| Background:The lumbar disc herniation incidence is increasing year by year,with the age trends to be younger.percutaneous endoscopic transforaminal discectomy（PETD）has currently as one of the most widely applicated minimally invasive for treatment LDH.The occurrence of hyperalgesia is frequently after surgery,due to surgical tissue trauma,nerve irritation harassment and stress reactions,which may discomfort patient.thus,effective analgesic measures in PTED remain a problem.Objective:To assess the clinical efficacy and safety of different doses of dezocine pre-emptive analgesia in percutaneous endoscopic via transforaminal approach with lumbar disc herniation,and impact of inflammatory factors Interleukin-6（IL-6）and Tumour necrosis factor-alpha（TNF-α）.To investigate the optimal dose of dezocine for prevents intraoperative pain of PTED.Methods:A total of 160 patients of lumbar disc herniation,accepted surgery under local anesthesia,including 82 males and 78 females,with the range 22 to70 ages and an average age of（49.00±8.57）,during the period from January2018 to June 2019 were randomly divided into four groups to analyzed.0.10mg/kg,0.15mg/kg and 0.20mg/kg dezocine was used preemptive analgesia before surgery,defined as group A,B and C.group D received 8 mg lornoxicam intravenously injected for control.The VAS score,JOA score,Ramsay score were evaluated pre-postoperatively to asses the preemptive analgesia effects of dezocine.The change of inflammatory factors IL-6,TNF-αat 24h,48h after surgery were compared between groups,and the incidence of adverse complications were recorded.Results:All of the cases were completed surgery successfully without severe complication.There were no significant differences in gender,age,weight,resonsiblesegment,discherniationposition,ASAanesthesia grade,symptoms,signs among four groups（P>0.05）.At T1,the heart rate（HR）,mean arterial pressure（MAP）,blood oxygen saturation（Sp O2）without statistically significant（P>0.05）.At T2,the HR and MAP in Group C（0.2mg/kg）were lower than other groups,but no significant differences at T1or T3.The operation time,bleeding volume,hospital stay,VAS and JOA scores before surgery were not statistically significant（P>0.05）.Group B（0.15mg/kg,n=40）,high-dose group C（0.20mg/kg,n=40）were statistically different from other groups,and the difference between group C and group D was statistically significant（P<0.05）.The Ramsay sedation scores of group C at 2h and 6h were higher than those of group A,group B,and group D,and the differences were statistically significant（P<0.05）.There was no significant difference between group A and group B（P>0.05）.At 8 hours after operation,there was no significant difference in the scores of the four groups（P>0.05）.At 24 and 48hours after surgery,there were significant differences in serum IL-6 and TNF-αlevels between the low-dose,medium-dose,high-dose,and control groups（P<0.001）.The levels of serum IL-6 and TNF-αin group C were lower than those in the other three groups,and the decrease was significant after 48 hours（P<0.001）.Serum IL-6 and TNF-αlevels in group D were higher than those in the other three groups,the difference was statistically significant,and recovery to baseline levels was slow（P<0.001）.In the control group D,the number of patients who used analgesics within one day after operation was the most,and group C was the least.The difference was statistically significant.Complications were similar in the four groups without significant differences（P>0.05）.Conclusion:The analgesic and sedative effects of different doses of dezocine in patients undergoing PTED are exact and dose-dependent.It is observed that 0.20mg/kg dezocine pre-emptive analgesia showed the better sedative and analgesic effect with low side events maybe the optimal dosage.Furthermore,the analgesic effects of dezocine may be associated with regulate the expression of inflammatory factors IL-6 and TNF-αby suppresed its expression in PTED. |
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