| Background:Laparoscopic inguinal hernia repair is the mainstream surgical method for adult inguinal hernia surgery,as it has the advantages of less trauma and faster recovery.However,acute postoperative pain(APP)still exists,varying degrees of pain are complained by abouut 80% of patients and have influenced on daily activities.There are many factors of acute pain that result in laparoscopic surgery,and it can not be controlled timely and effectively by the single drug.Multimodal analgesia(MMA)under the guidance of enhanced recovery after surgery(ERAS)has become the major consensus of perioperative acute pain Management.Patient controlled intravenous analgesia(PCIA)has become an effective means of MMA,which is widely used by the clinic.In clinical practice,there are situations of different PCIA pump-stop time and sequential analgesia randomly after stopping PCIA.Based on them,acute pain after laparoscopic inguinal hernia repair(LIHR)will be treated with PCIA sequential celecoxib in this study.Objective:To observe the effect of the diferrent PCIA,s model after LIHR and investigate the time of PCIA,s model and the time of sequential oral celecoxib after LIHR,so as to provide reference for future clinical work.Method:Two kinds of LIHR which were the transabdominal preperitoneal technique(TAPP)and the totally extraperitoneal technique(TEP)would be used.ERAS wiould be managed for patients during the perioperative period.In this study,240 patients would be included in the study from October2015 to December 2017.They were randomly divided into 3 groups(A,B,and C groups)with 80 patients in each group and different analgesic regimens will be.The model of PCIA-72 hours,analgesia was used by Group A,The model of PCIA-48 hours,analgesia sequential celecoxib by Group B,The model of PCIA-24 hours,analgesia sequential celecoxib by Group C.Postoperative analgesia plan:Group A: The PCIA,s formulation of flurbiprofen axetil(FA)150 mg + sulfentanil(SF)90 ug + tropisetron injection 3 ml,150 ml would be deployed with normal saline,locked in 2ml/h continuous intravenous infusion Immediately after resuscitation,oral analgesics would not be administered within 72 hours.after the end of analgesia treatment,the patient would be discharged according to the discharge standard.Group B: he PCIA,s formulation of FA 100 mg + SF 60ug+ tropisetron injection 2ml,150 ml would be deployed with normal saline,locked in 2 ml/h continuous intravenous infusion Immediately after resuscitation,after 48 hours,Celecoxib would be orally administered 200 mg orally every 12 hours and orally for 1 day.After the treatment of analgesia,the patient would be discharged according to the discharge standard.Group C:he PCIA,s formulation of FA 50 mg + SF 30 ug + tropisetron injection 1ml,50ml would be deployed with normal saline,locked in 2 ml/h continuous intravenous infusion Immediately after resuscitation,after 24 hours,Celecoxib would be orally administered 200 mg orally every 12 hours and orally for 2 days.After the treatment of analgesia,the patient would be discharged according to the discharge standard.Observing the level of pain at different time points(1?2 hour,6 hours,12 hours,24 hours,48 hours,72 hours after initiation of PCIA)during analgesia,using the Numeral Rating Scalle(NRS))The patient's level would be scored and the analgesic effect will be compared.Results: 1.Of the 240 patients who were repaired with LIHR,5 patients were withdrawn and 235 were actually completed with the observations.There was no statistically significant difference in NRS between group A(n=77),group B(n=78),and group C(n=80)at 1?2 hour,6 hours,12 hours,24 hours,and 48 hours after PCIA initiation.(P>0.05).At the 72-hour time point after PCIA,NRS was compared between the three groups.The NRS of group A(0.69±0.494)was lower than that of group B(0.95±0.556).The comparison was statistically significant(P<0.05);the group A lower(0.69±0.494)than group C(0.90±0.587),the difference was statistically significant(P<0.05).There was no significant difference between the NRS of group B(0.95±0.556)and the NRS of group C(0.90±0.587)(P>0.05).2.106 patients of 235 were underwent TAPP: group A(n=39),group B(n=37),group C(n=30).There was no statistically significant difference in NRS between the three groups at 1?2 hour,6 hours,12 hours,24 hours,and 48 hours after PCIA initiation(P>0.05).At the 72-hour time point after PCIA,NRS was compared between the three groups.The NRS of group A(0.76±0.502)was lower than that of group B(1.00±0.627).The comparison was statistically significant(P<0.05);the group A(0.76±0.502)lower than group C(1.05±0.590),the difference was statistically significant(P<0.05).There was no significant difference between the NRS of group B(1.00±0.627)and the NRS of group C(1.05±0.590)(P>0.05).3.There was no statistically significant difference between the three groups which Nausea occurred in 235 patients with LIHR,11 in group A,8 in group B,and 7 in group C.4.There was statistically significant difference in the average length of hospital stay between groupgroup C(3.1±0.92d)and group A(4.1±2.72 d),as group C was less than group A.There was no statistically significant difference in the average length of hospital stay betweengroup A(4.1±2.72 d)and group B(3.4±1.37 d)and between group B(3.4±1.37 d)and group C(3.1±0.92d).5.There was statistically significant difference in the price of three,as the price in group C(275.26±8.90 yuan)was lower than in group A(549.60±15.10yuan),in group C(275.26±8.90 yuan)lower than in group B(404.52±7.99yuan),and in group B(404.52±).7.99 yuan)lower than that in group A(549.60±15.10 yuan)?Conclusion(s): 1.After LIHR,the model of PCIA-72 hours,analgesia was more effective than both of the 24-hour,and 48-hour,model on the third day.However,the cost of drugs was higher than them,the length of hospital stay was longer than the model of PCIA-24 hours,,and no different with the model of PCIA-48 hours,.2.After LIHR,the model of PCIA-48 hours,analgesia was more worse than both of the 72-hour,and no different with the model of PCIA-24 hours,on the third day after LIHR.However,the cost of drugs was lower than the model of PCIA-72 hours,,and higher than the model of PCIA-24 hours,.The length of hospital stay was no different with both of the model of PCIA-24 hours,and the model of PCIA-72 hours,.3.After LIHR,the model of PCIA-24 hours,analgesia was more worse than both of the 72-hour,and no different with the model of PCIA-48 hours,on the third day after LIHR.However,the cost of was lower than both of the model of PCIA-72 hours,and PCIA-24 hours,.The length of hospital stay was the shortest of three.4.Although the model of PCIA-24 hours,analgesia was more worse than both of the 72-hour,on the third day after LIHR.However,NRS was lower than one,at the same time its cost of drugs is low,and the length of hospital stay is short;so the 24-hour PCIA model is recommended for management of postoperative analgesia after LIHR. |
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