The Effect Of Fentany Transdermal System Combined With Epidural Analgesia On Postoperative Pain In Lung Cancer Patients

Object:To investigate the effect of fentany transdermal system combined with epidural analgesia on postoperative pain in patients with lung cancer.Methods:Ninty cases of thoracic lobectomy of lung cancer patients in Ganzhou Tumor Hospital of Jiangxi province from June 2016 to December 2017were selected and randomly divided into three groups.Fentany Transdermal System combined epidural analgesia group（Combined group）,epidural analgesia group（Epidural group）,Fentany Transdermal System analgesia group（Fentanyl group）.We assessed the pain visual analogue scale（VAS）,blood glucose,mean pressure heart rate product,blood gas analysis（PaO₂,PaCO₂）,and the number of press times of the postoperative analgesia pump,pulmonary infection rate,adverse reactions（respiratory depression,skin itching,urinary retention,nausea and vomiting,prolonged anus exhaust time）in perioperative period.Application method of fentanyl transdermal patch:25μg/h（4.2mg/paste）fentanyl transdermal patch was pasted to a patient’s skin at the contralateral subclavian at 12h before surgrey,and the contralateral subclavian requires that shin without hair,radiation,infection which affect drug absorption.The fentanyl transdermal patch was removed two days after the surgery.Epidural analgesia:Indwelling epidural catheter at thoracic vertebrae 4 to5 clearance through epidural puncture.5ml 1%lidocaine hydrochloride injection was used to epidural anesthesia plane test.After no abnormal performance,Slowly inject5-8 ml 0.3%ropivacaine hydrochloride for 30 minutes before surgery and to remain in operation and postoperative analgesia.General anesthesia method:Induced anesthesia:midazolam（0.05mg/kg）,FentanylCitrate（3⁴μg/kg）,propofol（1.5-2.0mg/k g）,and injectable attracurium besylate（0.3-0.6mg/kg）.Maintain anesthesia:Continuous injection of 0.5%-1.0%sevoflurane,4-8mg/kg/h propofol and5-5ug/kg/min alcurium benzoate.Fentanyl citrate injection is added according to the needs of the surgery.Bispectral Index is maintained between 40 and 55.Disable fentanyl 30 minutes before the end of surgery and disable propofol injection and sevoflurane when preparing for dressing.Disable propofol injection and sevoflurane when preparing for dressing.Atropine sulfate 1mg and 1 to 2mg neostigmine injection for antagonistic muscle relaxant when spontaneously breathing.Flumazenil injection 1²mg intravenously for wake up.Follow the instructions to pull out the tracheal tube.Result:Compared with the Epidural group and Fentanyl group,the analgesic effect of combination group was significantly increased（P<0.01）at 24h.And it is significantly improve the stablity of postoperative vital signs,especailly at the 1h,2h in operation and 12h,24h,48h,72h after operation（P<0.01）.And also had a stable effect on blood gas（PaO₂,PaCO₂）at 12h and the blood glucose of 24 h and 48h after operation（P<0.05,P<0.01）.And decreased the times of postoperative analgesia pump（P<0.05）.The lung infection rate in the fentanyl group was higher（2/30）,while epidural group and combined group did not occur lung infection.There were 5 cases of adverse reactions in Fentanyl group（5/30,3 cases of itchy skin,1 case of nausea and vomiting,1 case respiratory depression）,and 3 cases in epidural group（3/30,2cases of urine retention in,anal 1 case of exhaust time extension）,only 1 case in combined group（1/30,1 case in itchy skin in）.Conclusion:First,the application of combined epidural analgesia with fentanyl transdermal system is in favor of vital signs stable during and after operation for patients with lobectomy.Second,the effection of multi mode combined analgesia was accurated,which may promote the recovery of lung function of patients,less adverse reaction,safe and reliable,and help the patients to accelerate the recovery after operation.