Comparison of different doses of nalbuphine combined with propofol in oocyte retrieval procedure in reproductive center

Abstract

Objective To investigate the clinical efficacy of different doses of nalbuphine combined with propofol for general anesthesia in oocyte retrieval procedure in a reproductive center. Methods Included in this study were a total of 150 patients who underwent transvaginal ultrasound-guided puncture and oocyte retrieval under general anesthesia in the reproductive center of our hospital. The patients, aged 22 to 45 years old, with ASA Grade I, were randomly divided into 3 groups (n=50 each) : the control group (group C) , nalbuphine group 1 (N1 group) and nalbuphine group 2 (N2 group) . At 10 minutes before the start of surgery, the N1 and N2 groups were intravenously injected with nalbuphine 0.1 mg/kg and 0.2 mg/kg, respectively. The nalbuphine in the two groups was diluted to a volume of 20 ml. The Group C was given equivalent volume of normal saline. In addition, the three groups of patients were given preoperatively 4.48 mg tropisetron. Propofol (2 mg/kg) was used in combination with nalbuphine immediately before the ovarian puncture. During the procedure, propofol was added depending on patient mobility in single doses of 0.5 mg/kg which may be repeated when necessary. At time of entering the operation room (T1) , 5 minutes after nalbuphine injection (T2) , puncture (T3) , during the procedure (T4) , at the end of the procedure (T5) , by the time the patient wake up (T6) , by the time the patient left the operation table (T7) , 30 min after the procedure (T8) and at discharge (T9) , the three groups were recorded for changes in heart rate (HR) , mean arterial pressure (MAP) , respiratory rate (RR) , and oxygen saturation (SPO2) . The propofol use, operation time, time to wake-up, intraoperative mobility, the sedation score and pain score from T7 to T9 were compared in three groups. The patients were followed up for adverse reactions such as postoperative drowsiness, dizziness, nausea, vomiting and skin itching, as well as physical mobility on the day of surgery. Results There were no significant differences in the MAP, RR and HR at all time points among groups (P>0.05) . Except for a significant reduction in SPO2 in the N2 group at T4, there was no difference in the incidence of SPO2 below 90% among groups (P>0.05) . Compared with group C, the N1 and N2 groups experienced significantly less propofol use, shorter operation time, lower incidence of intraoperative mobility and mobility-related suspension of the procedure (P 0.05) . Compared with group C, the N1 and N2 groups showed significantly lower pain score (VAS) at T8, T9, and at 6 h after operation, as well as lower incidence of pain-induced limitation in physical mobility (P<0.05) . For postoperative adverse reactions, the patients in N1 group were more likely to have drowsiness at T9 (P<0.05) , and dizziness at T8, T9, and at 6h after operation (P<0.05) compared with C group; those in N2 group were more likely to have drowsiness, dizziness, nausea at T8, T9, and at 6 h after operation (P<0.05) , vomiting at T9 and at 6 h after operation (P<0.05) compared with group C. Compared with the N1 group, patients in the N2 group were more likely to have dizziness at T8 and T9 (P<0.05) , nausea and vomiting at 6h after operation (P<0.05) . Conclusion Nalbuphine combined with propofol can be use under general anesthesia in oocyte retrieval in reproductive centers. It can reduce the intraoperative propofol use and patient mobility, offer long-lasting postoperative analgesia, and does not interfere with patient wake-up. The dose of 0.1mg/kg is recommendable. Occurrence of over-sedative effects, nausea and vomiting should call for medical intervention with higher dose of nalbuphine. Key words: Nalbuphine; Propofol; Analgesia; Oocyte retrival