The Effect Of Postoperative Pain Management And The Stress Reaction To Organism With Multimodal Analgesia In Patients Undergoing Qynecological Surgery

The stress could be induced by trauma of the operation and pain after operation,the stress exist in the whole operation and it will reach spinnacle in post operation. Choosing a proper analgesic method and medicine to relieve the perioperative pain and suppress stress has been an important topic, but the result of traditional analgesic method is not satisfactory. Multimodal analgesia could combined several analgesic medicine and analgesic method can most effectively relieve pain and decrease the adverse reaction. Lornoxicam is a new analgesic medicine which belongs to the nonsteroidal anti-inflammatory drugs (NSAIDs). It can decrease the level of PGs to resist central sensitizatin and peripheral sensitization, it also can activate the nerve-endorphin system to enhance the effect of analgesia. Some earlier literatures studied the effect of preemptive analgesia or postoperative analgesia only with lornoxicam and showing unilateral and limited effect. Now patient controlled analgesia (PCA) have widely used, but very few studies have addressed the combination of preemptive analgesia and PCA post surgery. The study is to investigate the effects of the multimodal analgesia combined with intravenous Lornoxicam pre-operation and PECA post operation on postoperative pain management and stress reaction.Objective: To investigate the effect of postoperative pain management and the stress response to organism with multimodal analgesia in patients undergoing gynecological surgery.Methods: Forty ASAⅠ-Ⅱpatients undergoing selective transabdominal hysterectomy were randomly divided into two guoups (n=20). Group A was allocated to receive 16 mg lornoxicam intravenously about 30 minutes before skin incision. Group B as a contral group with no treatment before surgery. Every patient was supplied with a PCEA machine with 0.2% ropivacaine and fentanyl (4μg/ml)for analgesia after surgery. Pain and the movement of legs were assessed using visual analog scales (VAS), BCS scales and Bromage grade at 4h, 6h, 8h, 12h, 24h, 48h after surgery. Venous blood samples were collected before anesthesia and at the end of surgery, 12h,24h,48h after surgery. The level of blood glucose, cortisal and glucagon in serum were measured. The administration of analgesic after operation and the condition of nausea/vomiting were observed.Results: Two groups were similar in body weight, age, duration of surgery, consumption of local analgesic and intraoperative transfusion of fluid (P>0.05). The VAS scales and BCS scales was satisfied in Group A and Group B, and there was no obvious blockage on the leg's movement in two groups, there was no significant difference compared with group B (P﹥0.05). There was no patients in group A and group B received other postoperative analgesia medicine. In both groups, the levels of blood glucose significantly increased during operation, and the level of blood glucose was decrease to preoperative level at 12h post operative in group A, but it occurred at 24h post operative in group B. In both groups, the serum levels of COR were significantly increased post operation. And the serum levels of COR in group B was significantly higher than group A at 12h post operation. The serum levels of glucagon were significantly increased post operation in group A and group B. The serum levels of glucagon in group B was significantly higher than group A at the end of surgery and 12h post operation. One case of nausea was observed in each group and there was no significant difference about nausea. No vomiting case was found in two groups.Conclusions: The multimodal analgesia combined with intravenous Lornoxicam pre-operation and PECA post operation could provide effective pain relief and the incidence of adverse effect is less, and induce notable remission of the stress reaction of the patients in the perioperative period, having active protection.