The Effect Of Postoperative Analgesia On The Stress Response And Comparison Of Postoperative Pain Relief By Different Methods In Patient Of Cardiac Surgery

With the arising of fast track anaesthesia, the time to awake was decreased significantly.However, more patients of cardiac surgery complained of postoperative pain which would inducethe unstable status and changes of metabolism and immunity. To explore the effect and mechanismof postoperative analgesia in patients of cardiac surgery, the study was divided into two parts asbelow.Part 1 The effect of postoperative analgesia on the stress response in patient under fast trackanesthesia in off-pump coronary artery bypass graftingMethods: Twenty forth patients were randomly allocated to PCA group (n_Ⅰ=12) and CATgroup (n_Ⅱ=12). The patients in groupⅠreceived fentanyl with bolus dose of 0.5μg/kg andlock-out time of 20 min; the patients in groupⅡreceived morphine 5～10 mg I.M. intermittently.The VAS scores of the pain (rest and cough) observed at the extubation,12,24,36,and 48h afteroperation, and the levels of blood glucose, plasma insulin and cortical were measured beforeanesthesia, at 90min after incision and 24h, 48h after operation. Results: Pain scores of GroupⅠwere significantly lower than that of GroupⅡat the 12,24,36 and 48h after operation (P＜0.01).The levels of plasma insulin were markedly elevated at the 24h,48h after operation (P＜0.05), butthere is no significant difference between the two groups. The blood glucose and cortical of twogroups were raised at 90 min after incision (P＜0.05), the blood glucose of groupⅠbut not groupⅡwere restore to the level before anesthesia at the 48h after operation, and the levels of plasmacortical in GroupⅠwere restore to the level before anesthesia at the 36, 48h after operation and inGroupⅡkept at the high levels till the 48h after operation. The levels of blood glucose andcortical in GroupⅠwere lower significantly than that of GroupⅡafter operation (P＜0.05).Part 2 Comparison of postoperative pain relief by subcutaneous PCA and intravenous PCA inpatient with open heart surgery Methods: Twenty four patients were randomly allocated to subcutaneous PCA group (n_Ⅰ=12)and intravenous PCA group (n_Ⅱ=12). The mixture of fentanyl 20μg·ml^-1 and lidocaine10mg·ml^-1 was administered in both groups. Onset of analgesia was recorded after injection ofloading dose, and then pain status were recorded at 12, 24, 36 and 48 hours after the PCA start,VAS scores were used for evaluation. Results: Onset of analgesia in GroupⅠwas significantlyfaster than that in GroupⅡ(P＜0.01). There were no significant difference in VAS scores,demanded delivery, drug dose, sedation score, side effects, and patient satisfaction (P＞0.05).In summery, Intravenous PCA may alleviate the stress response of postoperative pain moreeffectively than conventional analgesia therapy in patient after OPCABG; while subcutaneousPCA can relief pain as intravenous PCA in patient after open heart surgery safely and efficiently.