Prevention Of Hyperalgesia After Stop Of Intravenous Infusion Of Remifentanil With Flurbiprofen Axetil Combining With Dezocine

Objective Opioids are the main drugs in the treatment of moderate to severe pain,In recent years in animal experiment and clinic were found associated with hypersensitivity phenomenon, namely the use of opioids, increased sensitivity to noxious stimuli, this phenomenon in the use of short acting opioids such as remifentanil more apparent after the. Clinical hypersensitivity phenomena can be manifested as pain hypersensitivity(hyperalgesia), namely the reduced pain threshold after operation, wound pain more intense, also can be manifested as abnormal pain(allodynia), which does not produce pain in normal individual light touch may causesevere pain. Guignard in major abdominal operation confirmed the use of postoperative pain after remifentanil, occurred early and strong, the required amount of opioid drugs increaseafter operation. Therefore, how to prevent the use of opioids allodynia after has become the main research topic for domestic and abroad anesthesia. This paper intends to effective dose and safety of remifentanil intravenous anesthesia pain hypersensitivityreaction Prevention Evaluation of flurbiprofen axetil combined with dezocine.Methods Select 60 patients undergoing hysterectomy patients,ASA class I~II,were randomly divided into morphine group(group M), dezocine group(group D),flurbiprofen axetil morphine group(group FM), flurbiprofen axetil dezocine group(F Dgroup), 4 groups, 15 cases in each group.Anesthesia method for half an hour before operation, intramuscular injection of atropine or scopolamine 0.3mg 0.5mg.After entering the room connected multi function monitor, calm 5min, measured BP, HR,Sp O2;repeated measurement of the above parameters and record the basic value.Oxygen tonitrogen 3min; To induce drug: 0.05mg/kg of midazolam hydrochloride;second, the propofol sufentanil 0.5 μg/kg; The propofol 1.5mg/kg; the rocuronium0.9mg/kg;satisfactory muscle relaxation after insertion of the endotracheal tube or laryngeal mask anesthesia machine, the connection, the initiation of mechanical ventilation, the parameters of repeated measurements and recording, continuousmonitoring and recording during the operation. VT:8ml/kg(laparoscopic operation after laparoscopic or moderate increase), RR:10-12 bpm,adjusting the ventilation,keep the Pet CO2 between 35-45 mm Hg. Anesthesia was maintained for the TIVA program: intravenous infusion of propofol 2-2.5μg/ml; intravenous infusion of Remifentanil400-800 μg/kg/hr; the intermittent intravenous CIS atracurium 0.1mg/kg maintain muscle relaxation. Each group in operation before the end of 30 minutes after intravenous injection of 5mg morphine(group M), dezocine 10mg(group D),flurbiprofen axetil 50mg+ morphine 2.5mg(group FM),flurbiprofen axetil 50mg+dezocine 5 mg(group FD), operation after PCIA treatment. Analgesic liquid formulations are: morphine 50 mg+ ondansetron 8 mg(M group), dezocine 1 mg/kg+ ondansetron 8 mg(group D), flurbiprofen 200mg+ morphine 30mg+ ondansetron 8mg(group F+M), flurbiprofen 200 mg + dezocine 0.6 mg/kg+ondansetron 8 mg(F+D group), The analgesic effect of the 4, 8, 12, 24, 48 h of the patients were observed after operation.Each group of patients underwent heart rate(HR), mean arterial pressure(MAP), oxygen saturation(Sp O2) monitoring and VAS, Ramsay, BCS score.Inadequate analgesia and remedial measures: VAS scores more than 4 defined asinadequate analgesia. Based on the main analgesic drug groups analgesic pump(opioids)respectively different, single intravenous supplemental morphine 5mg(M,FM group),dezocine 5mg(D, FD group), the VAS is less than or equal to 3.Results Each single intravenous dosing can effectively Inhibit The discontinuation of remifentanil allodynia after reaction, analgesic effect of satisfaction, the performance for the patients stay MAP fluctuations do not exceed 20% basic value,HR fluctuations do not exceed basic value 10%-15% in the PACU, oxygen mask When Sp O2≥97%, Sp O2≥95% breath the air, there were no significant differences between groups.Postoperative analgesic effect of each group are basically the same,the basic guarantee of VAS score less than or equal to 3, there were no significant differences between groups, each group of patients with an BCS score greater than or equal to 2, there were no significant differences between groups, each group ofpatients with modified Ramsay score no significant difference, no excessive sedation occurred.Conclusion Four groups of single intravenous injection can effectively inhibit the remifentanil after stopping drug hypersensitivity reaction, ostoperative PCIA treatment,F+M, F+D group composite flurbiprofen axetil can be frugalmorphine /dezocine dosage of 30%-40%, to reduce the economic burden of the patients at the same time, reduces the opioid related adverse reactions, FM, FD group composite flurbiprofen axetil preventing pain hypersensitivity and postoperative analgesia with M, D group, group F+D F+M, but the incidence rate of adverse reaction was lower than that in M, D group, recommended the use of.