Hydromorphone For Patient-controlled Intravenous Analgesia In Older Adults With Thoracotomy

Objective: This experiment was to study the postoperative analgesia method around awakening period and within 48 hours after thoracotomy surgery in the older adults, and to explore the effect and adverse reactions of hydromorphone for postoperative analgesia in older adults to guide the clinical medication.Methods: In 90 cases of ASA Ⅰ ~ level III marked open thoracic surgery patients, aged 60 to 80, using the single blind method. Due to the operation arrangement sequence, patients are divided into group HL(low-dose hydromorphine group, n = 30)、the HH group(high-dose hydromorphine group, n = 30) and group S sufentanil group(n = 30).Group HL: patients received 10 ug/kg hydromorphine 15 minutes before the surgery end, and PCIA with hydromorphine 3 mg;Group HH: patients received 15ug/kg hydrogenmorphine 15 minutes before the surgery end, and PCIA with hydromorphine 5 mg;Group S: patients received 0.1 ug/kg sufentanil 5 minutes before the surgery end,and PCIA with 100 ug sufentanil;Three groups of PCIA(electronic automatic infusion pump), all joined with ramosetron 0.6 mg, and saline solution diluted to 100 ml, set the flow rate of 2 ml/h, a single additional dose of 1.5 ml, locking time for 15 min. Operating time was about 48 h.The invasive blood pressure and heart rate of all patients were controlled within 30% of fundamental value, and the BIS value was between 40 to 60,and the intraoperative blood oxygen saturation was no less than 94% during the surgery. By adjusting the infusion rate of maintained drug and using vascular active drug to maintain the depth of anesthesia and the hemodynamic stability and according to the amount of bleeding and the result of blood gas analysis to decide whether to transfusing blood.Respectively observation records of HL, HH group, the group S operation time(t1), awakening time(t2), extubation time(t3);And group HL, HH group, S home time(T0), tube drawing immediate(T1), 15 min after the extubation(T2), 30 min after extubation(T3) of MAP, HR, Sp O2.All patients were sent back to wards after recovery. We recorded the VAS of 15 min、30min after the extubation, and 4h, 8h, 24 h and 36 h after surgery, and the times of nausea and vomiting、pruritus、urine and retention、somnolence、respiratory depression.The situation of sputum and cough were observed too.If there were other side effects of all patients, we would dealt with them and recorded the situations.Results:1. The comparison of the basic information of the patients : three groups of patients in age, weight, duration of surgery, had no statistical significant difference(P > 0.05); awaking time( from end of operation to the time you can to follow commands to opening eyes and shaking hands)、 extubation time(from end of operation to the time to pulling out the endotracheal tube catheterization): there was no statistically significant differences in three groups(P > 0.05);2. The comparison of hemodynamics: there was no significant difference of the MAP、HR and SPO2 between the three groups(P >0.05); Compared with S group, BP、HR、SPO2 in HL group, HH group had no statistically significant difference(P > 0.05)3. comparison of amount of remifentanil、propofol and VAS:(1) the amount of remifentanil、propofol had no statistical difference among the three groups(P > 0.05).(2) comparison of VAS: VAS of group HL and group HH at each time point had no statistical significant difference(P > 0.05); compared with the group S, the VAS at each time in HL、HH had statistically significant difference(P < 0.05);4. The comparison of adverse reaction : times of nausea, vomiting, itching, urinary retention had no statistical significant difference(P > 0.05); times of respiratory depression,somnolence cases had statistically significant difference(P <0.05);5. Comparing the status of the cough and expectoration drainage: compared with group S, group HH and group HL can cough, cough up phlegm effectively, and the difference of the numbers was statistically significant(P < 0.05).Conclusions:Both hydromorphine and sufentanil can be used for postoperative analgesia in older adults with thoracotomy. The analgesia effect of hydromorphine used in thoracic surgery is better than that of sufentanil, both of them had no obvious adverse reactions. High-dose of hydromorphine for the older adults may produce excessive sedation, so low-dose of hydromorphine was recomanded for postoperative analgesia in older adults.