The Clinical Recherch Of Target Controlled Fentanyl Infusion After Laparoscopic Gynecological Surgery

Objective Apply target controlled fentanyl infusion to evaluate the efficacy and safety of patients with gynecological surgery by fitting fentanyl target concentration on Tivatrainer pharmacokinetic simulation software.Methods Choose 60 patients undergoing Laparoscopic cervical cancer surgery, with ASAI～Ⅱ,aged 18-70 y, weighted 40-70kg, who were randomly assigned to two groups of 30 patients each:fentanyl postoperative analgesia conducted by target controlled infusion(TCI)(Group A) and traditional intravenous analgesia (Group B). Propofol and fentanyl were administered by TCI during the operation both in Group A and B. Start the TCI pump and PCA pump respectively when Prince-Henry pain score is 3 and meanwhile Ramsay score gets 2 after surgery recovery. Set the initial target plasma concentration of fentanyl as 0.0009p.g/ml in Group A. Regulate up the target concentration by 0.000μg/ml if pain relief not appear. Set the parameter of PCA pump in Group B with 20μg/h continuous infusion and 15μg each time pressing the pump when pain occurs. Observe for 15 min locking the analgesia pump every pression. Following subjects are recorded at the pump start on (To) and at 30 min (T1),lh (T2),1h30min (T3),2h (T4),4h (T5),8h (T6),12h (T7) and 16h (T8)after the pump was started:Prince-Henry pain score, Ramsay sedation score, fentanyl dosage of each time point, additional pressing times, the incidence of adverse effect and life signs. Blood gas was collected at the time point of To, T2, T5, T6. Using Tivatrainer pharmacokinetic software to simulate the patients’plasma fentanyl concentration both intraoperative and postoperative, then record target fentanyl concentration at each time point.Results (1) 47 patients were involved in the research at end, with Group A 25 cases and Group B 22 cases,13 cases were excluded for some reason. The patient characteristics in the two groups had no statistical significance (.P>0.05). (2) The Prince-Henry pain score and Ramsay sedation score were similar in each group (P>0.05). (3) The simulated target plasma concentration of fentanyl in Group A was lower than in Group B at T1 and T2 (P<0.05).The variation range of target plasma concentration of fentanyl overall the process of analgesia in Group A was notable smaller than in Group B (P<0.05). (4) The dosage of fentanyl at T1, T2, T3 in Group A was significantly less compared with Group B (P<0.05).16h dosage of fentanyl in Group A was less than that in Group B either(P<0.05). (5) Compared with Group B, the additional pressing times in Group A was much less (P<0.05). (6) There was no significant difference of adverse effect between groups except for nausea and vomiting (P>0.05). (7) The life signs of MAP, HR, RR, SpO2 and blood gas value ranged in normal stage, the variation in each group had no statistical significance (P>0.05).Conclusion Applying TCI to fentanyl postoperative analgesia after gynecological laparoscopic surgery, the overall process of analgesia presented to be effective and safety. Even compared with PCA, TCI had a more stable plasma concentration, less dosage and adverse effect,expressed to be a more security manner to analgesia.