Application Of Hydromorphone In Patient-controlled Intravenous Analgesia After Endoscopic Nephrectomy

Objective:To evaluate the efficacy and safety of hydromorphone in patient controlled intravenous analgesia after endoscopic nephrectomy.Methods: 80 patients with ASA Ⅰ ~ Ⅲ,aged from 35 to 65 years old,weight between 45-75 kg,were divided into two groups randomly: the Sufentanil group(SF group)and the Hydromorphone group(HM group),each group of 40 patients.At the end of the procedure,the PCIA pump was attached and the load was applied.Dose mode : loading dose + continuous infusion + PCA volume,lockout interval 10 min.The SF group: the loading was 0.1μg / kg,the continuous infusion was 0.03μg-1 · kg-1 · h-1,the PCA was 0.02μg / kg;the HM group: the loading was 15μg / kg,the continuous infusion was 4.5μg-1 ·kg-1 · h-1,the PCA was 3.0μg / kg.The Ramsay sedation score,the VAS score within 24 hours after surgery.The times of PCIA presses,the NRS score of patient satisfaction,and the incidence of postoperative adverse events in 48 h were observed at each time point.Venous blood was collected before operation,1h,5h,24 h after operation,and the changes of IL-6 and PGE2 were measured by Elasa.Results: Compared with SF group,the lower agitation scores and higher sedation scores were in HM group at extubation time(P <0.05).Effective press times,total pressing times and 24 h total dosage were less in HM group compared with SF group(P <0.05).The levels of IL-6 in the two groups increased.The level of IL-6 in HM group was lower than that in SF group at T7 and T9 time point(P <0.05).Wake up time,extubation time in HM group were longer than SF group,and the incidence of postoperative gastrointestinal ventilation time in 48 h after operation was higher in HM group than that of SF group(P <0.05).Conclusion: Patient-controlled intravenous analgesia with hydromorphone can achieve similar sedative and analgesic effects to those of sufentanil,and relieve postoperative stress,but prolong postoperative awakening time,extubation time,and gastrointestinal ventilation time.