Effect Of Different Dose Of Nalbuphine Combined With Sufentanil For Postoperative Analgesia After Laparoscopic Hysterectomy

Objective Two kinds of common postoperative pain,incision pain and visceral pain.It was found that there was still visceral pain after laparoscopic hysterectomy,and there was deficiency in opioid analgesia.Nalbuphine was the agonist and antagonist of opioid receptor,which could alleviate visceral pain by activating Kreceptor,and antagonize ? receptor at the same time.Based on the previous clinical research,this experiment mainly observed the effect and adverse reactions of different doses of nalbuphine combined with sufentanil in PCIA after laparoscopic hysterectomy,and explored the best matching dose of nalbuphine in PCIA.Methods 120 patients with 40 to 60 years old and 45 to 70 kg,ASA I-II,in weight were selected for laparoscopic hysterectomy in our hospital.They were divided into s group,SN1 group,SN2 group and SN3 group according to the metho d of random number table.Tracheal intubation was performed after general anesthesia induction.Sufentanil induction dose was 0.3ug/kg.Sufentanil was pumped in 0.2-0.3?g/(kg·h)during the operation.Sufentanil was stopped 30 minutes before the end of the operation.The tracheal tube was pulled out after natural wakefulness.After the operation,each group was connected to the analgesia pump.The setting parameters of the analgesia pump were as follows: background infusion speed of the analgesia pump was 2ml/h,automatic infusion volume was 1ml every time,and every two time locking 15 min.In groups,Sufentanil 2.0?g/kg + granisetron 2mg + normal saline were given to 120ml;in group SN1,SN2 and SN3,nalbuphine 0.2,0.4 and 0.8mg/kg with sufentanil 2.0?g/kg with granisetron2 mg and normal saline were given to 120 ml.Main outcome measures: 1 h(T0),4 h(T1),8 h(T2),12 h(T3),24 h after operation(T4),48h(T5)pain visual analogue score(VAS),Ramsay Sedation score,PCIA total and effective compression times,sufentanil drug consumption at different time points,supplementary analgesia and adverse reactions,including drowsiness,nausea and vomiting,skin pruritus,dizziness and any other adverse reactions.Result1.General data: there was no significant difference in age,BMI,ASA grade,operation time and total sufentanil dosage between the four groups(P > 0.05);2.There was no significant difference in VAS score,total press times and effective press times of PCIA analgesia pump among the four groups(P > 0.05);3.Compared with S group,the VAS score,sedation score and PCIA total pressing times and effective pressing times of SN2 and SN3 group decreased(P < 0.05)was higher(P< 0.05)compared with SN1 group,the VAS score,PCIA analgesia pump total press times and effective press times of SN2 and SN3 groups were reduced(P < 0.05),and the sedation score was high(P < 0.05);compared with SN2 group,the sedation score of SN3 group was high(P < 0.05);T0 to T5,the incidence of nausea and vomiting in SN3 and SN2 groups was lower than that in S and SN1 groups(P < 0.05),and the incidence of drowsiness in SN3 group was higher than that in SN2 group(P < 0.05).4.There was no significant difference in sufentanil dosage between S group and SN1 group 8 to 48 hours after operation,and there was no significant difference in sufentanil dosage between SN2 group and SN3 group.The dosage of sufentanil in SN2 group and SN3 group was significantly lower than that in SN1 group(P < 0.05)(Table 4).14 cases(47%)in s group,12 cases(40%)in SN1 group,2 cases(7%)in SN2 group,1 case(3%)in SN3 group.The rate of remedial analgesia in s group and SN1 group was significantly higher than that in SN2 group and SN3 group(P < 0.05).Conclusion The effect of 0.4 mg / kg nalbuphine combined with 2.0?g/kg sufentanil in laparoscopic total uterine postoperative intravenous analgesia is satisfactory,and the incidence of adverse reactions is low.