The Effect Of Tramadol Using In Patient-controlled Intravenous Analgesia With Different Background Dose:A Double-blind Randomized Clinical Trial

Objective:To analyze the effect of different background dose of tramadol for postoperative analgesia after laparoscopic renal or adrenal resection.Method:Select 90 elderly patients(year of 50-80)who are under general anesthesia in laparoscopic renal or adrenal resection,ASA Ⅰ-Ⅲ.All patients were randomly divided into casual background dose group(Ⅰ),low background dose group(Ⅱ),no background dose group(Ⅲ),30 cases in each group.All 3 groups were doing local infiltration anesthesia using 0.375%ropivacaine,PCIA was given after operation.10 mg/kg tramadol+saline to 100 ml were given to the pump.Patients were enrolled in series and were randomly divided into 3 groups according to various backgroud dose of tramadol:2ml/h background dose,the single dose for PCA was 0.5ml each time(Group Ⅰ);1ml/h background dose,the single dose for PCA was 2ml each time(Group Ⅱ);0ml/h background dose,the single dose for PCA was 4ml each time(Group Ⅲ);and the lockout time was 15 minutes in each group.The index for evaluation included the numeric rating scales(NRS)of pain,Bruggrmann comfort scale(BCS),the press number,the assumption of tramadol at 6h,12h,24h,48h after operation.Also,patients with postoperative adverse reaction happening within 48h(nausea,vomiting,dizziness,itching,respiratory depression and lethargy,etc.)as well as the recovery of gastrointestinal function were recorded.Results:There is a significant statistic difference of NRS in time 24h after operation between group Ⅰ with group Ⅲ[(2.07 ±0.828)vs(2.87±1.008),P=0.014<0.05].About BCS,compared with group Ⅰ,group Ⅱ in 6h after operation can see a significant statistic difference[(2.07±0.785)vs(2.50±0.509),P=0.006<0.05].The consumption of tramadol in group Ⅲ and Ⅱ were less than that in group Ⅰ[(55.600±21.817)vs(58.067±13.083)vs(73.000±1.737),P<0.05]in 36h and[(71.133±14.148)vs(62.000±23.670)vs(96.900±1.441),P<0.05]in 48h.The number of PCIA boluses in group Ⅲ and groupⅡ was more than that in group Ⅰ in every time after operation(P<0.05)and there was a significant statistic difference between group Ⅱ and group Ⅲ.There was no significant statistic difference in the incidence of adverse reactions among the three groups.Conclusion:Tramadol used in laparoscopic resection of kidney and adrenal gland in patients with patient controlled intravenous analgesia(PCIA),low background dose compared with no background dose and conventional background dose,having a similar effect of analgesia,at the same time the drug assumption and press number were less than the other two groups,may be it is a more suitable way for patients with patient-controlled intravenous analgesia(PCIA).