| Objective: postoperative pain can produce strong stress response and result in blood pressure and heart rate increased, emergence agitation. Reducing the stress reaction during extubation period of general anesthesia is a very important problem solved by the anesthesiologists. preemptive analgesia(PA) is one of the methods to reduce postoperative pain. Hydromorphone hydrochloride is a semisynthetic opioid, and the derivative of the morphine. It performs its analgesic effect through the μ-opioid receptor of the central nervous system. So that it is regarded as a powerful opiate analgesic. Besides, it has the following characteristics: rapid onset, long analgesia time, strong analgesic effect, no toxicity and no side effect of the main metabolite. So, it has been widely applied in the treatment of the postoperative pain. Although hydromorphone has been widely applied in the clinic, the research of hydromorphone for preemptive analgesia is less. The research aimed to observe the effects of preemptive analgesia of hydromorphone on the postoperative analgesia, sedative effect, adverse effects and stress response of the patients undergoing laparoscopic cholecystectomy, and discuss the feasibility and safety of the hydromorphone preemptive analgesia, which provides reference for the clinical application. Methods: 60 patients undergoing laparoscopic cholecyste-ctomy with general anesthesia from September to December, 2014(ASA I-II level, 17 men, and 43 women) were selected and divided into observation group and control group randomly according to the random number table(30 cases for each group). 10 min before the operation, the observation group received 15 ug/kg hydromorphone intravenously(diluted to 10 ml with normal saline), the control group received 10 ml normal saline intravenously. General anesthesia was performed in the two group. Both the two groups used general anesthesia, The analgesic effect was assessed by Visual analogue scale(VAS) at 10min(T4), 30min(T5), 1h(T6), 2h(T7), 4h(T8), 6h(T9), 12h(T10), and 24h(T11) after extubation. Plasma epinephrine(E), noradrenaline(NE), and dopamine(DA) level were measured before anesthesia and at 5min after extubation. Mean arterial pressure(MAP), heart rate(HR) were recorded before anesthesia(T1), at the end of operation(T2), immediately after extubation(T3), and 10 min after extubation(T4). Spontaneous breathing recovery time and extubation time were recorded. Sedation effect was assessed by Ramsay sedation score at 10min(T4), 30min(T5) and 1h(T6) after extubation. The Emergence agitation(EA)was assessed by sedation-agitation scale(SAS) and the adverse effects(nausea and vomiting, respiratory depression, hypotension, skin itch, etc.) were recorded within 24 hours after operation. Results:(1) There were no statistical significance in the gender ratio, age, weight, HR, MAP between both groups(P>0.05).(2) VAS score: compared with the control group, the VAS score of the observation group at T4, T5, T6, T7, T8, T9 and T10 was obviously reduced(P<0.05). But there was no difference at T11 between the observation group and the control group(P>0.05). compared with T4,the VAS score of both group at T9 was obviously increased(P<0.05).(3) Plasma epinephrine(E), noradrenaline(NE) and dopamine(DA): comparison in groups, the plasma E, NE, and DA level of the observation group 5min after extubation were higher than those before anesthesia(P<0.05); the plasma E, NE, and DA level of the control group 5min after extubation were higher than those before anesthesia(P<0.05). Comparison between groups: there were on significance of the plasma E, NE, and DA level of both groups before anesthesia(P>0.05); the plasma E, NE, and DA level of the control group were higher than those of the observation group 5min after extubation(P<0.05).(4) Haemodynamics(MAP and HR): In the observation group, MAP at T2, T3, T4 and T5 was obviously increased respectively compared with that at T1(P<0.05). In the control group, MAP at T2, T3, T4 and T5 was obviously increased respectively compared with that at T1(P<0.05). HR of the observation group was remarkably increased at T2 and T3 respectively compared with that at T1(P<0.05), but there was no difference At T4 and T5 compared with that at T1(P>0.05). HR at T2, T3, T4 and T5 of the control group was remarkably increased respectively compared with that at T1(P<0.05). There were no difference of MAP and HR at T1 between the two groups(P>0.05); through the comparison, MAP and HR of the control group at T2, T3, T4 and T5 were obviously higher than those of the observation group(P<0.05).(5) There were no difference on Spontaneousbreathing recovery time and extubation time between two groups(P>0.05).(6) Ramsay sedation score: There was no difference between two groups at T4, T5 and T6(P>0.05).(7) Adverse effects: EA was observed in 2/30(6.7%) patients of the observation group and in 9 /30(30%) patients of the control group, the incidence of EA of the control group was obviously higher than that of the observation group(P<0.05). There were no difference on the other adverse effects between two groups(P>0.05). Conclusion: Preemptive analgesia of hydromorphone hydrochloride can reduce the postoperative pain of the patients undergoing laparoscopic cholecystectomy under general anesthesia. It does not affect the recovery quality with less adverse effects. Moreover, it can effectively inhibit the patients’ cardiovascular response and the release of E, NE, and DA during the recovery period. |
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