子宫切除术后舒芬太尼病人自控-靶控镇痛的安全性和有效性

Objective To investigate the efficacy and safety of patient-controlled analgesia (PCA) with target controlled infusion (TCI) of sufentanil after abdominal total hysterectomy. Methods Sixty ASA I or II patients aged 20-59 yr weighing 45-75 kg undergoing elective abdominal total hysterectomy were randomly allocated into 3 groups of 20 patients each. The initial target plasma concentration (CP ) of sufentanil was set at 0.08 μg/L in group I and II and at 0.1 μg/L in group Ⅲ . The operation was performed under combined spinal-epidural anesthesia with 0.75% bupivacaine (for spinal) and 2% lidocaine (for epidural). The epidural catheter was removed after operation. TCI of sufentanil was started after operation when the patients felt no pain (VAS = 0) in group I and when VAS ≥ 2 in group Ⅱ and Ⅲ . The lockout interval was set at 6 min. If the patients pressed the button once, the target CP increased by 0.005 μg/L. If the button was pressed 3 times successively within 20 s, the target CP increased by 0.008 μg/L. If the button was not pressed for 80 min, the target CP decreased by 0 .005 μg/L automatically. VAS scores, BIS values, MAP, HR, SpO2 and RR were recorded immediately before (T0) and at 1, 2, 4, 8, 16, 24 h (T1-6) after TCI was started. The number of attempts (D1) and successfully delivered doses (D2) was recorded. The total amount of sufentanil administered and side effects were recorded during the 24 h after operation. Results The analgesia was satisfactory in all 3 groups. The VAS scores were < 3 and significantly higher in group Ⅱ and Ⅲ than in group I . The total amount of sufentanil administered during the 24 h after operation was significantly larger in group II and HI than in group I . The D1 and D2 were significantly larger during the 0-2 h after operation in group Ⅱ and Ⅲ than in group I .Tachycardia, bradycardia, respiratory depression, hypotension and over-sedation were not observed. Conclusion PCA with TCI of sufentanil is effective and safe for postoperative analgesia. It is better to start PCA-TCI before the patient feels pain after operation with the initial target CP set at 0.08 μg/L.

Efficacy and safety of patient-controlled analgesia with target controlled sufentanil infusion after abdominal total hysterectomy