Clinical Study Of Butorphanol In Relieving Hyperalgesia After By Remifentanil In Burn And Sputum Skin Grafting

Objective To observe the effect of butorphanol on remifentani opioid-induced hyperalgesia(OIH)after burn escharectomy and skin grafting.Methods Sixty patients(ASA I~II,aged 20-70 years,BMI<30 kg/m~2,burn area1%~30%)scheduled for escharectomy and skin grafting under general anesthesia were randomly divided into two groups(n=30):butorphanol group(group B)and control group(group C).Patients in group B were given butorphanol 20μg/kg before skin incision;patients in group C were given a volume of normal saline equal to butorphanol before skin incision.Both groups were treated with general anesthesia.Intravenous continuous intravenous infusion of remifentanil 0.3 g·kg-1·min-1.The patient’s tenderness threshold was recorded0.5 h before surgery and 1 h after surgery on the medial aspect of the right forearm and near the site of skin harvesting.Postoperative recovery time of spontaneous respiration and extubation time were recorded.The pain visual analogue scale(VAS score)and Ramsay sedation score were recorded at 6 time points:5 min after extubation,30 min after extubation,1 h after extubation,6 h after extubation,12 h after extubation,and 24 h after extubation.Heart rate(HR),systolic blood pressure(SBP),diastolic blood pressure(DBP),and mean arterial pressure(MAP)were recorded at five time points after the patients were admitted to the room,before intubation after induction,at the time of surgical incision,at the beginning of bandaging,and after extubation.The Von Frey ciliary mechanical stimulation needle was used to determine the tenderness threshold of the patient’s skin on the medial aspect of the right forearm and near the site of skin harvesting.The frequency of postoperative use of analgesics and the occurrence of adverse reactions such as nausea and vomiting,vertigo,somnolence,and bradycardia were recorded.Result1 Comparison of general conditions:There were no difference in ASA classification,age,burn area,BMI and gender between the two groups(P>0.05).2 Comparison of hemodynamic parameters:There was no difference in the intraoperative heart rate and mean arterial pressure between the two groups(P>0.05).3 Comparison of pain threshold:(1)Comparison between groups:There were no difference in the pain threshold between group B and group C(P>0.05);the pain threshold of group B were greater than that of group C(P<0.05);there were no difference between the two groups(P>0.05);(2)Comparison within groups:There were no difference in the pain threshold of group B before and after operation(P>0.05);the pain threshold of group C were lower than that before operation(P<0.05);the pain threshold of group B and C were lower than that before operation(P<0.05).4 Postoperative related data results:VAS scores at each postoperative time point in group B were lower than those in group C(P<0.05).The Ramsay scores at 5 min,30 min and 1 h after extubation in group B were higher than those in group C(P<0.05),but there were no difference in Ramsay scores at 6 h,12 h and24 h after extubation between group B and group C(P>0.05);the number of analgesics used after surgery in group B were lower than that in group C(P<0.05);the incidence of postoperative nausea and vomiting in group B were lower than that in group C(P<0.05).There were no difference in the incidence of postoperative vertigo,somnolence,bradycardia and other adverse events between the two groups(P>0.05).Conclusions Butorphanol can relieve hyperalgesia after remifentanil anesthesia in burn excision and skin grafting,and reduce the dosage of postoperative pain medication.