Observation On The Analgesic Effect Of Pre-injection Of Pentazocine On Patients Undergoing Laparoscopic Total Hysterectomy

Objective:The purpose of this study is to compare the early postoperative analgesic effect of pentazocine and sufentanil in patients undergoing laparoscopic hysterectomy,and to evaluate the postoperative analgesic effect and adverse reactions of pentazocine according to the analysis of objective and subjective pain results of patients,so as to provide a reasonable choice for clinical medication.Methods:From October 2018 to October 2019,80 patients were enrolled in the gynecological ward of Chengde Central Hospital for elective laparoscopic total hysterectomy.All patients were included in ASA grade I-II,aged 40-65 years,weighing 50-70 kg,with normal liver and kidney functions.The exclusion criteria included: 1)patients with opioid allergy;2)patients with long-term chronic pain;3)patients with mental diseases;4)patients who had taken opioids or other analgesics within 1 week before operation;5)patients with motion sickness;6)patients who refused to accept the test.The patients were randomly divided into two groups,the experimental group(P group)and the control group(F Group),40 cases in each group.All the patients in the group did not use preoperative drugs.After entering the room,they established venous access,connected with routine monitoring,monitored noninvasive arterial blood pressure(NIBP),electrocardiogram(ECG),blood oxygen saturation(Sp O2),respiratory rate(RR),end of breath carbon dioxide(Pet CO2),analgesia index(PRI),sedation index(WLI),pain index(PI),body temperature,urine volume,etc.The two groups were inducedby general anesthesia.It is consistent with the maintenance of medication.Anesthesia induction: intravenous midazolam 0.05mg/kg,remifentanil 1.0ug/kg(administration time is more than 60s),etomidate 0.15-0.3mg/kg,cisatracurium besilate 0.15mg/kg,after induction,patients were intubated to connect the ventilator for mechanical ventilation,tidal volume(VT)7-8ml / kg,respiratory rate(RR)12-14 times / min,and maintain between Pet CO2 35-45.During anesthesia,propofol 4-6mg / kg / h,remifentanil 0.2-0.3ug/kg/min,and cisatracurium besilate 0.1-0.2mg/kg/h were added.According to intraoperative blood pressure,heart rate,PRI,WLI and PI,the pump speed of propofol and remifentanil was adjusted to maintain the PRI between 40-79,WLI between35-69 and PI below 10.At the end of the operation,propofol and remifentanil were stopped.In group P,0.5mg/kg of pentazocine was injected intravenously slowly 15 minutes before the end of the operation.In group F,0.17ug/kg of sufentanil was injected intravenously 15 minutes the end of the operation.Flumazenil was used to antagonize midazolam and neostigmine to muscle relaxant.When patients wake up,swallowing reflex and spontaneous respiration return to normal,remove the laryngeal mask,connect the intravenous analgesia pump,and send them to the anesthesia recovery room for further observation.The basic MAP,HR and Sp O2 of the two groups were recorded,the time from drug withdrawal to recovery and the time of laryngeal mask extraction were recorded.MAP,HR,Sp O2,the score of the PI and the VAS pain index were recorded at five time points after pulling out the laryngeal mask(T0),5minutes(T1),10 minutes(T2),30 minutes(T3)and 60 minutes(T4)after operation,and nausea,vomiting,respiratory depression and urinary retention after operation.And other adverse reactions.Statistical analysis of the collected data showed that P < 0.05 was statistically significant.Results:(1)General There was no significant difference in age,ASA grade,BMI and operation time between the two groups(P > 0.05)(Table 3).(2)No respiratory depression(SPO2 < 90%),hypotension(map < 70 mm Hg) and bradycardia(HR < 50 times / min)were observed in all the patients of the two groups.The map of the two groups at each time point after the laryngeal mask was pulled out was lower than the preoperative basic value, the difference was statistically significant(P < 0.05),and there was no statistically significant difference in the other indicators between the groups (P > 0.05,Table 4).(3)There was no significant difference between the two groups(P > 0.05)(Table 5).(4)Comparison of PI and VAS scores of patients in the two groups showed that there was consistency between PI and VAS in evaluating patients' pain(Table 6).There was no statistical difference between group P and group F at each time point(P > 0.05)(Table 7).(5)The main adverse reactions of the two groups were dizziness,drowsiness,nausea and vomiting.No other adverse reactions were found.The number of adverse reactions in group P was significantly less than that in group F,with a statistically significant difference(P < 0.05)(Table 8).Conclusion:Intravenous injection of pentazocine has good analgesic effect and less adverse reactions in patients with laparoscopic hysterectomy.