| Background:The pain after thoracic surgery is severe.How to control the pain effectively after thoracic surgery has been a hot issue in recent years.At present,multimodal perioperative pain treatment is widely recommended,that is,to control perioperative pain with different analgesic mechanisms or methods in order to achieve accelerated recovery(ERAS).Although dexmedetomidine has been used for postoperative analgesia for a long time,most domestic and foreign studies focus on the reduction of opioid use and patient satisfaction after combined use of dexmedetomidine.Clinical findings show that the degree of postoperative pain decreases with the passage of time.The analgesic method which is provided by traditional analgesic scheme is that all drugs are confined to the use of the "single reservoir" intravenous analgesic pump.There will be excessive drugs or inconsistent drug concentration needed by patients.Therefore,this study proposes the development and design of a time-division,double-reservoir and multimode analgesic pump(fund:CYCG18-02),which uses double-pump analgesia and separates opioids and dexmedetomidine into different analgesic pumps for post-operative pain treatment.Opioids and dexmedetomidine can achieve the best cooperation with different concentration,speed and time,in order to obtain the most effective postoperative analgesic treatment,and avoid the adverse reactions caused by long-term use after surgeryThis study will be conducted in two parts.The first part explores the appropriate concentration of dexmedetomidine combined with opioids for postoperative analgesia in thoracic surgery,and screens out the appropriate dosage that can meet the needs of clinical analgesia without excessive sedation.In the second part,on the basis of choosing the appropriate dosage of dexmedetomidine in the first part,the suitable time of analgesia of dexmedetomidine combined with opioids for thoracic postoperative analgesia is discussed,so as to meet the goals of postoperative analgesia of thoracic patients without excessive sedation and analgesiaPart ? Feasibility and appropriate dosage of dexmedetomidine for postoperative analgesia in thoracic surgeryObjectives:To explore the feasibility of dexmedetomidine combined with opioids for patient controlled intravenous analgesia after thoracic surgery and the appropriate dosage of dexmedetomidine for clinical analgesia without excessive sedation.Methods:Eighty patients undergoing thoracic surgery under general anesthesia in our hospital from March to July 2018 were randomly divided into four groups,each group was given the same anesthesia scheme,and double-pump analgesia was used after operation.Sufentanil 0.04ug/kg/h+Dezocine 10mg+Tropisetron 10mg was administered to each group of pump 1 to prepare 200ml solution;pump 2 was administered different doses of dexmedetomidine to prepare 200ml solution:low dose group(L group,0.03ug/kg/h),medium dose group(M group,0.04ug/kg),high dose group(H group,0.05ug/kg)for postoperative analgesia treatment,while control group(C group)was administered with the same amount of saline.The analgesic pumps were removed from the four groups at 96 hours after operation.Pulse oxygen saturation(SpO2),mean arterial pressure(M AP),heart rate(HR),vi sual analogue scale(VAS),patient controlled analgesia(PCA),the la consciousness score in the National Institutes of Health Stroke Score(NIHISS),Semi quantitative cough strength score(SCSS)and activities of daily living score(ADL score)were observed and recorded at 1h(T1),6h(T2),12h(T3),24 h(T4),36h(T5),48h(T6),72h(T7)and 96h(T8)after operation,as well as VAS,SCSS and ADL score on the 7th day(T9)after operation were recorded,and adverse drug reactions and analgesic remedies were recorded within 7 days after operation.Results:There were no significant differences in gender,age,height,weight,ASA grade,operation time,and postoperative SpO2 and sedation score among the four groups.Postoperative MAP and HR were more stable in each group using dexmedetomidine.The difference was statistically significant compared with group C(P<0.05),but there were no significant differences among group L,group M and group H(P>0.05).VAS showed that the analgesic effect of group H was significantly better than that of the other three groups(P<0.05),and that of group M was significantly better than that of group C(P<0.05),but there was no significant difference between group C and group L,group L and group M(P>0.05).PCA showed that the analgesic remedy in group H was significantly less than that in group C and group L,and that in group M was significantly less than that in group C(P<0.05),but there was no significant difference between group C and group L,group L and group M,group M and group H(P>0.05).SCSS and ADL score showed that the cough ability and daily activity ability of group H were significantly better than those of group C and group L(P<0.05),and those of group M were significantly better than those of group C(P<0.05),but there was no significant difference between group C and group L,group L and group M,group M and group H(P>0.05).There were no significant differences in the incidence of postoperative vomiting,respiratory depression and bradycardia among the four groups(P>0.05),but the incidence of nausea in group C was significantly higher than that in the other three groups(P<0.05).Conclusions:This study shows that dexmedetomidine combined with opioids is safe,effective and feasible for thoracic postoperative analgesia.Three concentrations of dexmedetomidine as adjuvant opioids can achieve good analgesic efrect after thoracic surgery.When dexmedetomidine is combined with 0.05ug/kg/h(group H),patients not only have better analgesic effect,but also have faster recovery of cough and activity after operation.The second part of this study will be based on 0.05ug/kg/h dexmedetomide.Part ? The appropriate analgesic time of dexmedetomidine for Thoracic Postoperative analgesia.Objectives:To investigate the suitable time of dexmedetomidine combined with opioids for patient controlled intravenous analgesia after thoracic surgery.Methods:Eighty patients undergoing thoracic surgery under general anesthesia in our hospital from August to December 2018 were randomly divided into four groups,each group was given the same anesthesia scheme,and double-pump analgesia was used after operation.Sufentanil 0.04ug/kg/h+Dezocine 10mg+Tropisetron 10mg was administered to each group of pump 1 to prepare 200ml solution;Pump 2 was administered with dexmedetomidine with a capacity of 150 ml and a concentration of 0.05ug/kg/h.Different groups were administered for different periods of time:one day group(Di group,24h),two days group(D2 group,48h),three days group(D3 group,72h),while control group(D0 group)was administered with the same amount of saline.The analgesic pumps were removed from the four groups at 96 hours after operation.Pulse oxygen saturation(SpO2),mean arterial pressure(MAP),heart rate(HR),visual analogue scale(VAS),patient controlled analgesia(PCA),the la consciousness score in the National Institutes of Health Stroke Score(NIHISS),Semiquantitative cough strength score(SCSS)and activities of daily living score(ADL score)were observed and recorded at 1h(T1),6h(T2),12h(T3),24h(T4),36h(T5),48h(T6),72h(T7)and 96h(T8)after operation,as well as VAS,SCSS and ADL score on the 7th day(T9)after operation were recorded,and adverse drug reactions and analgesic remedies were recorded within 7 days after operation.Results:There were no significant differences in gender,age,height,weight,ASA grade,operation time,and postoperative SpO2 and sedation score among the four groups.Postoperative MAP and HR were more stable in each group using dexmedetomidine.The difference was statistically significant compared with group D0(P<0.05),but there were no significant differences among group Di,group D2 and group D3(P>0.05).VAS showed that there was no significant difference between group D2 and group D3(P>0.05),but the difference was statistically significant compared with group Do and group D1(P<0.05).The analgesic effect of group D2 and group D3 was significantly better than that of group D0 and group D1.PCA showed that there were no significant differences among group Di,group D2 and group D3(P>0.05),but the difference was statistically significant compared with group D0 and group D1(P<0.05).The number of analgesic remedies in group D1,group D2 and group D3 was significantly less than that in group Do.SCSS and ADL score showed that there was no significant difference between group D2 and group D3(P>0.05),but the difference was statistically significant compared with group D0 and group Di(P<0.05).Postoperative cough ability and daily activity ability of group D2 and D3 were significantly better than those of group Do and group D1.There were no significant differences in the incidence of postoperative vomiting,respiratory depression and bradycardia among the four groups(P>0.05),but the incidence of nausea im D0 group was significantly higher than that in the other three groups(P<0.05).Conclusions:This study shows that dexmedetomidine assisted thoracic surgery can play a significant role in postoperative analgesia,and is conducive to postoperative rehabilitation.We recommend intravenous infusion of dexmedetomidine 0.05ug/kg/h for 48 hours combined with sufentanil 0.04ug/kg/h + dizocine 10mg for 96 hours for pain treatment after thoracic surgery,which can help patients achieve good postoperative analgesia and functional recovery.Postoperative double-pump analgesia makes the advantages of different analgesic drugs play a full role while minimizing the incidence of adverse drug reactions.By optimizing the compatibility of different analgesic drugs with appropriate analgesic dose and appropriate analgesic duration,the purpose of rapid postoperative rehabilitation is promoted. |
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