Inhibitory Effect Of Nalbuphine On Pain And Stress Response After Orthognathic Surgery

ObjectivePostoperative pain is a negative factor that seriously affects a surgical patient's Rehabilitation.We aim to investigate whether nalbuphine provides superior postoperative analgesia in orthognathic surgery comparing to sufentanil and whether it is achieved by the regulation of inflammatory and oxidative stress.MethodIn this randomized,double-blind,controlled clinical study,we randomly assigned 60 patients scheduled for orthognathic surgery to the sufentanil group(group S,n = 30)or the nalbuphine group(group N,n = 30).Patients in group S were given sufentanil citrate injection(2.5 ?g / kg),and patients in group N were given nalbuphine hydrochloride injection(2 mg / kg).All patients were treated with a patient-controlled intravenous analgesia(PCIA)pump for analgesia.Visual analogue scale(VAS),Ramsay sedation score(RSS)and anxiety score at 4,8,16,24 hours after surgery,as well as patient satisfaction within 48 hours after surgery were compared between two groups.Enzyme-linked immunosorbent assay(ELISA)was used to measure levels of blood inflammatory factors [tumor necrosis factor-?(TNF-?)and interleukin-6(IL-6)] and oxidative factors [Superoxide dismutase(SOD)and malondialdehyde(MDA)] on the first and second days after surgery.ResultsThe VAS scores of the group N was significantly lower than group S,while the Ramsay scores in group N was higher(P<0.05);there was no significant difference in the anxiety scores between the two groups.The levels of inflammatory factors TNF-? and IL-6 and oxidative factor MDA were significantly lower in group N than in group S,while the levels of oxidative factor SOD was significantly higher than group S(P<0.05).In addition,Spearman correlation analysis showed that the VAS scores was positively correlated with plasma levels of TNF-?,IL-6 and MDA,and negatively correlated with SOD.Compared with group S,the heart rate(HR)value at 16 h and the respiratory(R)value at 24 h and 48 h after surgery were significantly lower in group N(P<0.05),and the peripheral capillary oxygen saturation(SpO2)value at 48 h after surgery was significantly higher(P<0.05).At the same time,the total incidence of postoperative complications and anesthesia-related adverse reactions in group N was significantly lower than group S(P<0.05),and the incidence and severity of postoperative nausea and vomiting(PONV)in the two groups were significantly different between 0 and 12 hours after surgery(P<0.05).The overall patient satisfaction of postoperative analgesia of group N was significantly higher than group S(P<0.05).ConclusionCompared with sufentanil,nalbuphine offers better postoperative analgesia and sedation following orthognathic surgery.Nalbuphine seems to provide superior postoperative analgesia by reducing inflammatory and oxidative stress.In addition,the usage of nalbuphine for analgesia after orthognathic surgery may reduce the incidence of postoperative complications and anesthetic-related adverse reactions.