Efficacy Of Nalmefene Combined With Hydromorphone In Postoperative Patient-controlled Intravenous Analgesia In Patients With Gynecological Laparoscopic Surgery

Objective:To study the effects of different doses of nalmefene combined with hydromorphone on PCIA in patients undergoing gynecological laparoscopic surgery to enhance analgesia and inhibit adverse reactions,and to explore the best dose of nalmefene.Methods:80 patients who undergoing laparoscopic hysterectomy under general anesthesia were randomly divided into 4 groups with 20 cases in each group.The PCIA of the four groups were hydromorphone 2ug/(kg·h),Group C had no other drugs.However,0.25ug/kg,0.5ug/kg and 1.0ug/kg nalmefene were added to the group N1,N2 and N3 group,respectively.All drugs were diluted to 100 ml with normal saline,the background dose was 2ml/h,the single dose was 2ml,the lock-in time was 15 min,and the maintenance time was 48 h.The hemodynamic indexes,dynamic and static VAS scores,Ramsay sedation scores of the patients were recorded at Preoperative(T0),extubation(T1),postoperative 2 h、6h、12h、24h、48h(T2～T6),and the use of PCIA pumps,the occurrence of postoperative adverse reactions,and the recovery of gastrointestinal function were compared.Results:1.There was no significant difference in age,height,weight,body mass index,operation time,doses of sufentanil and remifentanil,hemodynamic indexes at each time point among the four groups(P>0.05).2.The addition of nalmefene to the PCIA pump did not affect the patient’s static VAS score at each time point(P>0.05),but it affected the dynamic VAS score.The dynamic VAS scores of the group N2 at T3,T4,and T5 were lower than those of the other three groups,and the results were statistically significant(P<0.05);The dynamic VAS scores of the four groups were all highest at T3,and then gradually decreased over time.3.Nalmefene can improve the Ramsay sedation score of patients.Both the group N2 and group N3 have better effects;the Ramsay sedation scores of the four groups are all highest at T1,and then gradually decrease over time.4.The least number of PCIA pump compressions in the group N2 indicated the best analgesic effect,but there was no significant difference in the amount of additional analgesics between the four groups in the PACU and the ward(P>0.05).5.The total incidence of nausea,the incidence of severe nausea,the incidence of severe vomiting,and the need for antiemetics in the groups N2 and N3 were less than those in the groups C and N1(P<0.05),but the total incidence of vomiting was not statistically different(P >0.05);There was no significant difference in the incidence of pruritus,respiratory depression,and lethargy among the four groups(P>0.05),but the recovery of the gastrointestinal tract of the patients in the groups N2 and N3 was faster than groups the C and N1(P<0.05).6.The group N2 had the lowest treatment failure rate,and the difference was statistically significant(P<0.05).Conclusion:A certain dose of nalmefene combined with hydromorphone for gynecological laparoscopic surgery PCIA can enhance the analgesic effect,reduce the adverse reactions of opioids,and no other side effects(e.g.nausea,slow gastrointestinal peristalsis),and the application of 0.5ug/kg nalmefene is more effective.