Effect of preemptive analgesia with PCEA on stress reaction in patients at perioperative period

Abstract

Objective To explore the effect of preemptive analgesia with PCEA on stress reaction in patients at perioperative period.Methods 80 ASA grades I and Ⅱ patients scheduled for upper abdominal surgery were randomly divided into two groups:preemptive analgesia group (group A) and postoperative analgesia group (group B),40 for each group.Mixed solution of 100 ml with sufentanil of 0.7 ug/ml and ropivacaine of 0.15％ was used for analgesia.Group A received mixed solution with an initial loading dose of 10 ml and continuous analgesia with a background dose of 2 ml/h using an analgesic pump; while group B received analgesia with PCEA postoperatively with the same method used in group A.Levels of cortisol (COR),adrenocorticotropic hormone (ACTH),and C-reactive protein (CRP) were measured in the two groups at l0 minutes after entering into the operating room (To),the beginning of surgery (T1),2 hours after surgery (T2),and 6 am on the next day (T3).Pain scores were recorded at hours 2,6,12,and 24 after surgery with VAS rating scale.Results Vital signs were stable in both groups at different periods.The effect of analgesia was better in group A than in group B at T2 (P＜0.01).Levels of COR,ACTH,and CRP were significantly increased in both groups at T1,T2 and T3,as compared with T0 (P＜0.01).Levels of COR,ACTH and CRP were significantly higher in group B than in group A at T1,T2,and T3 (P＜0.05).Conclusions Preemptive analgesia with PCEA using sufentanil of 0.7 ug/ml and ropivacaine of 0.15％ and conventional analgesia with PCEA have better analgetic effect in patients undergoing upper abdominal surgery.Preemptive analgesia with PCEA is more effective in control of stress reaction at at perioperative period than conventional analgesia with PCEA. Key words: Preemptive analgesia; Epidural analgesia; Perioperative period; Stress reaction