Effects Of Patient-controlled Intravenous Analgesia Research Articles

Effects of hydromorphone-based patient-controlled intravenous analgesia on postoperative hypoxaemia: a randomised controlled non-inferiority clinical trial

ObjectiveThis study aimed to compare the effects of patient-controlled intravenous analgesia (PCIA) with and without low-basal infusion on postoperative hypoxaemia.DesignA randomised parallel-group non-inferiority trial.SettingThe trial was conducted at a grade-A...

Application of superior iliac fascia block of inguinal ligament combined with patient controlled intravenous analgesia in elderly patients after hip arthroplasty

To compare the effect of patient-controlled intravenous analgesia(PCIA) and superior inguinal ligament iliac fascia block combined with PCIA after hip replacement in the elderly. Total of 82 elderly patients were treated with hip arthroplasty from June 2019 to June 2021 and randomly divided into observation group and control group. There were 42 patients in control group, including 18 males and 24 females, aged from 60 to 78 years old with an average of (70.43±3.67) years old, 28 femoral neck fractures and 14 femoral head necrosis, who received PCIA. The study group consisted of 42 cases, including 20 males and 22 females, aged from 61 to 76 years old with an average of (69.68±3.74) years old, 25 femoral neck fractures and 17 femoral head necrosis, who received superior inguinal ligament iliac fascia block combined with PCIA. Pain visual analogue scale (VAS) and Ramesay sedation scores at 2 h, 6 h, 12 h, 24 h and 48 h after operation were evaluated. In addition, the follow-up results of the total consumption of sufentanil and the total number of PCIA compressions at 48 hours after operation, the first time of landing after surgery, the time of hospital stay, the incidence of adverse reactions, the satisfaction with analgesia of two groups were observed. All patients were followed up for 9 to 24 months with an average of(13.85±2.67) months. There was no significant difference in operation time and intraoperative bleeding between two groups (P>0.05). There was no difference in VAS between two groups at 2 hours after operation (P>0.05), and the VAS of the study group at 6 h, 12 h, 24 h and 48 h after operation were lower than those of the control group(P<0.05). The Ramesay sedation scores of the study group at 2 h, 6 h and 12 h after operation were higher than those of the control group(P<0.05), and there were no differences in Ramesay score between two groups at 24 h and 48 h after operation (P>0.05). The consumption of sufentanil in the study group within 48 hours after operation was lower than that in the control group (P<0.05), and PCIA compression times were lower than those in the control group(P<0.05), and the time of first landing was earlier than that in the control group(P<0.05). There was no significant difference in hospital stay, adverse reaction rate, complications between two groups (P>0.05). The satisfaction of analgesia in the study group was higher than that in the control group (P<0.05). Superior iliac fascia block of inguinal ligament combined with PCIA has significant analgesic and sedative effects after hip arthroplasty in the elderly. It can reduce the amount of sufentanil used and the total number of PCIA compressions, which is conducive to the early activity of patients out of bed, improve the satisfaction of analgesia.

Preventing nausea and vomiting after gynecological laparoscopic surgery by patient-controlled intravenous analgesia with a naloxone admixture: A randomized controlled trial.

Background:Opioid-induced nausea and vomiting are common side effects of patient-controlled intravenous analgesia (PCIA). This study aimed to explore the inhibitory effect of a naloxone admixture on the incidence of sufentanil-induced postoperative nausea and vomiting (PONV).Methods:A total of 132 Uyghur American Society of Anesthesiologists I and II patients scheduled to undergo elective gynecological laparoscopic surgery were recruited; among these, 120 patients were enrolled and randomly allocated into 4 groups: patients receiving PCIA but no naloxone were included in the control group (group A); patients receiving PCIA with a low-dose naloxone admixture at 0.2 μg·kg−1·h−1 were included in group B; patients receiving PCIA with naloxone admixture at 0.4 μg·kg−1·h−1 were included in group C; patients receiving PCIA with naloxone admixture at 0.6 μg·kg−1·h−1 were included in group D. All patients were administered sufentanil at 0.04 kg−1·h−1, butorphanol at 2 kg−1·h−1, and dexmedetomidine at 0.08 kg−1·h−1 using a PCIA device within 2 days of surgery. The occurrence of nausea and vomiting, visual analogue scores for pain intensity, mean arterial pressure, heart rate, oxygen saturation, pruritus, lethargy, respiratory depression, etc, was recorded at 2, 8, 12, 24, and 48 hours postoperatively.Results:There was a significant difference in the PONV scores between the groups at 8, 12, and 24 hours after surgery (P < 0.01). At 8 and 12 hours, the score of group C/D was significantly lower than that of group A/B (P < 0.01). At 24 hours after surgery, the PONV score of group B/C/D was significantly lower than that of group A (P < 0.01). No significant difference was observed in the general data and visual analogue scores for postoperative pain between the 4 groups.Conclusion:Naloxone admixture administered at 0.4 to 0.6 μg·kg−1·h−1 can exert an effective inhibitory effect on the incidence and intensity of PONV in gynecological laparoscopic surgery.

The Effect of Patient-controlled Intravenous Analgesia (PCIA) on Postoperative Delirium in Patients with Liver Transplantation: a Propensity Score Matching Analysis

Objectives Postoperative opioid use and pain are related to postoperative delirium. This study aims to compare the incidence of delirium in patients with and without patient-controlled intravenous analgesia (PCIA) among liver transplant recipients. Methods The medical records of 253 patients who received liver transplantation (LT) from January 2010 to July 2017 in a single university hospital were retrospectively reviewed. Patients were divided into two groups: the patients who had used PCIA (P group, n = 71) and those who did not use PCIA (C group, n = 182) after LT in intensive care unit (ICU). The patient data were collected, which included demographic data, and details about perioperative management and postoperative complications. Results There was no difference in the model for end-stage liver disease (MELD) score between the two groups. Postoperative delirium occurred in 10 / 71 (14.08 %) in the P group and 26 / 182 (14.29 %) in the C group after LT, respectively (P = 0.97). After propensity score matching, no differences were observed in the incidence of delirium (P = 0.359) and the time from surgery to discharge (P = 0.26) between the two groups. Conclusions Patients with PCIA after LT exhibited no relationship with postoperative delirium. Therefore, it is necessary to actively control postoperative pain using PCIA.

Effect of patient-controlled intravenous analgesia combined with flurbiprofen axetil and dezocine on postoperative analgesia for lobectomy (EPIC-FAD): a trial protocol

BackgroundThe optimal analgesic strategy for surgical pain after lobectomy remains undefined. To compare the combination of flurbiprofen axetil and dezocine with flurbiprofen axetil alone and dezocine alone, in post-lobectomy patients.MethodsA single-center, parallel-design double-blind superiority trial, with 5 groups (1:1:1:1:1 ratio) with different combinations of flurbiprofen and dezocine. Patients scheduled for lobectomy will be recruited. The primary outcome is total sufentanil use in patient-controlled intravenous analgesia within the first 24 postoperative hours. Secondary outcomes include pain numeric rating scales at 6th, 12th, 24th, 48th, and 72th postoperative hours, and on the 1st, 3rd, and 6th postoperative months at rest and during coughing, adverse effects from experimental drug treatment, sufentanil use at other time points, analgesia cost, time to chest tube removal, length of hospital stay, time to pass first flatus, and serum level of cytokines. Doctors, patients, and nurses are blinded, and only the manager is unblinded. Analysis is intention-to-treat. Statistical analysis is pre-specified. Statistical comparison of the treatment groups includes one-way analysis of variance followed by Tukey’s post hoc test.DiscussionTrial did not begin to recruit. Participant recruitment start date is planned to be June 1, 2020. Approximate recruitment end date is May 31, 2021. If successful, the trial may shed light on the use of certain analgesic combinations in post-lobectomy pain control.Trial registrationChinese Clinical Trial Registry ChiCTR1800018563. Registered on September 25, 2018.

Effects of patient-controlled intravenous analgesia with butorphanol versus sufentanil on early postoperative rehabilitation following radical laparoscopic nephrectomy

Objective: To investigate the effects of patient-controlled intravenous analgesia with butorphanol versus sufentanil on early postoperative rehabilitation following radical laparoscopic nephrectomy. Methods: One hundred patients undergoing radical laparoscopic nephrectomy in Affiliated Cancer Hospital of Zhengzhou University from September 2018 to February 2020 were divided into two groups (n=50) using a random number table: butorphanol patient-controlled intravenous analgesia group (group A) and sufentanil patient-controlled intravenous analgesia group (group B). Patient-controlled intravenous analgesia (PCIA) was performed at the end of surgery. The formulation of group A was butorphanol (0.15 mg/kg) and ketorolac tromethamine (180 mg) using the physiological saline at a dilution of 100 ml. The formulation of group B was sufentanil (1.5 μg/kg) and ketorolac tromethamine (180 mg) using the physiological saline at a dilution of 100 ml. At the time points of 4, 8, 24, 48 h after operation (T(1), T(2), T(3), T(4)), VAS scores at rest and cough were recorded. The incidence of remedial analgesia, the number of pressings during 48 h after the operation, the postoperative anal exhaust recovery time of the patients were recorded. Quality of recovery-40(QoR-40) scores were recorded at T(3) and T(4). Adverse reactions were recorded. Results: There was no significant difference in VAS scores at rest and cough at T(1), T(2), T(3) and T(4) between two groups (all P>0.05). There was no significant difference in the incidence of remedial analgesia and the number of pressings during 48 h after the operation between two groups (all P>0.05). The postoperative anal exhaust recovery time of the patients in group A was (32±6) h, which was lower than that in group B with statistically significant difference [(40±5) h, t=7.937, P<0.01]. The QoR-40 total scores in group A were higher than those in group B at T(3) and T(4), which were (185.8±2.5) vs (170.7±2.7), (194.8±1.9) vs (183.6±2.6), and the differences were statistically significant (t=28.878, 25.025, all P<0.01). The incidence of nausea, retching/vomiting, respiratory depression and itch during 48 h after the operation in group A were 10%, 6%, 2%, 2%, which were lower than that in group B (32%, 20%, 14%, 18%), with statistically significant difference (χ(2)=7.294, 4.322, 4.891, 5.983, all P<0.05). Conclusion: PCIA with butorphanol or sufentanil can provide satisfactory analgesia for patients undergoing radical laparoscopic nephrectomy, but butorphanol can promote postoperative rehabilitation with fewer adverse reactions.

The analgesic effect of tramadol combined with butorphanol on uterine cramping pain after repeat caesarean section: a randomized, controlled, double-blind study.

This study aimed to explore the effect of patient-controlled intravenous analgesia (PCIA) using tramadol combined with butorphanol on uterine cramping pain in women undergoing repeat caesarean section. A total of 126 patients, who were scheduled to undergo repeat caesarean section under spinal anesthesia, were included. PCIA using tramadol combined with butorphanol or sufentanil was randomly performed for postoperative pain control. Postoperative uterine cramping pain and wound pain within 48h after surgery were evaluated. Postoperative analgesic consumption, early activity time, and length of hospital stay were also recorded and analyzed. Uterine cramping pain intensity in women undergoing repeat caesarean section was significantly higher compared with their wound pain (P < 0.05). The mean visual analog scale (VAS) score for uterine cramping pain in the tramadol-butorphanol group was significantly lower than that in the sufentanil group at rest, and at 6h and 12h after surgery. VAS scores for uterine cramping pain during movement at 6h, 12h, and 24h after surgery in the tramadol-butorphanol group were also significantly lower than that in sufentanil group (P < 0.05). There was no significant difference in VAS score for wound pain at the different time points between the tramadol-butorphanol and sufentanil groups (P > 0.05). Patient-controlled intravenous analgesia with tramadol accelerated early rehabilitation and decreased the length of hospital stay (P < 0.05). PCIA using tramadol combined with butorphanol provided a better analgesic effect and accelerated postoperative rehabilitation compared with sufentanil, and may be an optimal analgesic strategy for women undergoing repeat caesarean section. The trial was registered at Chinese Clinical Trial Registry ( www.chictr.org.cn ) with ID: ChiCTR-1800014986.

Analysis of the effect of patient-controlled analgesia after cesarean section with nabufine and sufentanil

Objective To compare the effects of alone and combined administration of nalbuphine and sufentanyl for patient-controlled intravenous analgesia (PCIA) after caesarean section. Methods From June 2017 to December 2017, 90 women undergoing cesarean section in the Sixth Hospital Affiliated to Shanxi Medical University were selected.They were divided into three groups(with 30 cases in each group) using a random number table: sufentanyl 1.5μg/kg group (group S), nalbuphine 2.0mg/kg group (group N) and nalbuphine 1.0mg/kg+ sufentanyl 1μg/kg group (group NS). In each group tropisetron 6 mg was added, and PCIA solution was then diluted to 10mL in normal saline.Postoperative vital signs, visual analogue scale (VAS) score, the highest Ramsay sedation score, number of self-control analgesia and the occurrence of side effects within 24h after operation were recorded. Results The highest VAS score within 24h after surgery had statistically significant difference among the three groups [group N (2.66±1.09)points > group S (1.45±0.57)points > group NS (0.90±0.55)points](F=40.11, P 0.05). The number of controlled analgesia among the three groups had no statistically significant difference [group S (0.76±0.69), group N (2.93±0.87), group NS (0.54±0.57)] (F=101.11, P>0.05). The incidence rates of adverse reactions of the three groups were 26.66%(8/30), 16.67%(5/30) and 6.66%(2/30), respecyively, the difference was not statistically significant (P>0.05). Conclusion Combination of nalbuphine and sufentanyl has more significant effect of PCIA after cesarean section than either of the drugs use alone, which is worthy of clinical promotion. Key words: Cesarean section; Analgesia, patient-controlled; Analgesics, opioid; Nalbuphine; Sufentanyl

Effects of PCIA with nalbuphine on postoperative cellular immune function in patients undergoing liver cancer resection

Objective To evaluate the effects of patient-controlled intravenous analgesia (PCIA) with nalbuphine on postoperative cellular immune function in the patients undergoing liver cancer resection. Methods Eighty hepatoma patients of both sexes, aged 40-64 yr, with body mass index 19-25 kg/m2, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, undergoing elective liver cancer resection, were divided into 2 groups (n=40 each) using a random number table method: sufentanil PCIA group (S group) and nalbuphine PCIA group (N group). Transverse abdominal plane block was performed in two groups.In group S, sufentanil 0.1 μg/kg was intravenously injected at 30 min before the end of surgery, PCIA was performed with sufentanil 2 μg/kg plus ondansetron 16 mg (diluted to 100 ml in normal saline) at the end of surgery, and PCA pump was set up with a 1 ml bolus dose, a 10-min lockout interval and background infusion at a rate of 2 ml/h.In group N, nalbuphine 0.1 mg/kg was intravenously injected at 30 min before the end of surgery, PCA was performed with nalbuphine 2 mg/kg plus ondansetron 16 mg (diluted to 100 ml in normal saline) at the end of surgery, and PCIA pump was set up with a 1 ml bolus dose, a 10-min lockout interval and background infusion at a rate of 2 ml/h, maintaining visual analog scale score <4 within 48 h after surgery.Blood samples were collected from the right internal jugular vein on admission to operating room (T1) and 24 and 72 h after surgery (T2, 3) for measurement of levels of T lymphocyte subsets CD3+ , CD4+ and CD8+ , B cells and NK cells.CD4+ /CD8+ ratio was calculated. Results Compared with S group, levels of CD3+ and CD4+ cells at T2 and levels of CD4+ and NK cells at T3 were significantly increased in N group (P<0.05). Compared with the baseline at T1, the levels of CD3+ , CD4+ , NK and B cells at T2 and NK cells at T3 were significantly decreased in two groups, and CD4+ /CD8+ ratio was decreased at T2 in group S (P<0.05). Conclusion PCIA with nabuphine can improve the postoperative cellular immune function in the patients undergoing liver cancer resection. Key words: Nalbuphine; Analgesia, patient-controlled; Immunity, cellular

Effects of patient-controlled analgesia with hydromorphone or sufentanil on postoperative pulmonary complications in patients undergoing thoracic surgery: a quasi-experimental study

ObjectiveTo compare the analgesic effects of patient-controlled intravenous analgesia (PCA) with hydromorphone and sufentanil after thoracic surgery on postoperative pulmonary complications (PPCs).MethodsA total of 142 patients who were scheduled for thoracic surgery were randomly allocated to receive PCA with hydromorphone (group A: experimental group): hydromorphone 0.2 mg/kg + dezocine 0.5 mg/kg + ramosetron 0.6 mg diluted with normal saline to 200 mL; or with sufentanil (group B: control group): sufentanil 3.0μg/kg + dezocine 0.5 mg/kg + ramosetron 0.6 mg diluted with normal saline to 200 mL. The parameters of intravenous analgesia pump were set as background dose 4 ml/h, PCA dose 1 mL, locking time 15 min. Pain NRS (numerical rating scale), Ramsay sedation score, nausea or vomiting score were evaluated at 0 h, 6 h, 12 h, 24 h, 48 h after operation. The cases of PPCs (atelectasis, pulmonary infection, respiratory failure), CRP (C-reaction protein) and inflammatory cells (white cell count and percentage of neutrophils) and blood gas analysis at 12 h after operation, length of ICU and postoperative stay were recorded for each patient.ResultsData of 136 patients were analyzed. Compared with group B (4[IQR:2,2]), the pain NRS in group A (2[IQR:4,4]) was significantly lower at 6 h after operation (P = 0.000). The CRP in group A (69.79 ± 32.13 mg/L) were lower than group B (76.76 ± 43.42 mg/L) after operation, but the difference was not significant (P = 0.427). No difference of nausea or vomiting was found between group A (7.3%) and group B (5.8%) postoperatively (P = 0.999). The PPCs were happened in 11 patients in group A (16.2%) and 22 patients in group B (32.4%) and the difference between two groups was significant (P = 0.027). Seven patients in group A (10.3%) and eighteen patients in group B (26.5%) had clinical evidence of pneumonia and the difference between two groups was significant (P = 0.014). The length of ICU and postoperative stay in group A were 2.73 h and 1.82 days less than group B respectively but the differences were not significant (P = 0.234, P = 0.186 respectively).ConclusionCompared with sufentanil, hydromorphone may provide better postoperative analgesic effect with less pulmonary complications for patients undergoing thoracic surgery, and it may accelerate patients’ rehabilitation.Trial registrationRandomized Controlled Trials ChiCTR1800014282c. Registered 3 January 2018.

Effects of patient-controlled intravenous analgesia using hydromorphone supplement with dexmedetomidine on patients undergoing transcatheter arterial chemoembolization

Objective: To evaluate the safety and efficiency of patient-controlled intravenous analgesia (PCIA) using hydromorphone supplement with dexmedetomidine on patients undergoing transcatheter arterial chemoembolization. Methods: One hundred and eighty patients, age ranged from 40 to 65 years, body mass index from 18 to 25 kg/m(2,) ASA physical status Ⅱ-Ⅲ, who were scheduled for transcatheter arterial chemoembolization (TACE) under monitor anesthesia care (MAC) were randomly divided into 3 groups: hydromorphone group (H group), hydromorphone supplement with dexmedetomidine 1 μg/kg group (D1 group), hydromorphone supplement with dexmedetomidine 2 μg/kg group (D2 group), 60 patients in every group. All the groups of patients received PCIA pump, in the H group, the PCIA reagent was composed of 120 μg/kg hydromorphone and 5 mg tropisetron in 100 ml of normal saline. In comparison, PCIA regiment was composed of 120 μg/kg hydromorphone, 1 μg/kg dexmedetomidine and 5 mg tropisetron in 100 ml of normal saline in the D1 group, while 120 μg/kg hydromorphone, 2 μg/kg dexmedetomidine and 5 mg tropisetron in 100 ml of normal saline in the D2 group. The visual analogue scale (VAS) score, the observer's assessment of alertness/sedation scale (OAA/S) score, patients' satisfaction index, consumption of hydromorphone, the additional dose of morphine, the effective pressing times of PCIA and adverse reactions were recorded in detail at 0, 0.5, 1, 4, 12 and 24 hours after the patients underwent TACE. Results: The total consumptions of hydromorphone were (4.3±0.1), (4.1±0.1), and (3.8±0.1) mg in group H, D1, and D2, respectively, and the effective pressing times were 13±3, 6±2 and 2±1, the additional doses of morphine were (30±5), (15±3), and (3±1) mg, and adverse reaction rates were 45.0%, 28.3%, and 10.0%, respectively. The manifestations mentioned above in D2 group were significantly lower than those in group H and group D1 (P<0.05). Immediately and 5 min after embolization, at the end of surgery and 0.5, 1, 4, 12 and 24 h after surgery, the VAS scores in the D2 group were 1.9±0.2, 2.1±0.3, 1.8±0.4, 1.8±0.3, 1.7±0.3, 1.6±0.3, 1.3±0.2, 1.3±0.3, respectively, lower than those in group H and group D1 (P<0.05); The satisfaction index in D2 group at these times were 8.7±1.1, 8.9±0.8, 9.2±0.9, 9.0±0.7, 9.1±0.8, 9.0±0.6, 9.1±0.7, 9.2±0.9, respectively, higher than those in group H and group D1 (P<0.05). No breath depression happened in these three groups. Conclusion: The formula of hydromorphone combined with dexmedetomidine to patients undergoing TACE is greatly safe and efficient, with advantages in alleviating pain, reducing hydromorphone consumption and the incidence of adverse reaction of hydromorphone, and without breath depression.

Patient-Controlled Intravenous Analgesia for Advanced Cancer Patients with Pain: A Retrospective Series Study.

Objective To compare the efficacy and side effects of patient-controlled intravenous analgesia (PCIA) with hydromorphone, sufentanil, and oxycodone on the management of advanced cancer patients with pain. Methods Patients allocated to receive PCIA between January 2015 and December 2016 were chosen for this study. After reviewing medical records, we verified if hydromorphone, sufentanil, or oxycodone for PCIA could equally provide effective pain relief. A numeric rating scale (NRS) of cancer pain was applied before PCIA, at 4 hours after PCIA, and at the discontinuation of PCIA. Secondary, the incidence of clinical side effects attributed to PCIA was observed. Results A total of 85 medical records were reviewed. PCIA with hydromorphone (n=30), sufentanil (n=34), and oxycodone (n=21) was used for cancer pain management. PCIA successfully improved pain control in 97.6% of the patients. The most common side effects were constipation (11.8%), nausea (8.2%), and sedation (5.9%). Drug addiction, delirium, or respiratory depression associated with PCIA was not reported in this case series study. No significant intergroup difference was observed in NRS at any of the abovementioned time points. There was no significant difference of analgesic effect among the hydromorphone, sufentanil, or oxycodone. Conclusion PCIA provided timely, safe, and satisfactory analgesia for advanced cancer patients with pain and may be useful for titration of opioids, management of severe breakthrough pain, and conversion to oral analgesia. There was no significant difference of analgesic effect and side effect among the hydromorphone, sufentanil, and oxycodone.

Effects of Dexmedetomidine for postoperative pain management in elderly patients with femoral head replacement

Objective To investigate the effects of different doses of dexmedetomidine combined with sufentanil for postoperative pain management in elderly patients with femoral head replacement(FHR). Methods Between January 2016 and August 2016, 160 elderly patients(>65 years and BMI 20-28 kg/m2)with American Society of Anesthesiologists(ASA)physical classification Ⅰ-Ⅲ scheduled for elective FHR under spinal anesthesia were randomly allocated into four groups(n=40 for each group). Forty patients, who received patient-controlled intravenous analgesia(PCIA)with sufentanil(1.5 μg/kg)and tropisetron(5 mg)diluted by normal saline to 100 ml, were assigned to the control group.The other 120 patients who received Dexmedetomidine in addition to PCIA were allocated to the experimental group.Based on the dose of dexmedetomidine used in PCIA, the experimental group was divided into three subgroups: Group D1(1.0 μg/kg), D2(1.5 μg/kg)and D3(2.0 μg/kg). The background infusion rate was 2 ml/h, demand dose 0.5 ml and lockout interval 15 min.Pain scores at rest were evaluated with a visual analogue scale(VAS)and Ramsay sedation scores were recorded at 4 h, 8 h and 24 h after surgery.Effects of post-operative analgesia and sedation, supplementary doses of analgesics, and adverse events were also recorded and compared. Results Compared with Control group, VAS was significantly lower at 4 h, 8 h and 24 h after surgery in Group D1, D2, and D3(P 0.05). Meanwhile, there were no significant differences in Ramsay scores among the four groups.Doses of supplementary analgesics and rates of adverse events were markedly lower in Group D1, D2 and D3 than in Control group(P<0.05 for all). Conclusions Dexmedetomidine may enhance the analgesic effects of PCIA with sufentanil and reduce the side effects of opioids in elderly patients with FHR. Key words: Dexmedetomidine; Arthroplasty, replacement; Femoral head; Analgesia

Comparison of patient-controlled intravenous analgesia with sufentanil versus tramadol in post-cesarean section pain management and lactation after general anesthesia - a prospective, randomized, double-blind, controlled study.

IntroductionAcute pain is a common complication following cesarean section under general anesthesia. Post–cesarean section pain management is important for both the mother and the newborn. This study compared the effects of patient-controlled intravenous analgesia (PCIA) using sufentanil or tramadol on postoperative pain control and initiation time of lactation in patients who underwent cesarean section under general anesthesia.MethodsPrimiparas (n=146) scheduled for cesarean section under general anesthesia were randomized to receive PCIA with sufentanil or tramadol. Movement-evoked and rest-pain intensity were assessed by the Numerical Rating Scale (NRS) postoperatively. The number of PCIA attempts, amount of drug consumed, initiation time of lactation, and Quality of Recovery Score 40 (QoR-40) were recorded at 4, 8, 12, and 24 h postoperatively. Pre- and postoperative serum prolactin levels were recorded.ResultsNo between-group difference existed in the NRS at rest at any time point postoperatively. Patients on sufentanil had more movement-evoked pain and a higher sedation score at 4, 8, and 12 h postoperatively, as compared with the tramadol group. At 24 h, the QoR-40 was higher in the tramadol group compared with the sufentanil group. No significant between-group differences were present in patient satisfaction and nausea/vomiting scores. Postpartum prolactin levels were significantly higher in the tramadol group versus the sufentanil group, corresponding with a significant delay in initiation of lactation in the latter.ConclusionPCIA with tramadol may be preferred due to lower movement-evoked pain, higher quality of recovery, and earlier lactation in patients following cesarean section under general anesthesia.

Effect of patient-controlled intravenous analgesia with dexmedetomidine mixed with sufentanil on sleep quality after spinal surgery

Objective To investigate the effect of patient-controlled intravenous analgesia (PCIA) with dexmedetomidine mixed with sufentanil on the sleep quality after spinal surgery. Methods Eighty patients of both sexes, aged 21–72 yr, weighing 48–100 kg, of American Society of Anesthesiologists physical statusⅠ or Ⅱ, scheduled for elective spinal surgery, were randomly assigned into sufentanil group (group S) and dexmedetomidine mixed with sufentanil group (group DS) with 40 cases in each group.In group S, PCIA solution contained sufentanil 2 μg/kg and tropisetron 6 mg in 100 ml of normal saline.In group DS, PCIA solution contained sufentanil 2 μg/kg, dexmedetomidine 3 μg/kg and tropisetron 6 mg in 100 ml of normal saline.The PCA pump was set up with a 0.5 ml bolus dose, a 15 min lockout interval and background infusion at a rate of 2 ml/h.Sufentanil 5 μg injected intravenously and celecoxib 200 mg given orally were used as rescue analgesics, and numeric rating scale (NRS) score at rest was maintained ≤4 within 48 h after surgery.Ramsay sedation scores were recorded at 1, 2, 6, 12, 24 and 48 h after surgery.Sleep quality was evaluated using the Medical Outcomes Study Sleep Scale (MOS-SS), and the average time of daily sleep and Sleep Problems Index (SPI) were recorded at week 1 before and after surgery.Patient's satisfaction with sleep was assessed on the night of surgery and 1st day after surgery.The requirement for rescue analgesics was recorded. Results There was no significant difference in the requirement for rescue analgesics between group S and group DS (P>0.05). Compared with the value before surgery, the average time of daily sleep was significantly shortened, and SPI was increased at week 1 after surgery in group S (P 0.05). Compared with group S, the Ramsay sedation scores were significantly increased at 1, 2, and 6 h after surgery, the average time of daily sleep was prolonged at week 1 after surgery, the SPI was decreased at week 1 after surgery, and the degree of satisfaction with sleep was increased on 1st day after surgery in group DS (P<0.05 or 0.01). Conclusion PCIA with dexmedetomidine mixed with sufentanil is helpful in improving the sleep quality after spinal surgery in the patients. Key words: Dexmedetomidine; Sufentanil; Analgesia, patient-controlled; Sleep

Patient-controlled intravenous analgesia for non-small cell lung cancer patient after thoracotomy.

The objective was to evaluate the effect of patient-controlled intravenous analgesia (PCIA) in non-small cell lung cancer patients (NSLCPs) after thoracotomy. From January 2014 to March 2015, 40 patients of non-small cell lung cancer were recruited in this study and divided into two groups, (PCIA) group and control group with 20 patients in each group. The patients in the PCIA group were connected to intravenous self-control analgesia pump which contains 2 μg/ml of sufentanil and 8 mg of ondansetron diluting to 100 ml of 0.9% saline after surgery. Initial loading dose was 2 ml, background dose was 2 ml/h, single PCIA dose was 0.5 ml, and locking time 15 min. 10 mg of morphine was intramuscular injected, if necessary. Patients in the control group use an intramuscular injection of morphine 10 mg singly. The visual analog scale (VAS) score of the two groups were recorded in the time point of 2 h, 4 h, 8 h, 12 h, and 24 h. The morphine consumption of the two groups was also compared. Patients in PCIA group after surgery, 2 h, 4 h, 8 h, 12 h, and 24 h VAS score were obviously lower than those in control group (P < 0.05). Moreover, the incidence of nausea and vomiting and respiratory depression of patients in PCIA group was obviously lower than control group (P < 0.05). Consumption of postoperative morphine in PCIA group was obviously less than control group (P < 0.05). Intravenous PCIA-controlled intravenous analgesia can significantly decrease the VAS score without increasing the toxicity in NSLCP after thoracotomy.

Effects of PCIA with dezocine and Fentanyl on the immune function of elderly patients with gastrointestinal cancer

Objective To investigate the effect of patient controlled intravenous analgesia (PCIA) with dezocine and fentanyl on the distribution of T-Iymphocytes in elderly patients with gastrointestinal cancer.Method8 80 patients with tumor undergoing radical operation were randomly divided into dezocine group and fentanyl group,40 cases in each group.All patients used PCIA.The analgesic regimen of fentanyl group was 0.8 mg fentanyl+saline diluted to 100 ml,the analgesic regimen of dezocine group was dezocine 20 mg+saline diluted to 100 ml after intravenous injection of 5 mg load of dezocine.Peripheral blood samples were obtained before operation,24,48,72 hours after operation.T-Iymphocyte subsets were measured,and used VAS score to record patients' satisfaction.Results The amount of CD3+,CD4+,CD4+/CD8+ lymphocytes decreased 24 hours after operation in two groups (P＜0.05),The amount of CD3+,CD4+,CD4+/CD8+ lymphocytes in dezocine groups were nearly to baseline in 48 hours postoperatively,and sign ficandy higher than those of fentanyl group.The whole T-Iymphocytes recovered in 72 hours postoperatively in two groups.Conclusion Dezocine has less impact on immune function in elderly patients with gastrointestinal cancer. Key words: Dezocine; Fentanyl; Gastrointestinal cancer; Analgesia; Immune Function

Effect of postoperative analgesia with tramadol on serum levels of interleukin-2 and interleukin-6 in patients underwent laparoscopic cholecystectomy

Objective To investigate the effects of patient-controlled intravenous analgesia(PCIA)with tramadol on the postoperative visual analogue score(VAS),Ramsay score and serum levels of interleukin-2 and interleukin-6 in the patients underwentlaparoscopic cholecystectomy.Methods Forty ASA Ⅰ or Ⅱ patients aged 20 y-60 y undergoing selective laparoscopic cholecystectomy were randomly divided into 2 groups(n=20):fentanyl group(group Ⅰ)and tramadol group(group Ⅱ).The analgesic effect was assessed by VAS score,Ramsay sedation score,the number of effective button-pressing and side-effects such as nausea and vomiting were observed.Blood samples were taken immediately before induction,postoperative 2,4 and 24 h for determination of serum levels of IL-2 and IL-6 using enzyme-linked immunsorbent assay(ELISA).Results There were no significant difference in sex,age,body weight and duration of operation between the two groups(P＞0.05).The postoperative analgesia was satisfactory in both groups,and there was no significant difference in VAS score,Ramsay score and the number of effective button-pressing between the two groups(P＞0.05).No vomiting and respiratory depression were observed in both groups.The serum level of IL-2(group Ⅰ 12.4±2.0,group Ⅱ 12.1 ±2.1)increased significantly at 2 h(group Ⅰ 16.8±2.4,group Ⅱ 17.4±2.6)after surgery and kept uprising till postoperative 24 h in Ⅰ and Ⅱ group(group Ⅰ 16.9±3.0,group Ⅱ 17.5±2.8,P＜0.05),which presented no significant difference between the two groups(P＞0.05).The serum level of IL-6 showed no intra-(P＞0.05)or intergroup(P＞0.05)difference at above time points.Conclusions PCIA with tramadol after laparoscopic cholecystectomy can provide adequate analgesia,improve the immune function,and inhibit the stress response. Key words: Tramadol; Fentanyl; Interleukin-2; Interleukin-6

The effect of patient-controlled intravenous analgesia on postoperative hypokalemia in patients undergoing laparoscopic cholecystectomy

We investigated whether hypokalemia developed during the postoperative period and whether the use of intravenous patient-controlled analgesia (IV-PCA) could decrease the incidence of postoperative hypokalemia in patients who underwent laparoscopic cholecystectomy. Sixty patients undergoing laparoscopic cholecystectomy were randomly assigned to either IV-PCA (n=30) or control (n=30) groups. We measured serum potassium concentration at the outpatient department (T1), at 8:00a.m. on the day of surgery (T2), at 6h after the end of surgery (T3), and at 8:00a.m. on the first (T4), second (T5), and third (T6) postoperative days. Serum potassium concentration, incidence of hypokalemia, mean blood pressure, heart rate, respiratory rate, and the patient-reported visual analogue scale score were compared within each group and between groups at each time point. Serum potassium concentrations in all patients showed a significant decrease at T2-T4 compared to the preoperative concentration (T1). Serum potassium concentrations at T3 and T4 in the IV-PCA group were significantly higher than those in the control group. Also, the incidence of hypokalemia at T3 and T4 was significantly lower in the IV-PCA group. Mean blood pressure and heart rate were significantly lower in the IV-PCA group than in controls at T3 and T4. The results show that hypokalemia developed during the perioperative period and the use of IV-PCA in patients undergoing laparoscopic cholecystectomy effectively decreased the degree and incidence of postoperative hypokalemia on the day of the operation and postoperative day one.