| Objective:In recent years,with the vigorous development of the Chinese economy and the continuous improvement of people's living standards,people's attention to their own health has increased day by day.Pain has gradually become the focus of more and more attention in the course of diagnosis and treatment.As early as 1955,James Campell,president of the American Association of Pain Society,had proposed that pain be listed as the "fifth vital sign" following the four vital signs:temperature,pulse,respiration,and blood pressure.In the new century,the development of science and technology and the advancement of medicine have made people put forward new requirements for the treatment of pain.Spinal surgery is difficult,the technical requirements are high,and the operation time is long.At the same time,the surgical process has more traumas to bones and muscles.Postoperative pain is more frequent and early pain in the operating area is easy to occur,especially knife-edge pain.Therefore,postoperative pain is one of the most immediate concerns for postoperative patients.How to timely and effectively treat spinal postoperative pain is a hot topic in the field of spinal surgery in recent years,and it is also the most urgent problem for postoperative spinal surgeons.The purpose of this study was to explore a rational and effective postoperative analgesic regimen through the combination of medications and provide new ideas for clinical analgesia.Design:This study selected 120 patients with thoracolumbar fractures who were admitted to the Department of Spine Surgery,Jinan Central Hospital Affiliated to Shandong University from January 2014 to December 2016,aged 40-66 years,median age:53 years;weight 55-75 Kg;gender;patients were randomly divided into 4 groups:oxycodone hydrochloride group,buprenorphine group,dezocine group and blank control group.Four groups of patients received Flurbiprofen 50 mg+100 ml normal saline directly after operation.Patients in the oxycodone hydrochloride group were given 10 mg orally once a day after surgery.The buprenorphine transdermal agent started to take effect after 24 hours,so Ding C In the Norpridene Transdermal group,5mg external application was performed 24 hours before the operation.The application site may be the upper arm,the upper chest wall,the upper back,and the chest.The dezocine group received 10 mg intramuscular injection once a week.The blank control group The patient was given an equal amount of saline once after surgery.All groups received morphine 10 mg subcutaneously as an analgesic drug for postoperative analgesia.The scores of VAS pain and adverse reactions at 4 h,8 h,12 h,and 24 h after operation were recorded.The time and total amount of morphine used for the first time in each group were also recorded.The patient satisfaction with analgesia were recorded.The data obtained in this study were processed and analyzed with SPS21.0 statistical software.All parameters were expressed as mean ± standard deviation(x ± s).Data of each group were compared using one-way analysis of variance analysis.P<0.05 was statistically significant.The significance of this study is to provide a safe and reasonable analgesic plan for postoperative analgesia after spinal surgery.Results:1.120 cases of thoracolumbar fractures hospitalized in the spine surgery department of the central hospital selected in this study were aged 40-66 years,median age:53 years;weight 55-75 kg;gender is not limited;patients were randomly divided into 4 groups:Oxycodone hydrochloride group,buprenorphine group,dezocine group and blank control group.The VAS scores of the four groups were lower than those of the control group,indicating that the four combination prescriptions all have good analgesic effects.1.1 The statistical data obtained by combining the results can be seen,at 4h,8h when the dizocine analgesic score is lower than the other three groups,the analgesic effect is better,and to 12h and 24h,Dezocine VAS score Compared with the buprenorphine group,the VAS score was lower than that of the other three groups and showed good analgesic effect.In general,Tozosine showed good analgesic effect in the previous period of analgesia.However,the analgesic time is not ideal;buprenorphine is relatively stable,and the duration of analgesia is relatively long-lasting.1.2 The statistical results of adverse reactions showed that the number of cases of adverse reactions in the three groups of the control group compared to the experimental group increased,but there was no significant difference in the incidence of adverse reactions between the three groups of experimental groups.1.3 It can be seen from the statistical results of remedial analgesia that the first group of experimental groups used morphine to rescue analgesia for a longer time than the control group,and the buprenorphine group used morphine for the first time to rescue analgesia among the three experimental groups.The time was the latest;the total use of morphine in the three experimental groups was significantly lower than that in the control group,and the total amount of morphine used in the buprenorphine group was the lowest in the three experimental groups.2.Single-factor analysis showed that by recording the VAS scores at 4h,8h,12h,and 24h in four groups of subjects,the results were scored at 4h in the dizocine group<oxycodone hydrochloride group<buprenorphine group,8h Scores of dizocine<oxycodone hydrochloride group<buprenorphine group,score at 12h buprenorphine group score<deszocine group<oxycodone hydrochloride group,score at 24h buprenorphine group<Dizocine group<oxycodone hydrochloride group,all the time compared with the control group VAS score decreased,statistical results showed P<0.05,the difference was statistically significant;postoperative oxycodone hydrochloride nausea and vomiting incidence was 26.7 The incidence of nausea and vomiting was 20%(6/30)in the dezocine group,16.7%(5/30)in the nausea and vomiting in the buprenorphine group,and incidence of nausea and vomiting in the control group.At 10%(3/30),the difference was not statistically significant(P>0.05).There was no significant difference in the incidence of pruritus,respiratory depression,and delayed wound healing among the four groups(P>0.05);the three experimental groups The time for the first use of morphine was significantly delayed compared to the control group;the oxycodone hydrochloride group was compared between the three experimental groups.The earliest remedy for analgesia,followed by zocin group,and finally buprenorphine group,and morphine dose oxycodone hydrochloride group>dezocine group>buprenorphine group,but three experimental groups no matter the first use of morphine There was no significant difference in time or dose(P>0.05).The satisfaction survey of patients' analgesic effect showed that the satisfaction of the three experimental groups was higher than that of the blank control group(P<0.05).The difference was statistically significant,but there was no statistical difference between the three experimental groups(P>0.05).0.05),indicating that the three groups of programs can improve patients' analgesic satisfaction.Conclusion:The VAS scores of the three groups were significantly lower than those of the control group.The VAS score of the buprenorphine group was the highest 4 hours before and the VAS score of the dizocine group was lower than the oxycodone hydrochloride group.After 8 hours The VAS score of buprenorphine group was lower than that of oxycodone hydrochloride group and dezocine group,but there was no significant difference in the incidence of adverse reactions(P>0.05).The time of first use of morphine in the three experimental groups and the control group Compared with significant delays,the amount of morphine used was also significantly reduced(P<0.05).There was no significant difference in the time between the first use of morphine and the amount of morphine used between the three experiments(P>0.05).The analgesic satisfaction of the experimental group was significantly higher than that of the control group.It can be seen that three kinds of opioid analgesics combined with flurbidol ester can play a good effect in the postoperative single-segment lumbar fracture internal fixation analgesia,less adverse reactions,high safety,However,the long-term analgesic effect of buprenorphine group was superior to other groups,it is worthy of clinical promotion. |
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