The Clinical Research Of Postoperative Analgesia With Target-Controlled Infusion Of Sufentanil After Gynecological Laparoscopic Surgery

Objective To investigate the efficacy and safety postoperative analgesiawith target-controlled infusion (TCI) of Sufentanil after gynecologicallaparoscopic surgery.Methods Thirty-five ASA I or II patients aged less than65yr withgynecological carcinoma undergoing laparoscopic surgery under generalanesthesia were randomly and double-blindly divided into two groups:Group A(TCI,n=17) versus group B (PCIA,n=18). The initial target plasma concentration(Cp) of sufentanil was set at0.1ng/ml in group A, the pain increases when thetarget concentration, once increased0.01ng/ml with lockout interval15min.The PCIA rate was3μg/h, bolus of3μg with lockout interval15min. Theoperation was performed under intraoperative use of target-controlled infusionof sufentanil and propofol. After extubation we started the PCA pump atRamsay sedation score for2while Prince-Henry scores for3. Prince-Henry painscore,Ramsay sedation score,vital signs were recorded immediately before (T0) and at30min (T1),1h (T2),1h30min (T3),2h (T4),4h (T5),8h (T6),12h (T7) and16h (T8)after the PCA pump was started. The number of delivered doses wasrecorded. The total amount of sufentanil at each point time and side effects wererecorded during the16h after operation. The arterial blood samples were takenat T0, T2, T5, T6for analysis. According to the mode of administered and dose ofsufentanil used, after surgery every patient’s intraoperative and postoperativepharmacokinetic curve of sufentanil was simulated by using the TIVAtrainerpharmacokinetic software. And we recorded sufentanil target concentration ateach point in time.Results (1) There was no significant difference of MAP, HR, RR, SpO2and artery blood gas value between two groups.(2) Prince-Henry score in groupA at T1, T2, T3, T6, T7, T8was lower (P <0.05) compared to group B. There wasno significant difference in Ramsay score between two groups.(3) The totalamount of sufentanil administered at T1was significantly smaller in group Athan in group B, dose of two groups at T2, T3, T4, T5was nearly identical, doseof group A at T6, T7, T8was higher than in group B. A postoperative sufentanildosage at16h in group A was higher than group B. The total numbers of do notneed to press in group A was more than group B.(4) There was statisticallysignificant about target plasma concentration between two groups at T1, T2, T5,T6, T7, T8. The target concentration fluctuations in group A smaller than in groupB.(5) There was no significant difference in adverse reactions between twogroups.Conclusion Compared with conventional analgesia, use oftarget-controlled infusion (TCI) of Sufentanil after gynecological laparoscopicradical surgery at initial target plasma concentration of0.1ng/ml of showedseveral advantages: more stable plasma concentrations and better analgesia effect without increase of side effects.