Effect Of Intravenous Infusion Of Sufentanil And Ketorolac Tromethamine With Different Ratios On Postoperative Analgesia In Gynecological Patients

Objective:To compare and observe the difference of intravenous infusion of sufentanil and ketorolac tromethamine in different ratios in postoperative intravenous analgesia,adverse reactions and postoperative rehabilitation indicators in gynecological patients.To investigate the safety and feasibility of opioid-free Anesthesia(OFA)in postoperative analgesia.Methods:From December 2020 to April 2021,60 patients,aged 18～65,with Body Mass Index(BMI)of 18.5～24kg/m2,who underwent surgery in the Department of Gynecology of the Affiliated Hospital of Yunnan University and required postoperative analgesia through intravenous administration,were selected as the research subjects.AS A grade Ⅰ-Ⅱ,no relevant drug use contraindications,and randomly divided into A,B,C,D four groups.Sufentanil in group A was calculated as 0.06ug.kg-1.h-1;In group B,sufentanil was calculated at 0.03ug.kg-1.h-1 and 60mg ketolorac was added.In group C,sufentanil was calculated at 0.015ug.kg-1.h-1 and 120mg ketolorac was added.In group D,only 240mg ketolorac was added to the analgesia pump.Postoperative intravenous analgesics in the above groups were diluted to 150ml with normal saline for later use.Analgesia methods:the initial dose of 5ml,continuous pumping dose of 3ml/h,and self-administered dose of 2ml/time were set for all patients in the four groups,and the locking time of self-administered medication was set as 20 minutes.Static and dynamic Visual Analogue Scale(VAS)were observed and recorded at 4h,12h,24h,36h and 48h after surgery,respectively.VAS score of nausea and vomiting,Ramsay sedation score,the number of compressions,time of first out of bed activity,time of first ventilation,postoperative hospital stay and adverse reactions of PCA were recorded.All patients were anesthetised with endotracheal intubation after rapid intravenous induction.Intravenous inhalation combined with anesthesia was used to maintain the anesthetic depth.After intubation,30mg ketolorac ambutamine was injected intravenously,and dexamethasone 5mg was injected intravenously after surgery.Results:A total of 65 patients were enrolled and observed,of which 4 cases were excluded due to analgesia pump failure,pump pipe blockage and patients’ request to terminate analgesia in advance,and a total of 61 patients were actually observed.There were no statistical differences in age,height,weight,and other demographic comparisons among the four groups(P>0.05).There were no statistically significant differences in operative history,ASA classification and other basic conditions,and there were no statistically significant differences in operative duration,type of operation and operative methods among all groups.During postoperative analgesia,the vital signs of the four groups were stable,and no serious adverse events occurred,and there was no significant difference in the vital signs between the four groups(P>0.05).In the analgesia score,the static VAS pain score of group A at 48h after surgery was significantly lower than that of the other three groups(P<0.05),and there was no significant difference in static VAS pain score and dynamic VAS pain score(P>0.05).The total number of pressing PCA and the number of patients needing medication for acute pain in group D were significantly higher than that in group A(P<0.05).The number of patients requiring medication to relieve nausea and vomiting and the VAS scores of nausea and vomiting at 12h,24h and 3 6h after surgery in group A were higher than those in the other groups(P>0.05),48h postoperative VAS score of nausea and vomiting and the number of patients with postoperative nausea and vomiting were higher than those in group D.The first postoperative ventilation time of group A was longer than that of the other three groups(P<0.05).During the observation,there were more cases of dizziness in group A,but the difference was only statistically significant between group C and group A(P<0.05).Ramsay sedation scores of all patients were basically at the same level(P>0.05).There was no significant difference in the time of getting out of bed for the first time after surgery and the postoperative discharge days among the four groups(P>0.05).Conclusions:The drug regimen of group C achieved good analgesic effect,and the incidence of PONV and vertigo was lower than that of other groups,and had little effect on the early postoperative rehabilitation indexes.The drug regimen in group A had the best analgesic effect,but the incidence of adverse reactions was high,which was not conducive to the early recovery of patients.Although the incidence of postoperative analgesic adverse reactions was low in group D,the analgesic effect was not good.In the postoperative analgesia treatment of gynecological surgery,the low ratio of sufentanil combined with ketolorac ambutriol can reduce the incidence of adverse events during sufentanil analgesia.