Clinical Application Of Patient Controlled Intravenous Analgesia Postoperative With Ketorolac Tromethamine

Objective:to observe the safty and the effect of controlled intravenous analgesia postoperative on laparoscopic cholecystectomy patients with ketorolac tromethamine.To contrast four different analgesia method, to investigative the feasibility and good effect of anaglgesia postoperative with ketorolac tromethamine.Method:Select 60 patients of laparoscopic cholecystectomy, ASAI-Ⅱ,34-57 years old, weigh 45-70kg. The patients are divided into four groups(A, B, C, D) randomly and each group with 15 cases according to the different configuring method of PCIA. Group A:fentanyl 1.0 mg+ metoclopramide 10mg:Group B:ketorolac tromethamine 120 mg+ metoclopramide 20 mg;Group C:fentanyl 0.5mg+ketorolac tromethamine 90 mg+metoclopramide 10mg; Group D:ketorolac tromethamine 90 mg+lappaconitine 12 mg+metoclopramide 20mg. Start PCIA instantly when patient awake. Record the BP, HR, RR, SPO2 and side effect such as nausea, vomiting, respiratory inhibition, drowsiness, bleeding during PCIA at instantly (TO),0.5 h (T1), 1h (T2),2h(T3),4h(T4),8h(T5),12h(T6),24h (T7) time point. Use VAS to assess the effect of analgesia, use Ramsy to assess the effect of sedation.Result:(1) The changes of BP:compared in groups at TO, the BP increased significantly of four groups at T1, T2 and T3 time point (P<0.05); the BP increased significantly of group A and C at T4 time point (P<0.05); Compared group A and C with group B and D at T4 time point, the BP increased significantly (P<0.05).(2) The changes of heart rate:compared in groups at TO, the HR increased significantly of four groups at T1, T2 and T3 time point (P< 0.05); the HR of group C and D increased significantly at T4, T5 time point (P<0.05). Compared group C and D with group A and B at T4, T5 time point, the HR increased significantly (P<0.05).(3) The changes of RR and SpO2:there were no significant difference (P >0.05).(4) The changes of pain scores:pain scores of group C,D were markedly higher at T1,T2 time point (P<0.05); pain scores of group C and D were markedly lower at T3, T4 time point (P<0.05); pain scores of group A, B, C, D were markedly lower at T5, T6, T7 time point (P<0.01). Compared group C,D with group A,B the pain scores were markedly higher at T1,T2 time point (P<0.05), the pain scores of group C and D were markedly lower than group A and B at T4 time point (P<0.05).(5) The changes of sedation scores:compared in groups, the sedation scores of group A were markedly higher at T5, T6time point (P<0.05). the sedation scores of group B were markedly higher at T6 time point (P <0.05). The sedation scores of group A were markedly higher compared with group B, C, D at T5 time point (P<0.05). The sedation scores of group A and B were markedly higher than group C and D at T6 time point (P<0.05).(6) The side effect:Compared group A, B with group C, D, the incidence of nausea, vomiting, drowsiness were markedly higher (P<0.01). The four groups all did not happen respiratory inhibition and abnormal bleeding.Conclusion: 1.The postoperative analgesia effect of ketorolac tromethamine is similar to fentanyl.2. The incidence of nausea, vomiting, drowsiness were markedly lower than fentanyl during postoperative analgesia with ketorolac tromethamine...