| BackgroundPatients are known to experience greater postoperative pain after upper abdominal surgeries than any other surgery. Upper abdominal operations typically produce significant pulmonary dysfunction in the postoperative period leading to a significant incidence of atelectasis and pneumonia. This is mainly due to incisional pain and muscle splinting causing restrictive respiratory dysfunction. The adequate treatment of pain is important not only from a humanitarian point of view but also from a physiological aspect. Postoperative epidural analgesia with local anesthetic solutions is known to have beneficial effects on patient outcome after major abdominal surgery, improving recovery of normal bowel function. However, the use of local anesthetic alone for postoperative epidural analgesia is unsatisfactorybecause of motor blockade when administered in doses sufficient for analgesia. Epidural opioids combined with local anesthetic solution improve the quality of postoperative analgesia reducing the dose related adverse effects of either class of drug alone. Ropivacaine is a new, long-acting local anesthetic with a more favourable toxic profile than previous long acting local anesthetics, like bupivacaine. As a new lipid soluble opioid, sufentanil has been used to relieve acute and chronic pain. However, combination of sufentanil with ropivacaine in epidural analgesia following upper abdominal surgery has not been studied well.ObjectiveTo evaluate the efficacy and safety of different concentration of sufentanil combined with 0.125% ropivacaine in epidural analgesia following upper abdominal surgery. To study the optimal concentration of sufentanil combined with 0.125% ropivacaine in epidural analgesia following upper abdominal surgery.MethodsForty-four ASA I ~ II patients without epidural puncture contraindications scheduled for upper abdominal surgery were enrolled in this study and were randomly allocated into four groups: 0.15% ropivacaine (group R), 0.125% ropivacaine plus 0.25μg/ml sufentanil (group R+0.25S), 0.125% ropivacaine plus 0.5μg/ml sufentanil (group R+0.5S), and 0.125% ropivacaine plus 0.75μg/ml sufentanil (group R+0.75S) . Premedication Phenobarbital sodium 100mg andatropine 0.5mg were injected intramuscularly into all patients before sent into operation room. Then T9-10 or T10-11 was selected to perform epidural puncture, epidural catheters were successfully inserted and test dose was 1.5% lidocaine 5ml. The rapid-sequence induction (propofol 2mg/kg, sufentanil 0.5μg/kg, and vecuronium 0.15mg/kg intravenously administered), endotracheal intubations and machine-controlled ventilation were sequent done after epidural blocked segment confirmed. Continuously inhaled 1.0-2.0% Isoflurane and injected vecuronium intermittently. The interval of addition 1.5% lidocaine was 60 minutes. Loading dose 0.25% ropivacaine 5ml influxed before the end of the surgery. A visual analog scales (VAS ) of resting and coughing at the point of postoperative 3, 6, 12, 24 hours in four groups were evaluated. Times of supplementary opioids intake, possible adverse effects (sedation score, pruritus score, nausea and vomiting, respiratory depression), and confirmation of blockade segment, pulse oxygen saturation (SpO2), blood pressure (BP), heart rate (HR) were recorded in designed time-point in four groups.Results1. Postoperative VAS: There were significance differences in four groups (P<0.05). The difference between group R+0.25S and group R was no significance (P>0.05), while group R and group R+0.5S, group R and group R+0.75S were significance (P<0.05), but group R+0.5S and group R+0.75S was no significance (P>0.05).2. Times of supplementary opioids admission: Total times of admission in group R+0.5S and group R+0.5S were significant lower comparing with that in group Rand group R+0.25S within 24 hours (P<0.05). While the difference between group R and group R+0.25S was no significance (P>0.05).3. Adverse effects: Pruritus happened in different time and mainly within 12 hours. The incidence of pruritus in...
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