Effects Of Neostigmine Combined With Ropivacaine For Preoperative Epidural On Stress Response And Postoperative Analgesia In Patients Undergoing Lung Resection

Objective:Compared the effects of neostigmine combined with ropivacaine for preoperative epidural with pure ropivacaine on stress response and postoperative analgesia in patients undergoing lung resection.Methods:Choose 60 patients undergoing elective lung resection surgery during March2014 to July 2014,30-65 years old,ASA physical status I and II,all patients without epidural puncture taboo, immune disease and neurological disorders. The patients were randomly divided into three groups,20 cases in each group, group A was 0.15%ropivacaine+8μg/kg neostigmine, group B was 0.15% ropivacaine, group C was saline solution. An epidural catheter was inserted at the T6-7or T7-8 interval, injection of 2%lidocaine 4ml test quantity,test block plane. Then injected 0.15% ropivacaine+8μg/kg15 ml neostigmine 15 ml into epidural solution in A group, 0.15% ropivacaine15 ml in B group and saline solution 15 ml in C group before induction of general anesthesia 20 minutes.Three groups with midazolam0.1mg/kg,fentanyl 4μg /kg,propofol1-2mg/kg and Rocuronium Bromide 0.6mg/kg induced by intravenous administration.Postoperative epidural controlled analgesia(PCEA) adopted,formula sufentanil 0.5ug/ml+0.15% ropivacaine 200 ml.Testing the blood serum noradrenaline concentration of three groups at the points of before the induction(T1)、end of the surgery(T2)、24h after surgery(T3)、48h after surgery(T4) by ELISA method,and testing blood sugar,heart rate and blood pressure at the four time points simultaneous.By using visual analogue scale(VAS),to quantitative evaluation the analgesic effect of postoperative 4,8,12,24,48 hours.And record three groups of patients with intraoperative rehydration fluids,propofol and cis-atracurium dose and postoperative anal exhaust time at the first and postoperative adverse reactions.Results:1.The general information, anesthetic dose and intraoperative rehydration fluidsThe general information, the operative time and anesthetic drug use of three groups haven’t statistical difference; Intraoperative rehydration fluids were significantly increased, compared group A and group B with group C difference is statistically significance(P<0.05).2.The hemodynamicBP was no statistically significant difference at all time points,The three groups of patients T2 compared with T1 of HR was falling and has statistical significance( P<0.05); T3 and T4 compared with T1 of HR was rising and has statistical significance(P<0.05);3.The blood serum NE and blood sugarWithin groups: three groups of patients with serum NE concentration over time were gradually increased(P <0.05); blood sugar three groups except at T2 were also over time and gradually increased(P <0.05);Between the three groups: compared with the group C, A, B groups of serum NE concentration in T2, T3 and T4 in both lower(P <0.05); compared with the group C, A,B groups of glucose in T2, T3 time points were also lower(P <0.05).4.Postoperative VAS scoreThe patients with postoperative VAS score of three groups: Comparison in the group, the score of postoperative increased significantly in the three groups(P<0.05);comparison between three groups, contrast group A and B with group C the score of postoperative4,8, 12,24,48 h were lower(P<0.05).5.Postoperative exhaust time and adverse reactionsCompared with the group C, A group was first flatus time was significantly shorter(P <0.05), compared with group B, A postoperative first flatus time was significantly shorter(P <0.05). Fisher’s exact comparison between groups nausea,vomiting and respiratory depression were not statistically significant.Conclusion:The neostigmine combined with ropivacaine comparison with just use ropivacaine did not significantly reduce perioperative stress response andpostoperative analgesic effect following lung resection, can accelerate the recovery of intestinal function does not increase the risk of postoperative nausea and vomiting.