Effects Of Oxycodone Combined With Dexmetromidine On Catheter Related Bladder Discomfort In Patient After General Anesthesia

BACKGROUNDUnder the guidance of the "comfort Medicine" concept,indwelling urethral catheter after general anesthesia is common accepted.However,due to preoperative failure to adapt,during the recovery of anesthesia,the patients may occour catheter related bladder discomfort,the symptom including urination,frequency of urination,and even accompanied by restlessness,swinging their heads,moving their feet,and bending their legs into their knees,etc.Its incidence is as high as 47%-90%.It is one of the important causes of emergence agitation in patients with general anesthesia,resulting surgical incision dehiscence,cardiovascular system complications,falling bed,etc.Therefore,prevention of the occurrence of CRBD is the focus of current research.Oxycodone is a semi-synthetic opioid drug.It is a agonist of? receptor and ? receptor,has the advantages of quick action(three minutes to 5 minutes),mild inhibition of respiration,and better analgesic effect on visceral pain.Some scholars have found that oxycodone can prevent the occurrence of CRBD effectively after general anesthesia.It may be related to stimulating ? receptor to relieve pain caused by bladder neck spasm and urethral mucosa injury,and then acting on the central nervous system to regulate the input reflex from the bladder and the central excitability of the sacral reflex,so as to reduce the sensitivity of the patients to CRBD.Dexmedetomidine is a highly selective agonist of a2-adrenergic receptor,which has perfect effects of sedation,analgesia,inhibition of sympathetic excitability and reduction of catecholamine release,and reduces noxious stimuli in the body,and can reduce the consumption of opioid drugs when combine with opioids.Studies show that dexmetomidine can effectively prevent CRBD.This may be due to the fact that the urethra is innervated by a rich nervous system,and that the sympathetic and parasympathetic nerves are distributed throughout the urethra.The sympathetic nerves are responsible for the transmission of pain,warmth and tactile sensation.Urethral stimulation stimulates sympathetic nerves and produces CRBDs,while dexmetomidine has central anti-sympathetic effects.In addition,it has been found that dexmetomidine can effectively inhibit M3 muscarinic receptors,while CRBD is similar to bladder hyperactivity.The involuntary contraction of bladder was mediated by the action of acetylcholine released by activated cholinergic nerve on muscarinic receptor.Some studies have shown that dexmetomidine can prolong the action time of muscarinic receptor up to 6 hours.But how the effects of dexmedetomidine combined with oxycodone in CRBD prevention?The purpose of this study is to evaluate the differents dose of oxycodone combined with dexmedetomidine in CRBD prevention effect.ObjectivesTo evaluate the effect of different doses of oxycodone combined with dexmetomidine on CRBD after general anesthesia.To evaluate the analgesic efficacy and safety of different doses of oxycodone combined with dexmetidine.MethodsAll the patients were from our hospital,during January to Decembe of 2017,with the consent of the ethics committee of our hospital.The patients underwent laparoscopic enucleation of renal tumors or upper urinary calculi under general anesthesia or percutaneous nephrolithotomy,aged of 18 to 65 years old,ASA grade ?-?,body mass index was 18-28 kg/m2.All the patient had signed the informed consent form.The patients were divided into four groups randomly,including DOL group,DOM group,DOH group and O group.Before the end of the operation 30 minutes,all patients were given 0.07 mg/kg oxycodone intravenously.Patient-controlled intravenous analgesia pump was connected immediatly at the end of the operation,and the DOL group:oxycodone 0.6 mg/kg plus dexmetomidine 0.05 ?g/kg/h;DOM group:oxycodone 0.84 mg/kg plus dexmetomidine 0.05 ?g/kg/h;DOH group:oxycodone 1.2 mg/kg plus dexmetomidine 0.05 ?g/kg/h;0 group:oxycodone 1.2 mg/kg.All groups were filled with normal saline to 100 ml(background infusion dose was 2ml/h,with a bolus dose lml and a 15 minutes lockout time).After the extubation of tracheal catheter and the patient's ability to speak and follow the instructions immediately(TO),after the extubation of tracheal catheter lhour(T1),2 hour(T2),6 hour(T3),12 hour(T4),24 hour(T5),48 hour(T6)point,a blind obsever assessed the incidence and severity of CRBD in the trachea tracheal catheter,visual analogue pain(VAS)score andthe level of sedation(Ramsay score)was recorded,when the CRBD score was greater than 2,tramadol 50 mg was injected intravenously as a rescue measure,and when the VAS score was greater than 4,sufentanil 5 pg was injected intravenously as a rescue measure.Record the number of effective compressions of the analgesic pump within 48 hours after extubation,and the occurrence of adverse reactions such as nausea,vomiting,dry mouth,shivering,respiratory depression,bradycardia,excessive sedation,delayed recovery,etc.Statistical analysisThis experiment was designed as a random unit group.Setting ?=0.05,?=3.2.According to previous references and pre-experiments,the incidence of CRBD in the control group was 66%.Assume a 45%reduction in the incidence of CRBD.The rate of elimination or missing visit was estimated to be 10%,so the sample size was 124.The statistical method was analyzed by SPSS 22.0 software.The measurement data were expressed as mean ±standard deviation(mean ±standard deviation),median(quartile spacing),counting data were expressed by rate(%)and number of cases(n).Comparison of general data and PCIA effective press times were compared between groups using multi-factor ANOVA,intra-group comparison using single factor repeated measurement of ANOVA.The incidence of CRBD and the utilization rate of salvage drugs and the incidence of related clinical side effects were compared within the group by chi-square test or Fisher's exact test(if the number of cases ?5).The severity of CRBD(mild,moderate,moderate)and VAS score and Ramsay score was using non-parametric test Mann-Whitney test.P<0.05 was statistically significant.ResultsIn this study,126 patients met the inclusion criteria,two of them were excluded because history of alcoholism,that is,124 patients entered the trial.They were randomly divided into DOL group,DOM group,DOH group and O group,with 31 patients in each group.One case of in DOL group were excluded because of intraoperative blood transfusion.One case in DOH group were excluded because of missing visit.One case in DOM group and one case in O group were excluded because of incomplete data.A total of 120 cases were included in the statistical analysis,30 cases in each group.There was no statistical difference in the general situation among the four groups(P>0.05).There was no significant difference in the severity and incidence of CRBD in all groups at T0,T6(P>0.05).Incidence and severity of CRBD in 1h(T1),2h(T2),6h(T3),12h(T4),24h(T5):Compared with DOL group,the incidence and severity of CRBD in the DOM group and DOH group and O group were significantly lower,and the difference was statistically significant(P<0.05).Compared with O group,there was no significant difference in incidence and severity both DOM group and DOH group(P>0.05).There was no significant difference in CRBD incidence and severity between DOH group and DOM group(P>0.05).At the time of T0,there was no statistical difference in VAS score among the four groups(P>0.05).At the time of lh(Tl),2h(T2),6h(T3),12h(T4),24h(T5),48h(T6):Compared with DOL group,the VAS score of DOH group and DOM group and O group decreased significantly,and the difference was statistically significant(P<0.05).Compared with the O group,there was no significant difference in VAS score both DOM group and DOH group(P>0.05).Compared with the DOM group,the VAS score of the DOM group was not significantly increased,and the difference was not statistically significant(P>0.05).There was no significant difference on Ramsey sedation scale among the four groups.There was no significant difference in the dosages and times of tramadol among the four groups.Compared with O group,the dosages and times of tramadol and the number of sufentanil supplementation and the number of effective compressions of analgesic pump was no significant both DOM group and DOH group(P>0.05).Compared with DOL group,the dosages and times of tramadol and the number of sufentanil supplementation and the number of effective compressions of analgesic pump was decreased significant within 48 hours among O group and DOM group and DOH group,and the difference was statistically significant(P<0.05),but there was no significant betwteen DOM group and DOH group(P>0.05).The incidence of nausea and vomiting in DOH group was significantly lower than that in O group(P<0.05),and the incidence of nausea and vomiting in DOM group and DOL group was significantly lower than that in DOH group(P<0.05).There was no significant difference in the incidence of nausea and vomiting between the DOM group and the DOL group(P<0.05).There was no significant difference in residual adverse reactions such as respiratory inhibition among the groups(P>0.05).Conclusion(1)Oxycodone combined with dexmedetomidine can effectively reduce the incidence rate of CRBD in patients undergoing urological surgery.(2)0.84 mg/kg oxycodone combined with 0.05?g/kg/h dexmedetomidine for intravenous patient-controlled analgesia provide perfect analgesic effect and less adverse reactions in patients undergoing urological surgery.