| Background:Opioids is the first and foundational treatment of moderate and severe pain,remifentanil is ultra short-acting μ-opioid agonist,and is an ideal analgesic for general anesthesia.But animal and clinical studies have shown that remifentanil,especially in large doses,can cause opioid-induced hyperalgesia.Therefore,the threshold of postoperative pain was decreased and the sensitivity of pain was increased.Postoperative hyperalgesia can lead to restlessness and high stress in patients recovering from anesthesia.Significantly increase the body’s oxygen consumption,easy to induce cardiovascular and cerebrovascular complications,affect the patient’s recovery and recovery quality seriously,and the patient postoperative analgesic treatment effect.Nalbuphine is an antagonistic-agonist of opioids receptors,it can antagonist μ-opioid receptor and activate the κ-opioid receptor.The adverse effects of mental were small,respiratory depression was mild and had capping effect.Nalbuphine can alleviate the side effects caused by opioids such as morphine,such as pruritus,and its action period is 3-6h.Premediating the effect of the nalbuphine antagonist of remifentanil μ-opioid receptor,to prevent postoperative hyperalgesia caused by remifentanil.Numerous studies have shown that cyclooxygenase-2 and so on are also involved in postoperative pain sensitization induced by remifentanil.Studies have found that non-selective cyclooxygenase(COX)inhibitor,parecoxib,can prevent remifen The main mechanism of pain allergy is to inhibit the synthesis of prostaglandins and reduce the pain sensitivity of the spinal cord.And parecoxib can significantly improve the degree of postoperative pain in patients,and its long duration of action can also reduce the incidence of adverse reactions.In the volunteer study,parecoxib was also found to relieve pain sensitization after remifentanil infusion.In this study,we observed the effect of combined use of nalbuphine and parecoxib on postoperative hyperalgesia induced by remifentanil after gynecological endoscopic surgery.To study and evaluate the effect of nalbuphine combined with parecoxib in preventing postoperative hyperalgesia induced by remifentanil.And to provide evidence for more comfortable and scientific clinical anesthesia work.Materials and methodsSubjectsPatients undergoing selective Laparoscopic gynecological surgery under general anesthesia(Laparoscopic hysterectomy,adnexectomy,hysteromyoma resection)were chosen,aged 18-65 years,being at American Society of Anesthesiologists(ASA)physical status of Ⅰ or Ⅱ,BMI(18～30kg/m2),the operation interval is 1-3h.Agree to accept general anesthesia and postoperative intravenous analgesia treatment,can correctly use postoperative patient-controlled intravenous analgesia pump.Exclusion criteria included the following conditions:long-term smoking,known history of alcohol or drug abuse,chronic pain,psychiatric illness and poor control of medical disease.The study design was endorsed by the Medical Ethics Committee of Zhujiang Hospital and all of the subjects signed informed consent.Statistical analysisThe data was analyzed using SPSS 20.0 software.The normal distribution of the measurement data is expressed as mean±standard deviation(x±s),for age,body mass index(BMI),operation time,time from the end of surgery to the beginning of analgesia pump analgesia and extubation time,sufentanil dosage and sevoflurane inhalation concentration One-way analysis of variance was used for comparison between those groups The adverse reactions such as postoperative nausea,vomiting,and postoperative chill were performed by chi-square X2 test.P<0.05 was considered statistically significant.Anesthesia and AnalgesiaThe pain threshold and pain tolerance threshold were measured using Electronic von Frey Stimulator the day before surgery.Preoperative anxiety assessment and sensitivity to pain were performed simultaneously,the method is the same as in the first part.A standardized endotracheal general anesthesia technique was used for all patients.When a patient complained of obvious pain discomfort or restlessness after the surgery,5μg sufentanil was given as the analgesic first agent,then the patient-controlled intravenous analgesia was started.The degree of pain during PCIA treatment was assessed with numerical rating scale(NRS).Follow-up assessments were made at 1,3,6,12,24 and 48 hours after the surgery,and the NRS scores,the number of effective compressions of PCIA,sufentanil consumption and occurrence of any adverse effects were recorded at each time point.The total capacity of the PCIA pump was 100ml,contained sufentanil 1.5μg·ml-1,Tropisetron mesylate 12mg and normal saline.The PCIA pump was set to give a2ml bonus of sufentanil solution with 15 min lockout time,1ml/h background infusion.ResultsPart 1:General situationA total of 96 female patients were enrolled in the study.The overall mean age was 38.26±8.87 years(ranged from 19 to 57 years),and the total average height was 158.49±5.45cm(ranged from 145 to 172 cm).The total average weight was 55.97±6.48kg(ranged from 43 to 70kg),and the total average BMI was 22.28±2.35(ranged from 18.13 to 28.30).There were no significant differences in age,body mass index,operation time and extubation time between these four groups(P>0.05).Part 2:Evaluation of the effect of nalbuphine combined with parecoxib on preventing hyperalgesia caused by remifentanilIn this study,different perioperative interventions were observed in the four groups.The NRS scores at 1,3,6,12,and 24 h after surgery were significantly higher in the R group than in the S,RN,and RNP groups,indicating that high-dose remifentanil persisted.The infusion did cause postoperative hyperalgesia.The cumulative consumption of analgesic pump sufentanil at 3,6,12,and 24 h after operation in group R was also significantly greater than that in S,RN,and RNP groups.The mechanical pain thresholds of the incision and the medial forearm measured at 24 hours after operation in the R group were also lower than those in the other three groups,and the pain threshold at 24 h after RN was also lower than that in the RNP group.The difference was statistically significant;postoperative hyperalgesia The area results showed that the R group was significantly larger than the other three groups,and the area of hyperalgesia 24 h after RN was lower than that of the RNP group,indicating the preventive effect of nalbuphine and nalbuphine combined with parecoxib on RIH,and nalbuphine.The synergistic effect of combined parecoxib on the prevention of RIH.The time of the first dose of analgesia was given,the R group was also significantly smaller than the other three groups.For the incidence of postoperative adverse reactions,the incidence of nausea,vomiting,and chills in the experimental group(S,RN,RNP group)was significantly lower than that in the control group(R group),indicating that the combination therapy achieved effective analgesia satisfaction.At the same time,it also reduces the dosage of various drugs,and may also help to reduce the occurrence of adverse reactions.ConclusionsNalbuphine or nalbuphine combined with parecoxib can effectively prevent pain hypersensitivity caused by remifentanil,and the combination use of this two drugs is more effective,and may also help reduce the occurrence of related adverse reactions. |
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