Effect Of Nalmefene Added To Postoperative Analgesic Pump On Postoperative Analgesia And Adverse Effects In Open Hepatectomy

Objective:To observe the effect of adding nalmefene to a postoperative analgesic pump on postoperative analgesia and adverse effects after open hepatectomy.Methods:A random number table was used to divide 60 patients with ASA class I-III,age 18-70 years,BMI 18-30 kg/m~2 undergoing elective open hepatectomy under general anaesthesia with tracheal intubation and who voluntarily signed up for a postoperative self-administered intravenous analgesia(PCIA)pump into a control group(Group A)and a nalmefene group(Group B),with 30 patients in each group.In both groups,general anaesthesia was combined with static suction and a PCIA pump was administered postoperatively.Analgesic pump formulation:Group A:Fentanyl 20μg/kg+Tramadol 5 mg/kg+Dexmedetomidine 200μg+Toltestrone 10 mg diluted to200 ml with saline,Group B:Fentanyl 20μg/kg+Tramadol 5 mg/kg+Dexmedetomidine 200μg+Toltestrone 10 mg+Nalmefene 0.1 mg,diluted to200 ml with saline.Analgesic pump parameter settings:no loading dose,continuous dose 3 ml/h,self-controlled dose 3 ml/time,locking time 15 min.Application of visual analogue scoring to determine VAS scores of patients at 12h,24 h and 48 h after surgery.The duration of surgery,the total amount of intraoperative propofol and remifentanil,the time of defecation and postoperative hospital stay were recorded.The number of analgesic pump presses,the addition of tramadol and the occurrence of adverse reactions such as respiratory depression,nausea and vomiting,dizziness and headache,hypotension,urinary retention and skin pruritus were observed during the 48 h postoperative period.Results:There was no statistically significant difference between the two groups in terms of age,height,weight,BMI,duration of surgery,total amount of propofol,total amount of remifentanil and the incidence of adverse effects such as postoperative respiratory depression,hypotension,urinary retention and skin pruritus(P>0.05).Patients in Group B had lower VAS scores at 12 h,24 h and 48h postoperatively than in Group A(P<0.05).The incidence of nausea and vomiting,dizziness and headache was significantly lower in Group B than in Group A(P<0.05).The number of analgesic pump presses at 48 h postoperatively,the number of additional tramadol cases postoperatively,the number of days of defecation postoperatively and the number of days the patients stayed in hospital postoperatively were all lower in Group B than in Group A(P<0.05).Conclusion:The addition of nalmefene to the postoperative intravenous analgesic pump can enhance postoperative analgesia in patients undergoing open hepatectomy,while reducing the adverse effects of opioid analgesics such as nausea and vomiting,dizziness and headache,resulting in enhanced postoperative comfort and shorter postoperative recovery time for the patients.