Clinical Study Of Patient-controlled Intravenous Analgesia Wiht Morphine And Dexmedetomidine In Patients With Advanced Refractory Cancer Pain

Objective: To investigate the efficacy and safety of combined morphine with dexmedetomidine in patients with advanced refractory cancer pain by patient-controlled intravenous analgesia(PCIA).Methods: 119 patients with severe cancer pain who were admitted to the General Hospital of the Eastern Theater from January 2016 to September 2018(the former Nanjing General Hospital of Nanjing Military Region)were randomly divided into control group(59 cases)and dexmedetomidine group(60 cases).Patient-controlled intravenous analgesia(PCIA)was performed using an electronically controlled analgesia a patient-controlled analgesia(PCA)pump and the drugs were injected by the "background infusion + patient control" mode.Control group was injected with morphine.Dexmedetomidine group was injected with morphine and dexmedetomidine.The background and PCA doses of morphine injected in both groups were based on the intravenous morphine dose 24 h before treatment.When the patient felt that the pain was aggravated,the dose of morphine was rescued by a self-control button injection.If the patient's pain score(numeric rate scale,NRS)is less than 3 points,or the patient's conscious pain can tolerate and the outbreak pain is less than 3 times a day in the past 24 h,the patient's pain control is considered successful,and the dose continues to be applied to PCIA.Otherwise,it should adjust the background amount of the electronic analgesia pump and the patient's single self-control input amount until controling the patient's pain.If N>3 and the patient don't has self-controlled analgesia pump pain relief or the patient may not be able to tolerate adverse reactions(nausea,vomiting,constipation or drowsiness,etc.)or he patient is required to terminate PCIA treatment for other reasons.after 72 hours of intravenous self-controlled analgesia,the patient may need to withdraw the self-controlled analgesia and treated with other treatment methods.The patient's numerical rating scale score,the dose of morphine and dexmedetomidine,quality of life,satisfaction,and adverse reactions were investigated before the PCIA and at 1st day,2nd day,10 th day,20 th day,and 30 th days after PCIA,.Results:(1)There were no significant differences in gender,age,weight,primary disease,total morphine and pain between the two groups(P>0.05).(2)After self-controlled analgesia for 2 days,the effective analgesic number in the control group was 51(analgesia rate 86.44%),and the effective analgesia in the morphine group was 52(analgesia rate 86.67%).Some patients were out of the group,but in each period of time,both groups of patients achieved effective analgesia,and there was no significant difference between the groups.(3)After PCIA treatment,the NRS scores of the two groups were significantly lower than those before treatment(P<0.01).At the same time,there was no significant difference in NRS score between the two groups.(4)The dose of morphine that were used in two groups gradually increased with the prolongation of treatment time(P<0.05).However,at each time point after PCIA treatment,the dose of morphine in dexmedetomidine group was significantly lower than that of the control group(P < 0.01).(5)With the prolongation of treatment time,the dose of dexmedetomidine gradually increased,and the increase of dexmedetomidine was not significant at various time points after PCIA 2 days treatment.(6)The quality of life scores and satisfaction scores of the two groups of patients treated were higher than those before treatment(P<0.01),but there was no significant difference between the two groups.(7)After PCIA,the number of constipation,nausea and vomiting increased gradually in both groups,and side effects of drowsiness occurred at 2 days after PCIA treatment,while the incidence of constipation,nausea,vomiting,and lethargy was significantly lower in the dexmedetomidine group than those in the control group.Conclusion:(1)Based on the equivalent oral morphine dose used before the patient's PCIA for 24 h,the PCIA infusion method for the treatment of advanced refractory cancer pain can significantly improve the patient's pain and quality of life.(2)Dexmedetomidine combined with morphine can significantly improve the pain and quality of life of patients,reduce the amount of morphine,thereby reducing the incidence of adverse reactions in patients with advanced refractory cancer pain by PCIA.PCIA is a good adjuvant method that is worthy of clinical application.