Clinical Study Of Postoperative Patient-Controlled Intravenous Analgesia With Butorphanol In Gynecological Laparoscopic Medium And Minor Surgery Patients

Background and objectiveLaparoscopic surgery has the advantages of small trauma,fast recovery,short hospital stay and high patient satisfaction.With the development of ERAS,laparoscopic surgery accounts for more and more in gynecological surgery,so the requirement of perioperative analgesia is higher and higher.The goal of perioperative analgesia is to reduce the occurrence of adverse reactions as much as possible on the basis of achieving the best analgesic effect.Opioids are essential drugs in perioperative period,which have strong analgesic effect,but there are many side effects.How to reduce the use of opioids to reduce the adverse effects of perioperative analgesia has been a hot topic.Multimodal analgesia came into being.Multimodal analgesia is to combine two or more analgesic drugs and methods to reduce the dosage of each drug,so as to avoid adverse reactions.The postoperative pain of gynecological laparoscopic surgery mainly comes from incision pain,visceral pain and so on.So multimodal analgesia is strongly needed.There are many ways to control incision pain.The operation of abdominal transverse plane block is widely used.The ?receptor is mainly for visceral pain.Butorphanol is a ? receptor agonist-antagonist,which has definite effect on visceral pain.However,the dosage of butorphanol for postoperative patient-controlled intravenous analgesia has not been specified,especially in combination with abdominal transverse plane block.So this research aims to observe the clinical efficacy of different doses of butorphanol on postoperative patient-controlled intravenous analgesia for patients undergoing laparoscopic gynecological surgeries with transversus abdominis plane block(TAPB).Methods120 patients scheduling for elective laparoscopic gynecological surgeries under general anesthesia in the First Affiliated Hospital of Zhengzhou University were randomly divided into four groups(group TB1,TB2,TB3,TS).0.125mg/kg,0.15mg/kg,0.175mg/kg butorphanol and 2 ? g/kg sufentanil combining with 5mg tropisetron were used for patient-controlled intravenous analgesia.1mg butorphanol were intravenously injected for group TB1,TB2,TB3 and 5?g sufentanil for group TS 30 minutes before the end of the operation.At the end of the operation,transversus abdominis plane block was performed with 0.25%ropivacaine in all groups under ultrasound guidance.The visual analogue scores(VAS)and Ramsay scores of the patients were recorded at 1h,6h,12h,24h and 48h after the operation.The use of adjuvant analgesic drugs and effective pressing times were recorded.The incidence of adverse reactions such as pruritus,nausea and vomiting,headache and dizziness,respiratory depression and satisfaction score were also observed.Results1.There was no significant difference in age,weight,ASA,operation time,bleeding volume and hospital stays among the four groups(P>0.05).2.There was no significant difference in VAS scores of the four groups at 1h,6h,12h,24h and 48h(P>0.05).3.There were significant differences in Ramsay scores of the four groups at 1h,6h,12h,24h and 48h after operation(P<0.05).The scores of Ramsay in group TB1 at 1h,6h,12h,24h and 48h after operation were lower than those in groupTB2 and group TB3(P<0.05);the scores of Ramsay in group TB1 at 1h,12h,24h and 48h after operation were lower than those in group TS(P<0.05).4.There was no significant difference in the effective pressing times of analgesia pump among the four groups(P>0.05).There was one patient who use the adjuvant analgesic drugs respectively in group TB1,TB2,TB3,but no one in group TS(P>0.05).5.There was no significant difference in pruritus,nausea and vomiting,headache and dizziness,respiratory inhibition and other adverse reactions among the four groups(P>0.05),but the incidence of nausea and vomiting and respiratory inhibition in group TS was higher and the incidence of headache and dizziness was higher in group TB2,group TB3 and group TS.There was significant difference in the satisfaction score of the four groups(P<0.05).The satisfaction score of group TB1 was significantly higher than that of the other three groups.Conclusions1.0.125mg/kg butorphanol used in PCIA combined with transversus abdominis plane block(TAPB)can meet the requirements of postoperative analgesia for patients undergoing laparoscopic gynecological surgeries,it can offer satisfactory sedative effect,less adverse reactions and higher patient satisfaction.2.Compared with sufentanil,patient-controlled intravenous analgesia with butorphanol can improve satisfaction of patients.