| Objective:To investigate the effect of patient-controlled analgesia with hydromorphone on analgesic efficacy, side effects, mood and cognitive impact for patients undergoing radical colorectal cancer.Methods:Eighty patients undergoing elective radical laparoscopic or open colorectal cancer under general anesthesia were randomly divided into two groups (group S and group H). The patients in group S were received sulfentanyl, while the patients in group H were received hydromorphone for postoperative patient-controlled intravenous analgesia (PCIA) to control the VAS score below 3. The VAS score at rest and during mobilization, the consumption of PCIA, PCA D/D ratio and rescue analgesics were recorded at discharge from PACU and 6h(T1),12h(T2),24h(T3),36h(T4),48h(T5), 60h(T6),72h(T7),84h(T8),96h(T9) after surgery. The perioperative mood and cognitive function were evaluated before and at T5 and T9. The side effects such as nausea, vomiting, respiratory depression, dizziness, pruritus and Ramsay score, hemodynamic changes were assessed at T0-T9. Time to recovery, time to drainage tube removal, time to walk and the hospital duration after surgery were also recorded.Results:Patients’ demographic and historic variables were similar between groups including age, gender, weight, height, education level, ASA status, previous surgery, previous PCA use, diabetes, hypertension, smoking and rider vertigo(P>0.05). There were no significant differences between groups in the terms of operation mode, surgical treatment, surgeon, operation time, operative incision, intraoperative blood loss, intraoperative fluid replacement or urine volume(P>0.05). No significant differences were found in the terms of anesthetist, anesthesia time, extubation time, duration of PACU, the total consumption of propofol, the total consumption of fentanyl or remifentanil(P>0.05). There were no significant differences in the intensity of pain at rest and during mobilization, the consumption of PCIA, PCA D/D ratio, rescue analgesics, side effects such as vomiting, respiratory depression, dizziness and Ramsay score or hemodynamic changes at T0-T9 (P>0.05). Compared with the sulfentanyl group, the scores of anger at T5 and T9 in the hydromorphone group were lower(P<0.05). Compared with preoperative, the scores of Digit Symbol Test at T5 and T9 were lower(P<0.05); the scores of Trails Making A Test and Trails Making B Test at T5 and T9 were higher (P<0.05); however, there were no significant differences between the two groups in the scores of Digit Symbol Test, Trails Making A Test or Trails Making B Test at T5 and T9 (P>0.05). Compared with the sulfentanyl group, the incidence of pruritus and nausea at T1 was higher (P<0.05), but there was no significant difference between groups for the proportion of stopping pumping because of nausea and vomiting(P>0.05). There were no significant differences between the two groups in satisfaction at T3 and T5. Moreover, there were no significant differences between the two groups in the time to gastrointestinal recovery, time to drainage tube removal, time to walk or the hospital duration after surgery (P>0.05).Conclusions:Both hydromorphone PCIA and sulfentanyl PCIA could provide potent analgesia and satisfaction for the patients undergoing radical colorectal cancer. Compared with sulfentanyl PCIA, hydromorphone PCIA appeared to result in improved mood. The incidence of pruritus and nausea at T1 was higher in group H than that in group S, however, there was no significant difference between groups for the proportion of stopping pumping because of nausea and vomiting. The patients in both groups had postoperative cognitive disfunction, but the effects of the two different PCIA recipe on the postoperative cognitive score had no significant difference. Both hydromorphone and sulfentanyl can be the the ideal selections for the management of postoperative analgesia for the patients undergoing radical colorectal cancer. |
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