The Safety And Efficacy Of Different Dosage Of Dezocine For Postoperative Analgesia In Children

Objective: To investigate the safety and efficacy of dezocine forpostoperative analgesia in children, and the optimal dosage of dezocine forpostoperative analgesia in children undergoing abdominal surgery, providereference for the application of dezocine for postoperative analgesia inchildren undergoing other surgeries, and evaluate the safety and efficacy ofopioid receptor agonist-antagonist for postoperative analgesia in children.Methods:1Group:60ASA I or II patients aged from5to12years, including39males and21females, undergoing elective abdominal surgery were recruited into thestudy. Patients with chronic pain states, central nervous system or mentalillnesses, cardiovascular or respiratory system illnesses were excluded fromthe study. Patients were randomly divided into three groups, there were20patients in each group: group A (dezocine0.08mg/kg, group B (dezocine0.1mg/kg) and group C (dezocine0.12mg/kg). All patients and their parentswere instructed on the use of the visual analog scale (VAS) for painassessment before the induction of anesthesia.2Anesthesia:Fluid was prohibited for3h and food was prohibited for8h beforeelective surgery. All patients of three groups received intravenous instillationof atropin0.01mg/Kg30min before surgery so that it can prevent the decreaseof heart rate and decrease secretion from airway. On arrival to the operatingroom, physiological monitoring was established before the induction ofanesthesia (pulse oximetry, continuous electrocardiography, and noninvasivearterial blood pressure monitoring). Anesthesia drugs: patients received bolusinjection of midazolam0.1mg/kg, propofol1~2mg/Kg, sufentanil3~5μg/Kg, and cis-atracurium0.2mg/Kg at induction of anesthesia, inhaled100%oxygenwith high flow. After tracheal intubation, patients were supported by volumecontrolled ventilation with Datex Ohmeda. Fraction of inspiration O2(FiO2)was100%, tidal volume (VT) was8~10ml/kg, inspiratory time: expiratorytime (I: E) was1:2,respiratory rate was16~28breaths per minute. Philipsmonitor was used to monitor the vital sign and maintain the end-tidal carbondioxide pressure (PETCO2) at35~40mmHg. All patients were infusedconstantly with propofol at the rate of2~6mg·kg-1·h-1and emifentanil at therate of0.1~0.3ug·kg-1·min-1for maintenance, and cis-atracurium0.05mg/kgwas given intermittently according duration of surgery. Patients in group Areceived intravenous instillation of dezocine0.08mg/kg30minutes before theend of surgery for postoperative analgesia, patients in group B receivedintravenous instillation of dezocine0.1mg/kg30minutes before the end ofsurgery for postoperative analgesia, patients in group C received intravenousinstillation of dezocine0.12mg/kg30minutes before the end of surgery forpostoperative analgesia. All patients received intravenous instillation oftropisetron hydrochloride0.1mg/Kg30minutes before the end of surgery.Remifentanil and propofol were switched off5minutes before the end ofsurgery. When patients were up to the standard of extubation, the endotrachealtube were extubated, and patients were sent away after they were completelyconscious.3Record: The times to spontaneous respiration recovery (t1), eye opening(t2), extubation (t3) and HR, MAP, SpO2, RR at the time of baseline,extubation,1,2,4,6h after surgery were recorded. VAS (Visual AnalogueScale), CHW (The Children's Hospital of Wisconsin Sedation Scale) andadverse effect at four time points after surgery were also recorded. All datewere recorded by a doctor.Results:1There was no significant difference among three groups in the times tospontaneous respiration recovery (t1), eye opening (t2), extubation (t3) 2HR, MAP were higher in group A than that in group B and group C at thetime of extubation (P<0.05), and there was no significant difference betweengroup B and group C in HR and MAP at the time of extubation (P>0.05), nosignificant difference in RR and SpO2was found among three groups at thetime of extubation (P>0.05).3HR, MAP were higher in group A than that in group B and group C at1,2,4,6h after surgery (P<0.05), and there was no significant difference among threegroups in RR and SpO2at four time points after surgery (P>0.05).4VAS was higher in group A than that in group B and group C at four timepoints after surgery (P<0.05).5CHW was lower in group C than that in group A and group B at1h and2hafter operations (P>0.05), there was no significant difference between group Aand group B in CHW at1h and2h after surgery (P>0.05). There was nosignificant difference among three groups in CHW at4h and6h after surgery(P>0.05).6There was no significant difference among three groups in incidence ofrespiratory depression and pruritus, and only one patient nauseaed in group C.Extubation response was attenuated by intravenous instillation ofdezocine0.1mg/kg in childeren, and systemic haemodynamics was morestable. The times to spontaneous respiration recovery, eye opening, extubationdidn't be prolonged by intravenous instillation of dezocine0.1mg/kg. With theadequate analgesia effect and sedation state and low incidence of adversereaction, intravenous instillation of dezocine0.1mg/kg is a optimal dosage forpostoperative analgesia in children.Conclusion:1A single intravenous dose of dezocine is safe and efficacious in childrenundergoing abdominal surgery, and make postoperative analgesia rapid andsteady with long acting time and low incidence of adverse reaction.2Intravenous instillation of dezocine0.1mg/kg was the optimal dose forpostoperative analgesia in children.