| Background and ObjectiveLocal anesthetic combined with fentanyl is a commonly used drug compatibility program for intraspinal anesthesia.Its advantages are perfect analgesia,and can reduce the dose of local anesthetics and prolong the effective time.However,the incidence of skin itching increased after intraspinal injection of fentanyl,and some have more serious consequences.At present,it is believed that the activation of μopioid receptors and 5-HT3 receptors in the dorsal horn of the spinal cord and the trigeminal nerve spinal tract is closely related to the occurrence of pruritus.Dezocine and Palonosetron can antagonize μ opioid receptors and 5-HT3 receptors,respectively.Therefore,in theory,it can be used to prevent and treat skin itching after fentanyl is used for spinal anesthesia.However the effectiveness of the two drugs in preventing itching caused by fentanyl in the spinal canal is rarely reported.This study intends to evaluate the effect of dezocine combined with Palonosetron on skin pruritus after spinal anesthesia of ropivacaine-fentanyl in patients undergoing gynecological surgery,and to provide reference for clinical application.Materials and MethodsA total of 140 gynecological patients scheduled for open surgery,were devided into control group(group C),dizocine group(group D),palonosetron group(group P)and dizocine combined with palonosetron group(group DP)using a random number table.Vital signs were monitored after entering the operating room.In group D,dizocine 0.15 mg/kg was intravenously injected 10 min before spinal anesthesia.At the same time,in group P,palonosetron 3 μg/kg was intravenously injected;in group DP,dizocine 0.15 mg/kg combined with palonosetron 3 μg/kg was intravenously injected;In group C,equal volume of saline was intravenously injected.All the patients were lain on the right side,spinal anesthesia puncture were operated in the L3,4 or L2,3 gap.Ropivacaine 16.7 mg+fentanyl 20.8 pg was injected into the subarachnoid space,and the spinal anesthesia plane was adjusted according to the surgical requirements.Record the vital signs,itch score(Including classic three-item scoring method and patient subjective VAS scoring method),Ramsay sedation score and nausea/vomit score.SPSS 17.0 software was used for statistical analysis,and P<0.05 was considered statistically significant.Research Results1.Comparison of the general data of the 4 groups of patients,there was no statistically significant difference in the age,height,weight,BMI and ASA classification of the patients in each group(P>0.05);2.There was no statistically significant difference in data related to anesthesia,surgery-related indicators,and intraoperative vital signs changes among the 4 groups of patients(P>0.05);3.The three-item scoring in each group were lower in group D(3.3±1.7),group P(3.5 ± 2.1)and group DP(3.1 ± 2.0)than group C(4.9±2.2;F=5.694,P<0.05).The VAS score of group D(2.6 ± 1.7),group P(2.8±1.9)and group DP(2.6 ± 1.8)were smaller than group C(3.8±2.3;F=3.245,P<0.05);4.Compared with group C(2.7 ± 0.8),sedation score increased in group D(3.6±0.7)and group DP(3.7±0.8;F=20.910,P<0.05).5.Compared with group D(1.74±0.98),nausea/vomit score decreased in group P(0.69±0.63)and group DP(0.71±0.67;F=31.907,P<0.05).Research Conclusion1.Preventive intravenous injection of dezocine combined with palonosetron before spinal anesthesia can effectively reduce the occurrence of skin itching after ropivacaine-fentanyl spinal anesthesia in patients undergoing gynecological surgery.2.Intravenous injection of dezocine combined with palonosetron has a certain sedative effect,improves patient comfort,and has a certain effect on alleviating postoperative anxiety.3.There is no obvious nausea,vomiting and other adverse reactions in the combination of intravenous dezocine and palonosetron... |
PDF Full Text Request