| Background and PurposePain is the fifth vital sign besides temperature ,pulse ,respiration and blood pressure, "relieving pain is the patient's essential right".At present, patient -controlled analgesia , which was developed from the late 1970's,has been widely used in clinic. It is divided into patient controlled epidural analgesia(PCEA), patient controlled intravenous analgesia(PCIA), patient controlled subcutaneous analgesia(PCSA) and patient controlled nerve analgesia(PCNA)according to applying method of analgesics. Nowadays,PCEA and PCIA are widely used in postoperative analgesia, and both can lead to satisfactory result.Compared with PCIA, PCEA can alleviate immunosuppression to a certain extent ,and it is beneficial for the early recovery of the patient's immune function. Now various drugs have been used in postoperative analgesia, especially local anaesthetics and opioids , and the analgesic effect of these two kinds of drugs is certain, but the latter one has more adverse reaction . At the present time, the study focus is to look for a certain durg which has better analgesic effect and less adverse reaction.This experiment aim is to investigate analgesic effectand adverse reaction of lappaconitine with ropivacaine for patient controlled epidural analgesia after the radical operation for cancer of stomach and to investigate effect on the serum beta-endorphin, substance P and cortisol .We have also compared this method with fentanyl with ropivacaine. Through the present experiment ,we sought to figure out theoretic evidence for selecting analgesic drugs in the postoperative analgesia of patient with cancer ofstomach.Materials and MethodsThis experiment included 30 patients (male 23 and female 7, aged 30~65yr, weight 41~83kg, ASA I ~ II), scheduled to undergo radical operations for cancerof stomach. They were randomly divided into three groups, Group LR(lappaconitine with ropivacaine group, n=10), Group FR (fentanyl with ropivacaine group, n=10) and Group C (n=10). Gerneral and epidural anesthetic technique were used during the operation in the three groups. Blood pressure(BP) , Mean arterial pressurem(MBP), Heart Rate(HR), Electrocardiogram (ECG) , pulse oxygen satuvation and PetCC>2 were monitored continually during the whole experiment. The postoperative analgesic effects were evaluated by VAS(the score of visual analog scale), and at the same time, the adverse reactions were recorded. Blood samples were drawn from subclavicular vein at time of 5min before anesthesia (Ti), 4h postoperatively (T2), 8h postoperatively (T3), 24h postoperatively (T4) and 48h postoperatively (T5). The serum beta-endorphin ,substance P and cortisol were measured from Ti to T5 time points by radioimmunoassay. Quantitative data was expressed as mean+ SP(3c ±s). Chi-square test was used for categorical data. Statistical package (SPSSIO.O) was used for processing data. PO.05 was considered as statistically significant.Results1. General dataThere were no significant differences among three groups on age, weight, sex and ASA grade (P>0.05).2. Comparison of situations during operationThere was no significant difference among three groups on anesthetic conduction time, anesthetic duration time, operation time, transfusion volume , blood volume , urine volume and anesthetics used during operation(P>0.05).3. The postoperative analgesic effectsThe postoperative analgesic effects were similar in Group LR and FR, and the VAS values have no significantly difference at each time point of postoperation(P>0.05); the VASvalues were significantly higher in Group C at each time points than that in Group LR and FR(P<0.05).4. The changes of respiration and circulation(1). The changes of MAP: Compared with Ti time point, there was no significant differences at each time point of postoperation among three groups on MAPCP>0.05); At Ti, T2 and T4 time points, there was no significant differences (P>0.05) , At T3 and T5 time points, Group C were higher than Group LR (P<0.05).(2).The changes of HR: There was no significant difference at each time point of postoperation between Group LR and FR (P>0.05); There were significant differences at each time point of postoperation among Group C, Group LR and FR(JP<0.05).(3). The changes of SPO2 and RR: There was no significant differences among three groups at each time point (P>0.05);also no significant difference in the comparison of each time point after operation with Ti (P>0.05).5.Comparison of the adverse reactionsThe adverse reactions did not occurred on patient such as nausea and vomiting in Group LR, 20 percent occurred nausea in Group FR and C, There was no significant difference among three groups(/>>0.05).6. The changes of the serum substance P levels in three groups(l).The changes of the serum substance P levels : Comparison of the serum substance P levels at T2, T3, T4 and Tstime points with T] time point: It was lower in Group LR, In Group FR and C, it was higher .(2).Comparison of the serum substance P levels at T2, T3, T4 and T5 time points with Ti time point: ?In Group LR, the content of the serum substance P at T2, T3 ,T4 and T5 time points were all lower than that at Tj time point, there was no significant difference (P>0.05). ?In Group FR, the content of the serum substance P were higher at T2, T3 ,T4 and T5 time points than that at T! time point ,but there was no significant difference (P>0.05). ?InGroup C, the content of the serum substance P at T2, T3 ,T4 and T5 time points were significantly higher than that at Ti time point, there were significant differences (PO.05).(3).Comparison of the serum substance P levels among the three groups: ?At Ti time point, there was difference of the content of the serum substance P among three groups(P>0.05). (2)At T2, T3 ,T4 and T5 time points it was significantly higher in Group C than that in Group LR and FR; there were significant differences (PO.05). At T2, T4and T5 time points, although it was higher in Group FR than that in Group LR; but at T3 time point, it was lower in Group FR than that in Group LR; there was no significant difference (P>0.05).7. The changes of the serum beta-endorphin levels in three groups(l).The changes of the serum beta-endorphin levels: Comparison of the serum beta-endorphin levels at T2, T3, T4 and T5 time points with T] time point: it was higher in all three groups.(2).Comparison of the serum beta-endorphin levels at T2, T3, T4 and T5 time points with Ti time point: ?In Group LR and FR , the content of the serum beta-endorphin at T2, T3 ,T4 and T5 time points were higher than that at Ti time point ,but there was no significant difference (P>0.05). ?In Group C, the content of the serum beta-endorphin were significantly higher than that at Ti time point, there were significant differences (PO.05).(3).Comparison of the serum beta-endorphin levels among the three groups: ?At Ti time point, there was no difference of the content of the serum beta-endorphin among three groups(P>0.05).(2)At T2, T3 ,T4 and T5 time points, it was significantly higher in Group C than that in Group LR and FR; there were significant differences (PO.05). There was no significant difference between Group LR and Group FR (P>0.05).8. The changes of the serum cortisol levels in three groups(l).The changes of the serum cortisol levels: Comparison of the serum cortisol levels atT2, T3 T4 and T5 time points with Ti time point: it was higher in all three groups.(2).Comparison of the serum cortisol levels at T2, T3, T4 and T5 time points with Ti time point: (Din Group LR, the content of the serum cortisol at T2 ,T3, T4 and T5 time points were higher than that at Ti time point, At T2 and T3 time points ,there were significant differences (PO.05). At T4 and T5 time points , there was no significant difference (P>0.05). ?In Group FR, the content of the serum cortisol were higher at T2, T3 ,T4 and T5 time points than that at Tj time point ; At T2 and T3 time points ,there were significant differences (P<0.05). At T4 and T5 time points , there was no significant difference (P>0.05). ?In Group C, the contents of the serum cortisol were significantly higher at T2, T3 ,T4 and T5 time points than that at Ti time point, there were significant differences (PO.05).(3).Comparison of the serum cortisol levels among the three groups: ?At Ti time point, there were differences of the content of the serum cortisol among three groups(7>>0.05). ?At T2, T3 ,T4 and T5 time points ,it was significantly higher in Group C than that in Groups LR and FR; there were significant differences (P<0.05); there was no significant difference between Groups LR and FR (P>0.05).Conclusions1. Compared with PCA, the analgesic effect of the traditional intramuscular injection is not good after the radical operation for cancer of stomach.2.Lappaconitine(0.24~-0.5mg.kg'1) with ropivacaine can be used for patient-controlled epidural analgesia after the radical operation for cancer of stomach,it is safe,effective and feasible.3.Comparison of fentanyl with ropivacaine, it has small influence on circulation and respiration and has few adverse reaction,for example,nausea,vomiting and so on. it can reduce the releasing of substance P ; it can increase the releasing of beta-endorphin and cortisol. |
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