Observation Of Small Dose Ketamine Combined With NSAIDs In Prevention Of Postoperative Hyperalgesia Induced By Remifentanil

Objective: Observation of small dose ketamine combined with NSAIDs in the prevention of hyperalgesia in patients undergoing laparoscopic total hysterectomy under general anesthesia with remifentanil.Methods: A total of 200 patients hysterectomy with laparoscopy were randomly divided into 4 groups.Group R were injected 5 ml saline intravenously 1 minute before skin incision.Group RK1,group RK2 and group RK3 were respectively intravenously injected 0.25 mg/kg,0.5 mg/kg,0.75 mg/kg of small dose ketamine 1 minute before skin incision and continuous intravenous infusion of ketamine at 2 μg/kg·min till the end of the operation.After the end of surgery give Ketorolac Tromethamine Injection 30 mg intravenous injection.Record the time of extubation,the Ramsay Sedation score at 5min after extubation,the postoperative pain for the first time and the VAS pain score.Record the cases of postoperative hyperalgesia and 90 min VAS score of four groups.The occurrence of adverse reactions of four groups.Results: The first postoperative pain time of group R appeared earlier than the other three groups(P<0.05).Group RK1 appeared earlier than RK2 and RK3 groups(P<0.05).The first postoperative VAS pain score of group R was higher than the other three groups(P<0.05).The postoperative hyperalgesia cases group R more than the other three groups,90 min VAS score group R higher than the other three groups(P<0.05),group RK1 postoperative hyperalgesia cases more than RK2 and RK3 group,90 min VAS score higher than that of RK2 and group RK3(P<0.05),the difference was statistically significant;surgery after the occurrence of adverse reaction differences was not statistically significant between groups(P>0.05).Conclusion: A small dose of ketamine combined with NSAIDs can prevent remifentanil induced hyperalgesia,and delay the time of postoperative pain appearance while reducing the degree of postoperative pain.Using ketamine 0.5 mg/kg before skin incision,and intraoperative injection of ketamine of 2 μg/(kg·min)during the operation can better reduce the postoperative pain,and does not increase the occurrence of postoperative adverse events.