Effects of different analgesic methods on stress response and anxiety of surgical patients with lower limb fracture / 中华创伤杂志

ABSTRACT

Objective To observe the effect of different analgesic methods including patient controlled epidural analgesia (PCEA) and patient controlled intravenous analgesia (PCIA) on stress response and anxiety in surgical patients with lower limb fracture. Methods A total of 120 surgical patients with lower limb fractures were employed and divided randomly into Groups PCEA, PCIA and C (40per group). All patients were anaesthetized by using combined spinal-epidural anesthesia. After operation, PCEA and PCIA were applied in the patients of Groups PCEA and PCIA, respectively. No analgesic method was employed in the Group C. The dynamic indices including mean blood press (MAP) and heart rate (HR), blood serum cortisol (COR) and blood sugar (BS) were measured at different time points,ie, T0 ( pre-anesthesia), T1 ( the end of the operation), T2 (24 hours after operation) and T3 (48 hours after operation). The visual analogue pain score was conducted at time points of T1, T2 and T3. The measurement of anxiety score was done at pre-operation and at days 1 and 7 after operation. Results There were no significant changes in HR and MAP of Groups PCEA and PCIA (P＞0.05, compared with T0) at every time point after operation. Whereas, HR and MAP of Group C were increased at time points of T1 and T2 (P ＜ 0.05, compared with T0 ), with statistical difference compared with Groups PCEA and PCIA at the same time points (P ＜ 0.05 ). VAS in Group PCEA was lower than that in Group PCIA at time points of T2 and T3 ( P ＜ 0.05). Meanwhile, VAS in Groups PCEA and PCIA was lower than that in Group C (P＜0. 05). COR and BS in Group PCEA were significant lower than those in group PCIA at time points of T2 and T3 (P ＜ 0. 05 ). Meanwhile, COR and BS in Groups PCEA and PCIA was lower than that in Group C (P＜0.05 or ＜0.01 ). Moreover, the changes were more significant in Group PCIA than that in Group PCEA (P ＜ 0. 05 ). The anxiety score in Groups PCEA and PCIA was lower than that in Group C (P ＜ 0.05). Conclusions Two analgesic methods of PCEA and PCIA can provide safe and effective postoperative analgesia and attenuate the stress response and anxiety in surgical patients with lower limb fracture. Meanwhile, PCEA takes more advantages than PCIA.