| ObjectiveNot only does the acute pain after operation bring agony to patients,but it also affect the recovering.Moreover,it will lead to the happening of hyperalgesia and even grow to chronic pain,which would torture the patients for a long period of time.Through out these years,though new analgesia drugs and methods have been developed increasingly,it remains a thorny problem to crack for both doctors and patients.Therefore,it is important to find a new way or modify the existing analgesia program,which will improve the analgesia quality so as to reduce the chronic pain after operations.Researches have shown that a recent appeared medicine dexmedetomidine,whose function on postoperative analgesia attracted much attention,allied with opioid drugs can reduce the dosage of opioids and improve the quality of postoperative analgesia.However,it remains unknown whether the analgesia method performs better on postoperative hyperalgesia than other medicine such as the frequent-used flurbiprofen and whether it reduces the occurrence rate of postoperative chronic pain.Therfore,this thesis is to define:1.The effect dexmedetomidine allied with dezocine for postoperative analgesia causes on internal fixation of lumbar sine hyperalgesia and related indicators and especially the comparison of the differences between it and the flurbiprofen axetil allied with dezocine affecting on these indicators,and make an objective evaluation to make sure if dexmedetomidine can restrain operative hyperalgesia and whether it performs better than other kinds of medicine or not.2.A preliminary discuss on whether dexmedetomidine can reduce the occurrence of chronic pain so as to provide basis and measurement for the postoperative hyperalgesia and even the precaution and treatment for the chronicity of acute pain as well as a reference to the rational drug use on clinic anesthesia.Methods1.Effects of postoperative analgesia with dexmedetomidine on postoperative mechanical pain threshold in patients undergoing lumbar internal fixation.90 participants receiving Internal fixation of lumbar spine from December 2015 to July 2016 were selected and randomly placed in one of three groups including group of dezocine(group D),with fomula:dezocine 0.5mg/kg +palonosetron lmg;dexmedetomidine + dezocine(group DD),with fomula:dexmedetomidine 5?g/kg + dezocine 0.5mg/kg + palonosetron 1mg;and group of flurbiprofen axetil + dezocine,with fomula:dezocine 2mg/kg + dezocine 0.5mg/kg + palonosetron 1mg to observe the effects.Hyperpathia is the radical cause of occurrence of postoperative chronic pain.The experiment firstly measured mechanical threshold by electronic Von Frey pain threshold detector to determine occurrence of hyperpathia,secondly observed other analgesic effect indexes associated with occurrence of postoperative chronic pain,such as Visual Analogue Scale/Score(VAS),times of pump control of analgesia(PCA times)or complications such as nausea,vomiting.The experiment recorded mechanical thresholds of periphery of wound and forearm 2,6,24,48 hours before and after operation,Ramsay sedation sore,PCIA times,consumption volume of dezocine after 48 hours,as well as side effects such as respiratory depression,dizzy giddy,nausea,vomiting,cutaneous pruritus,etc.and complications.2.Effects of dexmedetomidine on postoperative chronic pain in posteriorlumbar vertebrae internal fixation.Select patients who have recovered at least one year after Lumbar surgeries,and use dezocine,dexmedetomidine + dezocine,or flurbiprofen axetil ?dezocine in patient controlled postoperative analgesia,devide them into 3 groups:Group Dexmedetomidine(Group Dex)and Group Flurbiprofen(Group Flu)were divided into Group Dezocine(Group Dez).These patients were followed up by telephone for details about the presence of chronic pain.Statistics of the incidence of chronic pain in each group were compared.Results1.It is shown from statistic analysis by using SPSS 19.0 software that the general data have no statistic difference for three groups of patients before operation(P>0.05).And it can be seen from comparison of mechanical thresholds of periphery of wound at various time points for various groups after operation with that before operation,that the mechanical thresholds for group D obviously declined(P<0.05),while the thresholds for group DD after operation,was slightly more than that before operation,but the difference had no statistic significance(P<0.05).The thresholds at various time points for group DF after operation have no obvious change(P>0.05).There' s no statistic differences for three groups of patients 2h after operation(P>0.05).The thresholds for group DD were higher than that for group DF and group D.But compared with that for group D,the thresholds of 24,48h after operation for group DF were higher(P<0.05),but had no statistic significance at 6h afer operation.The residual tendency was similar to mechanical thresholds of periphery of wound.As for VAS score,there was no obvious difference of scores 2 hours after operation for three groups(P>0.05).Compared with group D,the scores 6,24 and 48 hours after operation for group DD and group DF were obviously lower than that for group D,the difference had statistic significance(P<0.05).Compared with group DF,VAS scores 6,24,48 hours after operation for group DD were relatively low,the difference had no statistic significance(P>0.05).As for dezocine consumption,group D was obviously higher than group DD,the difference had statistic significance(P<0.05);group DD was higher than group DF,the difference had no statistic significance(P>0.05).The adverse reactions occurred after operation for three groups included nausea,vomiting,dizzy giddy and pruritus,wherein there was only one case for pruritus who had no other adverse reactions during observation period.The incidence rate of nausea and vomiting for group DD(10%,10%)were lower than that for group DF(20%,13.3%)and group D(26.7%,%),the difference had statistic significance(P<0.05);while group DD was lower than group DF,the difference had statistic significance(P<0.05).The mechanical thresholds of periphery of wound and forearm were not correlated with VAS scores(r=-0.014,P=0.869;r=0.094,P=0.252).2.The incidence of chronic pain in group Dex was 5.00%,which slightly lower than that in both group Flu(7.09%)and group Dez(8.39%),but the difference was not statistically significant(x2 = 1.523,P = 0.467).Conclusions1.The dexmedetomidine allied with dezocine has a good analgesic effect on internal fixation of lumbar spine.It can effectively restrain the occurrence of postoperative hyperalgesia.Compared with flurbprofen axetil allied with dezocine,dexmedetomidine can restrain the postoperative hyperalgesia better,in which case the occurrence rate of nausea and vomiting after operation got lower.2.The morbidity of chronic pain from the patients who have been treated with dexmedetomidine is slightly lower.It can be preliminarily inferred that dexmedetomidine can prevent the chronicity of postoperative acute pain.Nevertheless,research is still required to be furthered. |
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