| Background and objectiveWith the development of anesthesia, surgical technique, and faced with risingmedical costs, promote the vigorous development of the fast-trackanesthesia.Remifentanil is a new ultra-short-acting opioid analgesics, rapid onset ofaction, analgesic effect, it can provide good hemodynamic stability and reduce otheranesthetics usage, in vivo metabolic clearance fast, continuous infusion of noaccumulation.Because of remifentanil has more advantages, so more used to fast trackanesthesia. But the analgesia of remifentanil subsided quickly based on, and largedose of intraoperative use, may lead to the occurrence of remifentanil on hyperalgesia.Hyperalgesia is usually refers to the peripheral tissue injury or inflammation leadingto noxious stimulation produced a strong stimulation on the nociceptive response, ornon-noxious produce nociceptive response. Vinik study volunteers of continuousinfusion of remifentanil, regular measurement of pain threshold, found thatremifentanil with0.1μ g/(kg· min) velocity after90min, the analgesic effect isreduced, the infusion of remifentanil240minute, pressure pain threshold and theinitial base has no difference. Joly confirmed near intraoperative high dose ofremifentanil can induce obvious hyperalgesia operation incision, postoperativemorphine requirements. Remifentanil early postoperative pain and hyperalgesiaoccurs, not only increased the suffering of the patient, but also not conducive to therecovery after operation, may also make the development of acute pain is a chronicpain, while increasing patient treatment costs and length of stay in the hospital. At present, a variety of methods for prevention and treatment of remifentanilhyperalgesia diversity, this study used parecoxib sodium combined with sufentanilpreventive analgesia of remifentanil on hyperalgesia, prevention and treatment of theeffect, to provide the reference for clinical anesthesia.MethodsSubjects: The study by the Hospital Ethical Committee agreed, before operationall the patients signed the informed consent. From2012June to2013April in PanyuDistrict Central Hospital,66cases undergoing elective gynecologic laparoscopicmyomectomy operation patients, ASA Ⅰ or Ⅱ, age20to50years old, weight45-70kg. In the case of cardiopulmonary function is normal, without cerebral vasculardiseases and liver and kidney function is damaged, no history of drug allergy, nolong-term use of sedative and analgesic drug history, no peptic ulcer disease or blooddisease. Randomly divided into parecoxib sodium group (group P), parecoxib sodium+sufentanil0.1μ g/kg (group PS1), parecoxib sodium+sufentanil0.2μ g/kg (PS2group), each group of22cases. Halfway to the open operation were not included inthe.Study methods: Preoperative30min intramuscular injection of penehyclidinehydrochloride0.01mg/kg. After entering the room, open the upper limbs vein,infusion of compound sodium chloride solution10ml/kg/h. The routine monitoring ofnon-invasive blood pressure (BP), electrocardiogram (ECG), pulse oxygen saturation(SPO2), end tidal carbon dioxide pressure (PETCO2) and anesthesia depth index (CSI).Anesthesia induction therapy followed by intravenous injection of midazolam0.05mg/kg,1ug/kg, remifentanil atracurium injection0.06mg/kg, propofol2mg/kg.Tracheal intubation with breath control, tidal volume8ml/kg, respiratory frequency12-14times/min, PETCO2maintained at35-45mmHg. The carbon dioxidepneumoperitoneum, pneumoperitoneum pressure control below15cmH2O.Anesthesia was maintained with continuous intravenous infusion of propofol,remifentanil2-6mg/kg/h0.15-0.3μ g/kg/min, maintain CSI between40-60,interrupted administration of atracurium0.2mg/kg maintain muscle relaxation.Maintain MAP and HR wave amplitude does not exceed20%of the basic value.Before the end of operation30min discontinuation of atracurium, suture skindiscontinuation of propofol injection, operation deactivated at the end of Reventa Ni. Postoperative routine injection of neostigmine and atropine antagonized0.02mg/kg0.01mg/kg residual muscle relaxant effect. When the tidal volume of spontaneousbreathing air breathing>6ml/kg, SPO2remains>95%, cough and/or swallowingreflex recovery, sufficient suction after tracheal extubation, sent to the recovery roomto continue to observe.Grouping experiment method: Three groups of patients in operation beforeskin incision10min intravenous injection of parecoxib sodium40mg; the end ofoperation, PS1group and PS2group were intravenous sufentanil0.1μ g/kg and0.2μg/kg, group P intravenous injection of normal saline. When patients withpostoperative VAS score>4intravenous injection of tramadol100mg.Observation index: Records of patients before induction of anesthesia to every5minutes for a blood pressure and heart rate were measured, a total of three times theaverage base value (T1); recorded during three groups of remifentanil, propofoldosage; record extubation time (T2),5min after extubation (T3), extubation after10the clock (T4),15min after extubation (T5) MAP, SPO2, HR, PETCO2.; recording theconsciousness recovery time, extubation time, extubation agitation score, recovery ofconsciousness after5minutes of oral pain score,15min after extubation sedationscore record within1hours after operation (1h),2hours after the operation (2h),4hours after operation (4h),8hours after operation (8h),24hours after the operation(24h) of the static and dynamic visual analog scale and comfort score; postoperativetramadol remedial treatment; adverse reactions were recorded24hours after operation,such as nausea and vomiting, chills, intraoperative awareness, retention of urine,pruritus incidence; respectively before induction of anesthesia,2hours of surgery andpostoperative peripheral venous blood samples were collected,2ml, plasma PGE2andIL-6concentration by ELISA method.Statistical analysis: Packet data were analyzed using SPSS18.0software, mean±standard deviation measurement data (±s) said, within groups and between groupsof different time parameters compared with single factor analysis of variance test.There were statistically significant differences in P <0.05.Results1.Three groups of patients age, weight, operation time, anesthesia time, thedosage of propofol and remifentanil dosage had no significant difference (P>0.05). 2.Three groups of patients in the MAP group at each time point comparisonsshowed no significant differences (P>0.05). Group comparison: P group increased inT1, T2, T3at MAP compared with T0(P <0.05); PS1group in T1, T2in MAP than in T0increased (P <0.05), and T2was higher than that of T1(P <0.05), T3, T4is lower thanT2(P <0.05) T1, T4, T2, T3lower than the point (P <0.05); in group PS2, T2with T0increased (P <0.05), T3and T4compared with T1, T2decreased (P <0.05).3.Three groups of patients in the HR group at each time point comparisonsshowed no significant differences (P>0.05). Within group comparisons: three patientsin group T2at HR than T0, T1increased (P <0.05), T3and T4were lower than T1andT2time point decreased (P <0.05), in P group was higher than that of T1in T2(P <0.05), PS1group and PS2group was lower than that in the T4time T3(P <0.05).4.The recovery time and extubation quality score Group PS2patientsconsciousness recovery time and extubation time compared with P group, PS1groupextension (P<0.05); P group and PS1group consciousness recovery time andextubation time was no difference in Statistics (P>0.05);Group P oral pain scorehigher than that of PS1group and PS2group (P<0.05);No significant differencesbetween PS1group and PS2group oral pain score (P>0.05).5.Changes of static VASComparison between groups: resting VAS in postoperative1h,2h time point inPS1and PS2group were lower than those of group P (P <0.05), and PS2group waslower than that in PS1group (P <0.05); postoperative4h,8h and24h between thethree groups showed no significant difference (P>0.05). Each time point in groupwere compared. Results: the decreased P group:1h>2h>4h>8h>24h (P <0.05);PS1group:1h>2h>4h>8h>24h (P <0.05); group PS2:1h>2h>4h>8h>24h (P <0.05).6.The dynamic change of VASComparison between groups: in the postoperative1H,2h time point PS1and theaction of the PS2group VAS were lower than those of group P (P <0.05), and PS2group was lower than that in PS1group (P <0.05); postoperative4h,8h and24hbetween the three groups showed no significant difference (P>0.05). Each time pointin group were compared. Results: the decreased P group:1h>2h>4h>8h>24h (P <0.05); group PS1:1h>2h>4h>8h>24h (P <0.05); group PS2:1h>2h>4h>8h>24h (P <0.05). 7.Comfort score changesComparison between groups: in the postoperative1h,2h,4h time point in PS2group was significantly higher than that in group P comfort score (P <0.05);postoperative8h and24h time point between the three groups showed no significantdifference (P>0.05). Each time point in group comparison results: increased in Pgroups:1h <2h <4h<8h <24h (P <0.05); PS1group:1h <2h <4h <8h <24h (P <0.05); PS2group:1h <2h <4h <8h <24h (P <0.05).8.Rescue analgesia after operation8cases in group P tramadol, utilization rate was36.4%(P <0.05);2cases ingroup PS1, using the rate of9.1%(P <0.05); no patients need to use PS2tramadolgroup9.The adverse reactionIn group P, the incidence rate of adverse reaction was36.4%,8cases wereshivering;9.1%in PS1group,2cases were shivering with vomiting;18.2%in PS2group,4cases were vomiting.10.Plasma PGE2changesThree groups of preoperative plasma PGE2showed no statistical significance(P>0.05), surgery and postoperative2h were P group than PS1group and PS2group(P <0.05); but there were no significant differences between group PS1and group PS2(P>0.05). Within group comparisons: plasma PGE2three group showed preoperativepostoperative>2h after operation (P<0.05).11.Plasma IL-6changes:Plasma IL-6in three groups had no statistical significance (P>0.05), surgery andpostoperative2h performance for the P group, PS1group and PS2group (P <0.05).Within group comparisons: plasma IL-6three group showed preoperativepostoperative <2h after operation (P <0.05).Conclusion1Preoperative parecoxib sodium40mg intravenous sufentanil compositepostoperative before to0.1μ g/kg and0.2μ g/kg intravenous preemptive analgesia,early pain reaction effectively inhibit gynecological remifentanil fast track anesthesiaafter surgery, with0.1μ g/kg dosage and side effects of small, high safety.2. Preoperative parecoxib sodium40mg intravenous sufentanil composite postoperative before to0.1μ g/kg and0.2μ g/kg intravenous preemptive analgesia,can reduce postoperative PGE2and IL-6formation, to reduce inflammation and stressresponse. |
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