Preoperative Glycosylated Hemoglobin Level In Diabetic Patients And Postoperative Opioids Relationship Between Drug Demand

Objective:In recent years,the analgesic efficacy of opioids in patients with diabetes may differ from those in non-diabetics.Preoperative glycosylated hemoglobin concentrations in diabetic patients can predict insulin sensitivity during surgery.However,the relationship between preoperative blood glucose control and postoperative pain in diabetic patients is unclear.In this study,the glycosylated hemoglobin level at the time of admission was used as a predictor of preoperative blood glucose control.The relationship between preoperative glycosylated hemoglobin level and postoperative opioid demand was studied by sufentanil self-controlled analgesia.Methods:68 patients with type 2 diabetes and elective total knee arthroplasty were selected before surgery,gender is not limited,age 18-65 years old,body mass index BMI18-25,ASA grade II-III.According to whether the glycated hemoglobin at admission was>6.07%,they were divided into two groups:high glycosylated hemoglobin group?group H,n=36?and control group?group C,n=32?.The two groups of patients had good glycemic control since admission.All patients were not preoperatively administered,and the venous access was opened after entering the room,and ECG,BP,and SPO₂were routinely monitored.Narcotrend was used to monitor the depth of anesthesia during surgery.Anesthesia induction:intravenous sufentanil 0.3?g/kg,cis atracurium 0.15 mg/kg,propofol 2-2.5 mg/kg.After 5 minutes,the tracheal intubation was performed to confirm the depth of the tracheal tube and properly fix it.Connected anesthesia machine for mechanical ventilation?tidal volume 6-8ml/kg,respiratory rate 12 times/min,I:E=1:1.5,oxygen flow rate2L/min?,maintain end-tidal carbon dioxide partial pressure?PETCO₂?35-45mmHg.Anesthesia maintenance:propofol 6-12mg/h.kg continuous intravenous pumping,maintaining Nacrotrand value of 40-60.Cis-atracurium and sufentanil were administered intermittently.Vasoactive drugs are administered as necessary to maintain hemodynamic stability so that they do not fluctuate by more than 20%of the baseline value.Intraoperative sodium acetate Ringer's solution and hydroxyethyl starch 130/0.4 sodium chloride injection were added to supplement blood loss and fluid loss.When Hb<80 g/L or Hct<24%,the red blood cell suspension is infused as needed.Dolcetron12.5 mg was given slowly 30 min before the operation to prevent postoperative nausea and vomiting.Stop infusion of propofol before surgical suture.At the end of the operation,the"sujia"electronically controlled analgesia pump was connected.The PCIA formula:sufentanil 1.5?g/kg+physiological saline to100 ml.The analgesic pump parameters are set as follows:total amount 100ml,single dose 2ml,lock time 5min.Result:The mean blood glucose concentration in the H group,the blood glucose concentration in the PACU,and the average blood glucose concentration in the 48 hours after surgery were significantly higher than those in the C group?P<0.05?.Compared with patients in group C,the total consumption of sufentanil in group H was 17.9%higher than that in the group within 48 hours after operation,P<0.001.The VAS scores of group H in exercise and rest were significantly higher than those in group B after 4 hours.There was a statistically significant difference between the two groups?P<0.05?.There was no significant difference in VAS score between the two groups at 8h,24h and 48h after operation?P>0.05?.The percentage of analgesia in patients in group H was significantly higher than that in group C.The difference was statistically significant?P<0.05?.At 8h,24h and 48h after operation,the two groups were under rest and exercise.There was no significant difference in the percentage of analgesia?P>0.05?;the difference was statistically significant.Multivariate linear regression test found that preoperative glycosylated hemoglobin and body weight were independent factors influencing the need for postoperative sufentanil.Conclution:Preoperative glycosylated hemoglobin levels in diabetic patients are significantly associated with postoperative pain levels.