RESUMO
Objective To compare the effectiveness of patient-controlled intravenous analgesia with or without background infusion of dezocine plus flurbiprofen axetil injection in patients undergoing laparoscopic colorectal cancer operation. Methods Sixty patients scheduled for laparoscopic colorectal cancer surgery,35 males and 25 females,aged 18-65 years,ASA physical status Ⅰ or Ⅱ,were randomly divided into 2 groups:common-dose background infusion group(Group CB,n = 30),and no background infusion group(Group NB, n = 30). All patients were intravenously administered a PCA pump containing dezocine 0.6 mg/kg,flurbiprofen axetil 3 mg/kg and normal saline in a volume of 120 mL.Patients in Group CB were given background infusion rate of 2 mL/h with PCA bolus dose 2 mL,patients in Group NB were given PCA bolus dose 4 mL only.NRS scores, Ramsay sedation scores,pressing times,consumption of analgesic,supplementary analgesics,incidence of ad-verse reactions,time of first exhaust,time of first leaving bed and patients'satisfaction scores were recorded after surgery. The influence factors of time of first exhaust and time of first leaving bed were also analyzed. Results Compared with group CB,the NRS scores in group NB were higher both at rest and during movement(P<0.05), the Ramsay sedation scores in group NB were lower at 24 and 48 h after surgery(P<0.05),the pressing times in group NB were higher(P < 0.05),the consumption of analgesic in group NB were lower after surgery,and the incidence of using supplementary analgesics was higher(P < 0.05). No statistical difference was found on the in-cidence of adverse reactions between the two groups(P > 0.05). Moreover,the time of first leaving bed in group NB was longer than that in group CB(P<0.05).The satisfaction scores in group NB was lower than that in group CB(P<0.05).The main influence factors of the time of first leaving bed were gender and NRS score during move-ment at 24 h after the operation(P<0.05).The main influence factors of the time of first exhaust were age,BMI and fluid infusion volume(P < 0.05). Conclusion Postoperative patient-controlled intravenous analgesia with background infusion of dezocine and flurbiprofen axetil injection was more efficacious and satisfactory,and more suitable in postoperative pain management.
RESUMO
PURPOSE: This analysis was done to investigate the optimal regimen for fentanyl-based intravenous patient-controlled analgesia (IV-PCA) by finding a safe and effective background infusion rate and assessing the effect of adding adjuvant drugs to the PCA regimen. MATERIALS AND METHODS: Background infusion rate of fentanyl, type of adjuvant analgesic and/or antiemetic that was added to the IV-PCA, and patients that required rescue analgesics and/or antiemetics were retrospectively reviewed in 1827 patients who underwent laparoscopic abdominal surgery at a single tertiary hospital. RESULTS: Upon multivariate analysis, lower background infusion rates, younger age, and IV-PCA without adjuvant analgesics were identified as independent risk factors of rescue analgesic administration. Higher background infusion rates, female gender, and IV-PCA without additional 5HT3 receptor blockers were identified as risk factors of rescue antiemetics administration. A background infusion rate of 0.38 microg/kg/hr [area under the curve (AUC) 0.638] or lower required rescue analgesics in general, whereas, addition of adjuvant analgesics decreased the rate to 0.37 microg/kg/hr (AUC 0.712) or lower. A background infusion rate of 0.36 microg/kg/hr (AUC 0.638) or higher was found to require rescue antiemetics in general, whereas, mixing antiemetics with IV-PCA increased the rate to 0.37 microg/kg/hr (AUC 0.651) or higher. CONCLUSION: Background infusion rates of fentanyl between 0.12 and 0.67 microg/kg/hr may safely be used without any serious side effects for IV-PCA. In order to approach the most reasonable background infusion rate for effective analgesia without increasing postoperative nausea and vomiting, adding an adjuvant analgesic and an antiemetic should always be considered.