| The effective relief of pain is of paramount importance to the post operation patients'treatment. Postoperative pain influences patients'postoperative recovery and quality of life , especially the pain of abdomen operative. There is now evidence that pain relief has significant physiological benefit, and it could reduce the happening of complication. It means that patients could be discharged from hospital earlier and pay less for treatment. The goal for postoperative pain management is to reduce or eliminate pain and discomfort within a minimum of side effect, using little cost. Patient-controlled analgesia (PCA) reflects the needs of each patient, so it has been used widely. The selection of painkiller in PCA is to eliminate pain and discomfort in patients after surgery with a minimum of side effect. In recent years, opioid painkiller and antivomit drug have been used in PCA. If the clinical efficacy of opioid drug is satisfied for patients, it always makes nausea and vomiting. In contrast, if the dose of opioid drug is not enough, inefficient postoperative pain relief of patient will evoke the side effects, like agitation. It is the common goal of the anesthesia to provide moderate sedation, to reduce pain without unpleasant side effect.MethodsThe study subjects are 40 patients undergoing abdomial surgery from Nov 2009 to Feb 2010, using Patient-Controlled analgesia pumps. The age of these patients ranges from 18 to 60, ASA I~II level. These patients had no chronic pain medical history and the history long-term use analgesics, no diabetes or family, without a history of hypertension and cardiovascular disease, simply use steroidal anti-inflammatory drug allergies, except for patients with a history of substance addiction. No liver, kidney disease and a blood coagulation disorder.40 patients were randomly divided into two groups. The patients in group A (n=20) received intravenous injection of Isotonic na chloride, Sufentanil ,Lappaconitine and Romosetron through PCI, while in group B (n=20) the patients received intravenous injection Dexmedetomidine, Sufentanil ,Lappaconitine and Romosetron through PCI. When the operation was finished, patients were connected patient-controlled intravenous analgesia pump(PCIA). The following up observation includes:⑴the general condition of the patient;⑵blood pressure, heart rate, respiratory rate and SpO2 after the operation 2 hours, 4 hours, 8 hours, 24 hours and 48 hours.⑶pain level (visual analogue scale, VAS, 0~10) and sedation scores.⑷side effects including nausea and vomit, respiratory depression.⑸treatment satisfaction to PCA cure.Results⑴There was no statistic difference between the two groups in the patients'age, weight, the time of the operation, the dose of fentanyl and fluid during operation.⑵When SBP, DBP, HR, RR of the two groups were compared within 2 hours, 4 hours, 8 hours, 24 hours and 48 hours after the operation, the group A was better than the group B in myocardic metabolite. The two groups'patients did not have respiratory depression; SpO2 fluctuated from 93% to 99%.⑶Pain levels at rest group B was better than group A during 2~8 hours after the operation while during 8~24 hours there was no significant difference.⑷Sedation scores at rest had no significant difference between two groups throughout the study.⑸The incidence of nausea and vomiting of group A is less than that of the group B, and there is no respiratory depression in two groups.⑹Satisfaction to PCA cure, the group A and the group B were respectively 85% and 95%, group B is significantly deeper than group A.DiscussionPain after the surgery is a complex physical reflection which may cause discomfort of the patients both physically and mentally. And if painkiller is used not enough, it will lead to agitation, excites sympathetic system, which may bring about fast heart rate, high blood pressure, quick respiratory and may influence internal secretion and digestion system. These problems are unpleasant for the patients and harmful for the recover of the patients.In this study , the main reason of using dexmedetomidine to assist sufentanil for postoperative analgesia is:①As an anesthetic adjuvant setting, the main role of dexmedetomidine in the brain and spinal cord is inα2-AR, inhibition of neurons discharge, also produces sedation, analgesia, inhibition of sympathetic nerve activities. Particularly its role for postoperative sedation can make patients more comfortable, improve patient satisfaction in PCIA;②Dexmedetomidine can certainly reduce the dose of opioid analgesics, dexmedetomidin and opioid drugs are both synergies in applications;③Dexmedetomidine will result in a lower incidence of respiratory depression in the appropriate dose, so the effect of dexmedetomidine in postoperative analgesia is relatively safe;④The another advantage of dexmedetomidine is that it can effectively inhibit postoperative shivering, reduced the incidence of nausea and vomiting. As a novel anesthetic adjunctive agent, it was recently introduced into clinical anesthesia for its sedative, sympatholytic properties. It does not only have little adverse effect, but can also prevent postoperative nausea and vomiting, cause no respiratory depression, reduce the incidence of agitation and shivering thresholds. However, dexmedetomidine has gone on sale recently, and there were little studies on clinic pharmacokinetics and pharmacodynamics of it in China. The present study uses the dexmedetomidine in PCA, aiming to evaluate efficacy of dexmedetomindin assisting to sufentanil in PCA.Conclusion1. Compared with the simple application of sufentanil postoperative analgesia, the dexmedetomidine assisting sufentanil for postoperative analgesia provides higher degree of cardiovascular stability and higher satisfaction to the abdominal surgery patients under general anesthesia.2. Compared with the simple application of sufentanil postoperative analgesia, the dexmedetomidine assisting sufentanil in PCIA can reduce the incidence of adverse reaction as well as nausea and vomit, and lower the degree of respiratory depression in the appropriate drug doses.
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