Efficacy of dexmedetomidine for improvement of postoperative analgesia with sufentanil in pediatric patients with a large area of burn after tangential excision and skin grafting / 中华麻醉学杂志

ABSTRACT

Objective To evaluate the efficacy of dexmedetomidine for improvement of postoperative analgesia with sufentanil in pediatric patients with a large area of burn after tangential excision and skin grafting.Methods Forty-two pediatric patients of both sexes with a large area of burn,of American Society of Anesthesiologists physical status Ⅱ or Ⅲ,aged 2-10 yr,weighing 13-36 kg,scheduled for elective tangential excision and skin grafting under combined propofol-remifentanil-sevoflurane anesthesia,were randomly divided into 2 groups (n=21 each) using a random number tablesufentanil group (group Suf) and dexmedetomidine plus sufentanil group (group Dex-Suf).The patient-controlled intravenous analgesia (PCIA) was used for postoperative analgesia.PCIA solution contained sufentanil 2 μg/kg and granisetron 100 μg/kg in 100 ml of normal saline in group Suf,and contained dexmedetomidine 2.5 μg/kg,sufentanil 1.5 μg/kg,and granisetron 100 μg/kg in 100 ml of normal saline in group Dex-Suf.The PCA pump was set up with a 0.5 ml bolus dose,a 15 min lockout interval and background infusion at a rate of 2 ml/h after a loading dose of sufentanil 0.1 μg/kg.When Faces Pain Scale score＞2,sufentanil 0.1 μg/kg was injected intravenously as rescue analgesic.The consumption of sufentanil was recorded within 48 h after operation.Ramsay sedation scores at static and dynamic (during dressing changes) conditions were assessed after operation.The parents' satisfaction,requirement for rescue analgesics and incidence of adverse reactions such as agitation,nausea and vomiting were recorded after operation.Results Compared with group Suf,Ramsay sedation scores at static and dynamic conditions and patients' satisfaction scores were significantly increased,and the consumption of sufentanil,requirement for rescue analgesics and incidence of agitation,nausea and vomiting were significantly decreased after operation in group Dex-Suf (P＜0.05).Conclusion Dexmedetomidine significantly improves postoperative intravenous analgesia with sufentanil in the pediatric patients with a large area of burn after tangential excision and skin grafting,and combination of dexmedetomidine and sufentanil is recommended for this type of pediatric patients.