Evaluation Of Sufentanil For Patient-controlled Analgesia In Plastic Surgery And The Effects Of Tropisetron On Preventing Postoperative Nausea And Vomiting After Patient-controlled Analgesia With Sufentanil

Part one:Patient-controlled intravenous analgesia with sufentanil after maxillofacial surgery[Objective]To investigate the clinical efficacy and safety of sufentanil for patients with patient-controlled intravenous analgesia(PCIA) after maxillofacial surgery.[Methods]40 ASA classⅠ,aged 17～39y,female patients undergoing mandibular angle osteotomy and requiring PCIA(without loading dose) were randomly divided into two groups with 20 patients each:Suf group(sufentanil 0.03μg·kg^-1·h^-1,bolus:0.5ml;lockout time:8min;background infusion:2.0ml/h);Fen group(fentanyl 0.3μg·kg^-1·h^-1,bolus:0.5ml;lockout time:8min;background infusion:2.0ml/h).Pain levels(visual analogue scale,VAS,0-10) and sedation scores were recorded at 2h,4h,6h,12h,24h,48h after PCIA.The change of circulation and respiration,the push times of PCA,side effects and the patients' satisfactory degree were also observed.[Results]Pain levels and sedation scores at rest had no significant difference between two groups throughout the study.Compared with Fen group,the push times of PCA was lower in Suf group(P＜0.05).The incidence of dizzy,nausea,vomiting in two groups was low and had no significant difference. During PCA,there was no respiratory depression and pruritus happened.All patients urinated within 4 hours and evacuated within 24 hours postoperatively.Patients in the Sufgroup were significantly more satisfied with pain therapy(P＜0.05).[Conclusion] We conclude that PCIA with sufentanil at the rate of 0.03μg·kg^-1·h^-1,provides effective analgesia and high patient satisfaction.It is a safe analgesic method for female patients after maxillofacial surgery. Part two:Prevent nausea and vomiting associated with patient -controlled intravenous analgesia with tropisetron[Objective]To evaluate the efficacy of tropisetron in preventing postoperative nausea and vomiting(PONV) associated with patient-controlled intravenous analgesia in adult patients.[Methods]75 ASA classⅠorⅡ,aged 17～55y,female patients undergoing elective plastic surgery were studied.PCIA was used postoperatively with no loading dose.The patients were randomly divided into five groups:Ond group (received continuous infusion of ondansetron 16mg and fentanyl,n=15),Fen5 group (received single dose of tropisetron 5mg and continuous infusion of fentanyl,n=15), Suf5 group(received single dose of tropisetron 5mg and continuous infusion of sufentanil,n=15),Fen10 group(received continuous infusion of tropisetron 10mg and fentanyl,n=15),Suf10 group(received continuous infusion of tropisetron 10mg and sufentanil,n=15).Nausea and vomiting,sedation and pain scores were observed at 2, 4,6,12,24and 48 hours postoperatively.The time length between drug administration and the first time of PONV,the numbers of patients with PONV,the scores of PONV and side effects were studied respectively.[Results]The incidence of PONV was higher in control group than that in experimental groups during 6 hours and had significant difference at 2 hours(P＜0.05) postoperatively.Rescue antiemetic medication was needed for one patient in group Suf10 at 12 hours postoperatively.There were no significant differences among the five groups in headache,constipation and extrapyramidal symptoms.[Conclusion]Tropisetron of 5mg has the same efficacy and less side effects as10mg.We recommend the use of tropisetron(5mg) for preventing nausea and vomiting associated with patient-controlled intravenous analgesia undergoing elective plastic surgery in adult female.