Use of ketorolac tromethamine and dexmedetomidine in analgesia after transurethral resection of prostate

Abstract

Objective To investigate the analgesic effect of using ketorolac trometamol and dexmedetomidine via vein in patients performed by patient-controlled analgesia (PCA) after the transurethral resection of prostate (TURP). Methods A total of 120 patients with benign prostatic hyperplasia (BPH) , who were hospitalized in the Department of Urology in our hospital between October 2016 and May 2017 were included as the subjects in the study, and all patients underwent selective TURP. All patients were randomly divided into 3 groups: the control group (group C, n=40) , group K1 (n=40) and group K2 (n=40). The three groups were treated with epidural anesthesia and subarachnoid block anesthesia, and underwent continuous intravenous analgesia after the operation. Group C received 1.5 μg/kg sufentanil + 0.05 μg/kg dexmedetomidine, group K1 received 1.5 μg/kg sufentanil + 0.05 μg/kg dexmedetomidine + 0.025 mg/kg ketorolac tromethamine, group K2 received 1.5 μg/kg sufentanil+ 0.05 μg/kg dexmedetomidine+ 0.05 mg/kg ketorolac tromethamine. The drugs in each group were diluted to 100 ml with normal saline. At 10 min before the end of the operation, the patients in each group were rapidly given 2 ml of analgesic solution via pumps, with background infusion rate of 2 ml/h, PCA lockout time of 15 min, and dosage of 2 ml once. The intraoperative conditions in the 3 groups were recorded, including the operation time and anesthesia time. The visual analogue scale (VAS) score and Ramasy score were recorded at 4, 8, 12, 24 and 48 h after the operation. The incidence of adverse reactions, such as pruritus, nausea, vomiting and restlessness were recorded. The Bruggrman comfort scale (BCS) score was recorded at 48 h after the operation, and the pressing times of PCA and total sufentanil dosage were recorded. Results The operation time was (87±21) min and the duration of anesthesia was (110 ± 12) min. At 4, 8, 12, 24 and 48 h after the operation, the Ramasy score in groups K1 and K2 significantly increased as compared with that in group C, whereas the VAS score significantly decreased as compared with that in group C (all P<0.05). The incidence of pruritus in group K2 significantly decreased as compared with that in group C (P<0.05). At 48 h after the operation, the BCS score in groups K1 and K2 significantly increased as compared with that in group C, whereas the pressing times of PCA significantly decreased as compared with that in group C (all P<0.05). The BCS score in group K2 significantly increased as compared with that in group K1, whereas the pressing times of PCA significantly decreased as compared with that in group K1 (both P<0.05). At 48 h after the operation, the total sufentanil dosage in group C was significantly higher than those in groups K1 and K2, and group K1 was significantly higher than that in group K2 (all P<0.05). Conclusion The use of low dose of ketorolac after TURP may obviously improve the analgesic effect of dexmedetomidine and sufentanil, and reduce the adverse reactions and the total sufentanil dosage. Key words: Ketorolac tromethamine; Transurethral resection of prostate; Dexmedetomidine; Sufentanil; Analgesia, patient-controlled