The Effect Of Epidural Oxycodone On Insulin Resistance During Rectal Cancer Surgery

Objective:T_o study the effect of epidural oxycodone on insulin resistance(insulin resistance,IR)during perioperative rectal cancer surgery.Methods:Ninety patients with elective rectal surgery as the research object,and the patients were respectively classed into stage ? or ? based on the criterion suggested by American Society of Anesthesiology(ASA).For patients,the age between 35 to 75 years,the weights ranged from 46 to 75 kg,the operation time were 155 to 182 min.They were divided into A,B,C groups with 30 cases each using the random number table method.The patients in group A and B were given general anesthesia combined with epidural anesthesia,to which epidural space were given oxycodone hydrochloride injection and ropivacaine hydrochloride injection respectively.And the third group C was by the pure general anesthesia.Anesthesia process:The patients in group A and B were undergoing epidural anesthesia in the gap of T12?L1 epidural space which catheters up to 3 cm after the success of the puncture.Backing to the drawing without blood or cerebrospinal fluid and pushing the dose 3 ml of 2%lidocaine to determine whether epidural puncture success.The BIS of three groups remains at 40 to 60.Anesthesia induction:All patients were not given premedication..Three groups will be given the same anesthesia induction precept:The surface of endotracheal tube cuff was evenly daubed dyclonine conventionally and with 300ml sodium acetate ringer's solution for Intravenous anesthesia induction.A consecutive use of imidazole,sufentanil,cisatracurium besilate and etomidate was applied with the associated dose of 0.05-0.lmg/kg,0.4-0.6ug/kg,0.15-0.2mg/kg and 0.2-0.3mg/kg,inspiring oxygen 5min under pressurized with a mask until the patients consciousness disappear and the muscle relaxation completely,then the endotracheal tube was inserted by using ordinary laryngoscope fastly;after auscultating breath sounds of double lung(it should sound clear and symmetrical),machanical ventilation was conducted by Drager Fabius PLUS XL anesthesia machine,then the tidal volume of 8-12ml·kg-1 and breathing frequency of 10-14 times-min-1 were set with absorption ratio value of 1:2.Maintain anesthesia:propofol(4 to 6mg·kg-1·h-1),remifentanil(10-15ug·kg-1),h-1)cisatracurium besilate(0.15mg·kg-1.h-1)by micro-dosage pump were injected.On this basis,for the patients in group A,a single oxycodone hydrochloride injection with a dose of 4mg(by 0.9%sodium chloride injection diluted to 5 ml)was injected to epidural space at 10 min before skin open;compared with the patients in group B,0.5%ropivacaine hydrochloride injection with a dose of 5ml(by 0.9%sodium chloride injection diluted to 5 ml)was injected 10 minutes before the skin open,and the anesthesia plane was maintained upper bound of thoracic level 6.Three groups of patients through the infusion of sodium acetate salinger injection and hydroxyethyl starch with the ratio of 2-3:1 to maintain hemodynamic stability.observation record:Collection the venous blood samples of 5 ml was divided into two copies to lab and the blood glucose(FPG)and serum insulin(FINS)were examined before the anesthesia(T0),10 min after cut skin(T1),1 hour after the surgery(T2)and after the surgery right now(T3).Insulin resistance index was calculated(ln)(Homeostasis model assessment of insulin resistance,HOMA-IR),and the difference of insulin resistance was analyzed during the different periods.Results:The data was not significantly different among the three groups before anesthesia.The blood glucose(FPG),serum insulin(FINS)and homeostasis model assessment-insulin resistance index(HOMA-IR)of A and B groups were not obviously increased but C group were increased significantly at the time point of T1 and T3 whose the difference was statistically significant(P<0.05).There was not statistically significant difference(P>0.05)of the blood glucose(FPG),serum insulin(FINS)and In(HOMA-IR)between A and B groups at the time point of T_o to T3,At the same time,the corresponding numerical is still very low compared with the T_o.Conclusion:oxycodone hydrochloride used in general anesthesia combined with epidural anesthesia to reduce insulin resistance for rectal cancer surgery was safe and effective,in favor of an early resumption of the body which is a new method for epidural administration.