperative analgesia under gynecologic laparoscopy.Methods:According to the inclusion and exclusion criteria,172 patients who planned to undergo gynecological laparoscopic surgery from April 2022 to December 2022 were screened.After signing the informed consent form,the patients were divided into three groups by random number table method:Group B1(10μg/kg butorphanol),group B2(20μg/kg butorphanol),group B3(30μg/kg butorphanol).Ramsay scale was used to evaluate the sedation depth of patients at 10 minutes after administration.All patients underwent surgery under total intravenous anesthesia.The depth of anesthesia was monitored during the operation.The Numberical rating scale(NRS)and Bruggrmann comfort scale(BCS)were used to evaluate the degree of rest pain,active pain and postoperative comfort at 2h,6h,12 h,24h and 48 h after operation.The intraoperative doses of propofol and remifentanil were recorded.Intraoperative hemodynamic parameters;The use of postoperative analgesic drugs and the number of effective PCIA compressions were recorded.Postoperative Nausea and Vomiting(PONV),dizziness,respiratory depression,pruritus and other adverse reactions were observed.Result:(1)There was no significant difference in demographic characteristics among the three groups(P>0.05).(2)Ramsay score in all three groups was above 2 points,and compared with 10μg/kg group,the difference between the other two groups was statistically significant(P<0.05),and compared with 20μg/kg group,the difference between 30μg/kg group was statistically significant(P<0.05).(3)There was statistical significance in the degree of resting pain between the three groups at 12 h and 24 h after surgery(P<0.05).Compared with the20μg/kg group,the pain degree of the 30μg/kg group was statistically significant at 12 h and 24 h after surgery,and the NRS score of the 30μg/kg group was lower than that of the 20μg/kg group(P<0.05).There was statistical significance in the degree of activity pain between the three groups at 6h,12 h and 24 h after surgery(P<0.05).The results showed that the activity pain score of 20μg/kg group and 30μg/kg group was less than 10μg/kg group,and the NRS score of 30μg/kg group was less than 20μg/kg group at 6h and 12 h after surgery,the difference was statistically significant(P<0.05).(4)The BCS score of 20μg/kg group and 30μg/kg group was significantly different at 6h and 24 h after surgery(P<0.05).The results showed that the postoperative comfort of 20μg/kg group and 30μg/kg group was better than that of 10μg/kg group,and there was no statistical difference at other time points(P>0.05).(5)There were no significant differences in the mean arterial pressure and heart rate at resting state(T1),immediately after intubation(T2),immediately after extubation(T3),and 5min after extubation(T4)(P>0.05).(6)There was no significant difference in the number of effective intravenous analgesic pump pressing 48 h after surgery among the three groups(P>0.05),and there was a significant difference in the number of postoperative analgesic drugs added among the three groups(P<0.05).The number of additional analgesic drugs added in the 20μg/kg group and the 30μg/kg group was less than that in the 10μg/kg group.There was no significant difference in the incidence of postoperative adverse reactions(nausea,vomiting,dizziness,respiratory depression,pruritus)among the three groups(P>0.05).Conclusion: Intravenous injection of 30μg/kg butorphanol 15 min before gynecological laparoscopic surgery can achieve better analgesic effect with fewer adverse reactions,and should be used as the preferred dose for gynecological laparoscopic surgery.