Effects Of Preemptive Analgasia By Epidural Ropivacaine And Sufentanil On Postoperative Pain And Plasma IL-6,TNF-α

Objectives:To investigate the effects of Preoperative epidural ropivacaine and sufentanil on postoperative pain and plasma IL-6,TNF-αconcentration,so as to conclude the clinical effect of pre-emptive analgesia.Methods:31 patients suffering uterine cervix cancer(stageâ… b toâ…¡a,from 30 to 55 years old,ASAâ… -â…¡)undergoing total hysterectomy and extensive lymph node dissection were randomly divided into pre-emptive group(group A,n=16)and control group(group B,n=15).An epidural catheter was inserted through L1-L2 intervertebral space before induction of general anesthesia and was verified by 3 ml of 1%Lidocaine.They were all intracheal intubated after the induction of anesthesia with Midazolam (0.1 mg/kg),Fentanyl(5μg/kg)andAtracuronium(0.6mg/kg).Intermittent inspiration of Isoflurane(0.5%-1.0%)and continuous pumping of Propofol(4-8mg·kg^-1·h^-1),Remifentanil(1lmg propofol add 2μg remifentanil)and Atracuronium(8μg·kg^-1·min^-1)were adopted to maintenance of anesthesia, BIS was maintained between 40-50.Mean arterial blood pressure was maintained within 20%of baseline values and all vital signs remained stable.In group A,10ml bolus solution of 0.25%Ropivacaine plus Sufentanil 0.5μg/kg was administered via the epidural catheter 20min before anesthesia induction and the block level reach T6,10ml normal saline was administered via the epidural catheter at the closure of the Peritoneal.In group B,10ml normal saline was administered via the epidural catheter 20min before anesthesia induction,10ml bolus solution of 0.25%Ropivacaine plus Sufentanil 0.5μg/kg was administered via the epidural catheter at the closure of the Peritoneal.Blood sample was taken from vein when getting into the operating room(T₁),24 hours after operation(T₂),48 hours after operation(T₃),72 hours after operation(T₄)for determinnation of IL-6 and TNF-α;A 10-cm VAS was used to assess the pain intensity at rest and coughing at 4h,8h,12h,24h,48h,72h after completion of surgery;The actual number of button pressed and the dosage of Analgesics were recorded;The two groups recovery time were compared and the adverse reaction after operation were observed.Results:there was no signifiant difference on the indicators before surgery among the two groups(p＞0.05).1.Level of IL-6 in two groups increased significantly at T₂-T₄ as compared with the baseline value at T₁(p＜0.05);IL-6 were significantly lower at T₂-T₄ in group A than in group B(p＜0.05);Level of TNF-αin two groups increased significantly at T₂,T₃ as compared with the baseline value at T₁(p＜0.05);TNF-αwere significantly lower at T₂,T₃ in group A than in groupB(p＜0.05);there was no signifiant difference at T₄ among two groups.2.VAS scores at rest:there was no signifiant difference at 4h,8h, 12h,24h after operation among two groups;VAS scores at rest were significantly lower at 48h,72h after operation in group A than in group B(p＜0.05);VAS scores at coughing:there was no signifiant difference at 4h after operation among two groups;VAS scores at coughing were significantly lower at 8h,12h,24h,48h,72h after operation in group A than in group B(p＜0.05).3.The time of opening eyes and extubating after operation was higher in group B than in group A(p＜0.05);There are nausea,vomitting and sleepiness in two groups.Conclusions:1.Preemptive analgasia by epidural Ropivacaine and Sufentanil can effectively reduce postoperative pain.2.Preemptive analgasia by epidural Ropivacaine and Sufentanil can effectively attenuate IL-6,TNF-αresponse to surgery,which may be a factor in reducing postoperative pain.