Influence Of Multimodal Analgesia With Dezocine On Pediatric Perioperative Stress Hormone Levels

Objective To investigate the effect of multimodal analgesia and the regularity and clinical significance of cortisol(Cor),adrenocortieotrophic hormone(ACTH) changes in the pediatr-ic surgical patient during perioperative stage,discuss the effect of stress response on the pediatric postoperative analgesia and evaluate the safety and feasibility of multimodal analgesia for postoperative analgesia in children.Methods Following the principle of medical ethics,eighty children American Society of Anesthesiologists (ASA) I or II children aged five to twelve years old were selected and scheduled for Limbs or lower abdominal surgery. According to the principle of double-blind, they were randomly devided into blank control group (group A,n=20); patient-controlled intravenous analgesia of dezocine(group B,n=20); multimodal analgesia which used preemptive analgesia of dezocine(groupC,n=20);patient-controlled intravenous analgesia of fentanyl(groupD,n=20),which adopted different measures respectively to observe and record the variations of vital signs and the concentrations of stress hormone(such as Cor,ACTH)at the different time,and the different time of visual analog scale and Ramsay sedation score postoperatively.and the incidence of adverse reactions.Results 1.Four groups were not statistically significant differences in general information(P>0.05).2.Compared with group C, group A、B and D in MAP and HR were increased at the end of surgery and at 4h after surgery,the differences were statistically significant(P<0.05); compared with group B and D ,group A in MAP and HR were increased at the end of surgery and at 4h after surgery,the differences were statistically significant(P<0.05); group B and group D in MAP and HR were not statistically significant differences at each time(p>0.05).group A in MAP and HR was significantly higher than other times from extubation to 12 h after surgery (P<0.05).3.Compared with group B、C and D,group A in VAS was increased at each postoperative time,the differences were statistically significant (P<0.05);compared with group C,group D in VAS were increased at 4h and 12h after surgery, the differences were statistically significant(p<0.05);group A in VAS was significantly higher at 4h after surgery than other times,the differences were statistically significant (P<0.05).4. Four groups did not have excessive sedation.Compared with group C ,group A in Ramsay was higher at 4h and 12h after surgery,the differences were statistically significant(P<0.05);group C in Ramsay was superior to group B and D at each postoperative time,but the differences were not statistically significant(p>0.05).5. Compared with group C, group A、B and D in the level of COR were increased at each postoperative time，the differences were statistically significant(P<0.05);compared with group B and D ，group A in the level of COR was increased at each postoperative time ,the differences were statistically significant(P<0.05);group B and group D in the level of COR were not statistically significant differences at each time(P>0.05).6.Compared with group C, group A、B and D in the level of ACTH were increased at each postoperative time ,the differences were statistically significant(P<0.05);compared with group B and D ,group A in the level of ACTH was increased at each postoperative time,the differences were statistically significant(P<0.05);group B and group D in the level of ACTH were not statistically significant differences at each time(P>0.05).7.Four groups did not have respiratory depression ever.Compared with group C, group A in the incidence of adverse reactions were increased ,the differences were statistically significant(P<0.05);compared with group B and D ,group A in the incidence of adverse reactions were increased,the differences were statistically significant(P<0.05); compared with group C,group B and D in the incidence of adverse reactions were not statistically significant differences(P>0.05).group B compared with group D in the incidence of adverse reactions were not statistically significant differences at each time(P>0.05).Conclusion 1.The most severe pain occur within 4h after the elective surgery for 5 to 12 years old children.Cor and ACTH reached the peak at 24h after surgery and 48h closed to normal.2.Pediatric postoperative analgesia can reduce stress reaction and significantly lower stress hormones levels of Cor and ACTH.3.In multimodal analgesia,the postoperative vital signs of children are stable relatively and the incidence of adverse reactions are lower,the levels of stress hormones change significantly lower than the single analgesic model,the effects of analgesia and sedation in multimodal analgesia is superior to the traditional pattern of single fentanyl analgesia.