Applying Tramadol To Intravenous Versus Epidural Patient-Controlled Analgesia After Pneumonectomy

As results of local tissue damage during surgery produces, patients will be engendered a series of consequent reaction, such as nociceptive sensory, stress response with concomitance of an unpleasant emotional experience, which are called by a joint name of postoperative pain. Physiologic responses to it include pulmonary, cardiovascular and other organic dysfunction, especially after thoracotomy and these adverse effects have attached much importance of the society. At present, the anesthesia agent of "fast-in and fast-ouf is widely used in clinic and patients have paid attention to the life quality after surgery, but if used through either intravenous or epidural infusion at the delicate time, opiates will produce respiratory stress and delayed respiratory stress. So we clinicians should recognize the importance of good control over postoperative pain. For propose of "balanced analgesia", non-opiate narcotics is needed before the end of operation, whatsmore the efficacy of tramadol and local analgesics is best. Tramadol is a new type of non-opiate narcotic analgesics, and can cause an increase in blood pressure and headache via its monoaminergic actions and part of its analgesic activity being modulated via u-receptors, satisfying analgesic efficacy lack of respiration depressant effect. The aim of this clinical trial is to observe and compare the effect and agent of tramadol for intravenous versus epidural patient-controlled analgesia after pneumonectomy.40 hospitalized ASA I~ll lung cancer patients were enrolled, one of whose lung leaves were resected. Their ages are between 45~60years, they had neither other main organic or systemic diseases nor addictions for nicotine and wine before. All the patients wererandomly divided into two groups: Group I (patient controlled intravenous analgesia was applied) and Group E (patient controlled epidural analgesia was applied). The difference of patients' ages, sexes, stature, weight and the time for operations are not statistically significant between two groups. All patients received with 0.3mg scopolamine intramuscular as premedication. In Group E, a epidural catheter was inserted at the interspace of T/Tv or Tv/T respectively before surgery in the operating room. All were induced by midazolam0.1mg/kg, nocuron0.15mg/kg, fentanyl3.0 g/kg and propofol 1.0~1.5mg/kg, then were intubated endotracheally and ventilated intermittently with Detex-Ohmede anaethesia machine. Their non-traumatic blood pressure, heart rates, pulse rates and oxygen saturation of pulse blood were monitored continually in course of surgery with Detex-Ohmede anaethesia synthetically monitoring machine. The depth of anaesthesia was maintained with isoflurance and propofol, while nocuron was intravenous according to the need. Continual epidural anaethesia were combined intraoperatively in Group E. The operation was accomplished safely. Loading doses were given within two minutes respectively through venous or epidural catheter fifteen minutes before the end of operations, then analgesia pumps began work. In Group I patient controlled intravenous analgesia was provided with 0.0003% fentanyl 1% tramadol + 0.005% droperidol, while in Group E patient controlled epidural analgesia was provided with 0.1% ropivacaine + 0.0001% fentanyl + 0.3%tramadol + 0.002% droperidol. Of all the analgesia pump, the background dose-rate is 2ml/h, the bolus dose is 0.5ml, the lockout time is 15min, the loading dose is 5ml. Then all were transferred to post-anesthesia care room and breathed room air. Postoperative arterial pressure, heart rate, respiratory rate, pulse saturation in oxygen, levels of analgesics (visual analogue scale, VAS) and sedation (Ramsay scale)and side effects of analgesia were monitored and recorded once two hours.According to the statistical date, in Group I the degree of postoperative pain VAS was severer than in Group E C P 0.01 , and the patients' Ramsay scales in two groups were modest, but it's lower in Group E significantly C P 0.01. One patient was over sedative in Group I because...