Effect Of Dexmedetomidine Combined With Nalbuphine Preconditioning On Early Hyperalgesia After Remifentanil

Background and Objective Remifentanil is a commonly used short-acting opioid analgesic in clinical practice.It can be used in a variety of operations,from single administration to continuous intraoperative infusion to maintain analgesia,although remifentanil in surgery and immediate surgery After the clinical manifestations have certain advantages,but its unique characteristics of pharmacokinetics and pharmacodynamics are closely related to the hyperalgesia caused by opioids.The occurrence of hyperalgesia may slow the recovery rate of patients after surgery,not only because of the high pain score but also the amount of analgesics and related side effects.Although it has been reported in the literature that dexmedetomidine(DEX)and nalbuphine alone can prevent remifentanil-induced hyperalgesia(RIH),there are fewer studies on the effect of dexmedetomidine combined with nalbuphine on OIH.This study was mainly to observe whether the pretreatment of DEX combined with nalbuphine has a preventive effect on early OIH after remifentanil anesthesia.Methods One hundred and twenty patients(ASA I or ?),aged 20 ~ 65,undergoing gynecologiclaparoscopic hysterectomy were randomly divided into four groups using the random number table method: control group(group C),DEX group(group D),nabuphine group(group N),DEX combined with nabuphine group(group D+N).In group D,patients were given a pump injection of DEX 1 ?g/kg within 10 min before induction and continued pumping 0.5 ?g/kg/h until 30 min before the end of surgery.In group N,nalbuphine was injected intravenously 0.2mg/kg(diluted to 10ml)3min before induction.In group D+N,patients were pumped dexmedetomidine(0.5?g/kg)within 10 min before induction and continued to be pumped at continuous infusion of 0.3?g/kg/h until 30 min before the end of the operation,nalbuphine was injected intravenously at the speed of 0.15mg/kg(diluted to 10ml)3min before induction.Group C were intravenously injected normal saline with the same amount of nalbuphine 3min before induction,and the same amount of saline was pumped 10 min before induction.Anesthesia induction: etomidate(0.2-0.4mg/kg);remifentanil(1-2?g/kg)(intravenous infusion,bolustime>60 seconds);rocuronium(0.6mg/kg).Anesthesia maintenance: Remifentanil combined with sevoflurane,in which remifentanil was intravenously administered at a constant dose of 0.25 ?g/kg/min.All groups were given 0.1 ?g/kg sufentanil and tropisetron 5 mg before the suture.After extubation,the patient was sent to the PACU at least 1 h,and the PCIA was connected when the patient was send out of the PACU.The patient was interviewed 24 hours before the operation,and instructed to evaluate the pain score using the pain visual analog scale(VAS scale).The mechanical pain threshold of the left forearm skin was measured using a set of Von Frey filament mechanical stimulation needles.The general conditions of the patients were recorded.The mean arterial pressure,heart rate,BIS value,mechanical pain threshold before and after 24 hours of operation,and pain scores at various time points after surgery were recorded.Statistical of Results 1.The change of pain threshold at 24 h after operation in group C was lower than that in the other three groups,and the difference was statistically significant(P<0.05).2.The VAS scores of patients in group C at T0,T1,T2,T3,the dose of sufentanil within 1 h after extubation,and the number of effective compressions of PCIA within 24 h after surgery were statistically different from those of other groups(P<0.05).3.The time to first postoperative analgesic requirement in group C was significantly shorter than that of the other groups(P<0.05).The time to first postoperative analgesia postoperative was also significantly shorter in group N and D+N than in group D(P<0.05).4.The heart rate of the D group after intubation,pneumoperitoneum andextubation was significantly lower than that of group C,group N and D+N group(P<0.05).5.The Ramsay sedation score at T0 and the incidence of bradycardia(60%)in group D were significantly higher than those in the other three groups(P<0.05).6.The recovery time and extubation time of group D were significantly longer than the other three groups(P<0.05).7.The incidence of nausea and vomiting in group C was significantly higher than that in the other three groups(P<0.05).Conclusion 1.DEX can prevent hyperalgesia caused by remifentanil after laparoscopic hysterectomy.2.Nalbuphine pretreatment can prevent hyperalgesia caused by remifentanil after laparoscopic hysterectomy.3.DEX combined with Nalbuphine can prevent remifentanil-induced hyperalgesia after laparoscopic hysterectomy,with fewer side effects than using DEX or nalbuphine alone.