Effects Of Low-Dose Ketamine Combined With Dezocine On Patient-controlled Intravenous Analgesia After Burn Escharectomy And Skingrafting Operation

Objective:Burn crust autograft after skin grafting surgery,eschar skin graft area and the site of severe pain and pain in a wide range of parts,can cause severe hemodynamic fluctuations and a series of functional metabolism,endocrine disorders,So a good postoperative analgesia is particularly important.Good postoperative analgesia can reduce the patient's pain,and can improve the patient's ability to prevent perioperative complications,thereby promoting the body's recovery,improve the quality of life of patients after surgery.Multimodal analgesia,also known as combined analgesia,is the use of several analgesics with different mechanisms of action to block different targets and phases of the pain mechanism in order to reduce central and peripheral sensitization and to achieve optimal analgesic effect,and can also reduce the adverse reactions of a single use of certain drugs.Dezocin is a new opioid receptor agonist-antagonist,it has good analgesic effect,but respiratory depression,nausea and vomiting and other adverse reactions is relatively small,the current clinical mainly for the treatment of moderate to severe pain and postoperative analgesia.Ketamine is a derivative of phencyclidine,which is currently the only non-barbiturate intravenous anesthetic with analgesic effect in clinical practice.It has the characteristics of quick onset,short acting time and mild respiratory depression.Low-dose ketamine can enhance the analgesic effect of opioids,so it has drawn people's attention in multimodal analgesia.This study aimed to observe the safety,feasibility and analgesic effect of low dose ketamine compound dezocine for PCIA after burn escharectomy.Methods:A total of 80 patients,diagnosed and treated in accordance with the inclusion criteria of patients with burn escharectomy and skingrafting operation,ASA grade II or III,aged 23 to 55 years old,were divided into D1 group,D2 group,D3 group and D4 group according to the method of postoperative PCIA drug compatibility.Twenty patients in each group,The PCIA solution contained dezocine 1.2 mg/kg in Group D1.The PCIA solution contained combination of ketamine?3 mg/kg?with dezocine at 1.0,0.8 and 0.6 mg/kg in Groups D2,D3,D4,respectively.4 groups were added ondansetron hydrochloride injection 8mg,saline diluted to 100ml.The intravenous PCA device was set to deliver 1 mL bolus dose with lockout intervals of10 minutes and background infusion at 2 mL/h after a loading dose of 5mg of dezocine.VAS score,Ramsay sedation score,overall satisfaction of PCA?divided into four grades:excellent,good,medium and poor?were recorded at 1 h,2 h,4 h,8 h,16 h and 24 h after operation.Vital signs,including the mean arterial pressure,heart rate respiration and pulse oxygen saturation changes were observed.Adverse reactions were observed and recorded 24 h during PCIA period.Ratio of total number of attempts?P₁'?to times of effective delivery?P₂'?were recorded after 0¹h,²h,⁴h,⁸h,¹6h,²4h.ResultsThe VAS score in Group D2 was lower than that in Groups D1,D3 and D4 at 8,16,24 h after initiation of PCIA?P<0.05?.P₁'and the ratio of P₁'/P₂'in Group D2 were lower than Groups D1,D3 and D4 at 4²4 h?P<0.05?;The overall satisfaction of PCIA was significantly higher in Groups D1,D3 and D4 than that in Group D2?P<0.05?.The incidence of postoperative nausea and vomiting in Group D2 was significantly higher than that in Groups D1,D3 and D4?P<0.05?and there were similar among Groups D1,D3 and D4?P>0.05?.Patients in three groups showed no adverse reaction of itching,hallucinations,lethargy,hypotension or hypertension.ConclusionLow-dose ketamine combined with dezocine on Patient-controlled Intravenous Analgesia after burn escharectomy and ekingrafting operation is stable,sedative and analgesic.It was safe and reliable to reduce the effect of high dose of dezocine alone.