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ObjectiveTo evaluate the effects of parecoxib on efficacy of patient-controlled epidural analgesia(PCEA) with different doses of morphine after cesarean section.MethodsThree hundred ASA Ⅰ or Ⅱ parturients at full term aged 20-40 yr weighing 54-89 kg undergoing elective cesarean section were randomly divided into 3 morphine groups-regular,median and small dose (groups Ⅰ,Ⅱ[ and Ⅲ) ( n ＝ 100 each).Each group was further divided into 2 subgroups ( n ＝ 50 each):parecoxib group (groups P1.2.3 ) and control group (groups C1,2.3 ).In groups P1.2.3 psrecoxib 40 mg was administered iv at the end of operation while in groups C1.2.3 normal saline (NS) was administered instead of parecoxib.Groups Ⅰ,Ⅱ and Ⅱ received a loading dose of morphine 2.0/1.5/1.0 mg+ 0.15％ ropivacaine 8 ml respectively.The PCEA solution contained morphine 3.0/2.0/1.5mg+ ropivacaine 150 mg + granisetron 3 mg+ dexamethasone 5 mg in 100 ml of NS in groups Ⅰ,Ⅱ,and Ⅲ respectively.PCEA pump was set up with a background infusion of 2 ml/h,and a bolus dose of 0.5 ml with a lockout-interval of 15 min.VAS was used to assess intensity of pain (0 ＝ no pain,10 ＝ worst pain).VAS score ≤4 was considered as effective analgesia.Adverse effects including nausea and vomiting and pruritus were recorded.ResultsThere was no significant difference in the rate of effective analgesia between groups P1,P2 and C1,C2 The rate of effective analgesia during movement was significant higher in group P3 than in group C3.The incidence of nausea and vomiting and pruritis were significantly lower in group P3 than in groups P1 and P2.Conclusion Parecoxib can enhance the efficacy of PCEA with small dose of morphine.
ABSTRACT
Objective To investigate the regulation effect of bispectral index (BIS) on the depth of total intravenous anesthesia (TI-VA) by comparing with regulating the depth of anesthesia according to the changes of hemodynamics. Methods 60 ASA Ⅰ～Ⅱ patients undergoing laparoscopic cholecystectomy (LC) were randomly assigned into controlled group (group C) and trial group (group T) ,with 30 patients in each group, according to the rules of regulating the titration of propofol during TIVA. The target of group C was to keep SBP/DBP 100 ～ 140mmHg/60 ～ 89mmHg and that of group T was to keep BIS 40 ～ 60 during anesthesia. The measure indexes included SBP/DBP, HR, BIS, total dosis of Propofol, time to extubate, time to leave operating room and OAA/S (observer's assessment of alert-ness/sedation). After operation, we evaluated whether awareness during surgery happens. Results As compared with group C, there were higher SBP/DBP and BIS in group T after induction of anesthesia, during aeroperitonia, immediately after finishing operation and just before extubating endotracheal catheter, but less dosis of propofol and less time of extubation and leaving operating room in group T. The differences had significance (P <0.01). There were no significant differences in the changes of HR between two groups (P >0.05) and no awareness during surgery happened in both groups. Conclusion TIVA regulated by BIS during LC can decrease the dosis of propofol, accelerate the recovery from anesthesia and avoid extremely deep anesthesia and awareness during surgery.
ABSTRACT
Objective To investigate the influence of Bupivacaine injection speed on blood pressure of patients undergoing cesarean section.Methods 90 patients(ASAⅠ-Ⅱ)who underwent cesarean section were selected with combined spinal-epidural anesthesia were divided randomly into three groups(20 for each).0.5% bupivacaine 1.4ml(7mg),the speed of injection in group A,group B and group C is 10 seconds,20 seconds,30 seconds.Systolic blood pressure(SBP),Diastolic blood pressure(DBP)and Heart rate(HR)were recorded before anesthesia and 5min,10min,15min and 30min after anesthesia.Cases need to be added epidural drug were all recorded.Results The age,body length and body weight in the three groups has no significant difference,location of injection and posture were same.The best effect of anesthesia was founded in group B,blood pressure(BP)and HR was stable.The effect of anesthesia was better but BP and HR were obviously descent in group A.The block level of anesthesia was unsatisfactory and need to add epidural drug in group C.Conclusion The injection speed of 0.5% bupivacaine 1.4ml in combined spinal-epidural anesthesia is suitable of 20 seconds when patients underwent cesarean section.