Efficacy of butorphanol mixed with different doses of hydromorphone in improving PCIA after secondary cesarean section / 中华麻醉学杂志

ABSTRACT

Objective:To evalaute the efficacy of butorphanol mixed with different doses of hydromorphone in improving patient-controlled intravenous analgesia (PCIA) after secondary cesarean section.Methods:Two hundred American Society of Anesthesiologists physical status Ⅱsingleton pregnant parturients, aged 18-45 yr, at 37-42 week gestation, with body mass index≤30 kg/m 2, undergoing elective secondary cesarean section under combined spinal-epidural anesthesia, were allocated to one of 4 groups ( n=50 each) using a random number table method: butorphanol (group B) and butorphanol mixed with different doses of hydromorphone groups (group BH 1, group BH 2 and group BH 3). Flurbiprofen 50 mg, butorphanol 1 mg and granisetron 3 mg were intravenously injected after delivery during operation.The analgesic pump was connected and turned on at the end of operation.The PCIA solution contained butorphanol 0.24 mg/kg and granisetron 6 mg in group B, butorphanol 0.24 mg/kg and hydromorphone 0.06 mg/kg and granisetron 6 mg in group BH 1, butorphanol 0.24 mg/kg and hydromorphone 0.09 mg/kg and granisetron 6 mg in group BH 2, butorphanol 0.24 mg/kg and hydromorphone 0.12 mg/kg and granisetron 6 mg in group BH 3.The PCIA solution was diluted with normal saline to 150 ml, and the patient-controlled analgesia (PCA) pump was set up to deliver a 3.0 ml bolus dose with a 15-min lockout interval and background infusion at 2.5 ml/h in all the four groups.The degree of pain was evaluated using the VAS score.When the VAS score>5 points after pressuring analgesia pump at rest, flurbiprofen axetil 50 mg was intravenously injected for rescue analgesia.VAS scores during movement, at rest and during uterine contraction and observer′s assessment of alertness/sedation scale score were recorded at 3, 6, 24 and 48 h after operation.The requirement for rescue analgesia, effective pressing times of PCA, overall satisfaction score, OAA/S score<5, adverse reactions and time to the first flatus were recorded within 48 h after operation. Results:Compared with group B, VAS scores in different states were significantly decreased after operation, the effective pressing times of PCA were decreased within 48 h after surgery, and the overall satisfaction score was increased in BH 1, BH 2 and BH 3 groups ( P<0.05). Compared with group BH 1, no significant change was found in VAS score in different states after operation in group BH 2 ( P>0.05), and VAS score was significantly decreased at rest after operation in group BH 3 ( P<0.05). There was no significant difference in VAS scores between group BH 2 and group BH 3 ( P>0.05). There were no significant differences in the requirement for rescue analgesia, effective pressing times of PCA and overall satisfaction of the puerperae among BH 1, BH 2 and BH 3 groups ( P>0.05). There was no significant difference in the time to the first flatus after operation, requirement for rescue analgesia and incidence of observe′s assessment of alterness/sedation scale score<5 and adverse reactions among the four groups ( P>0.05). Conclusions:Compared with butorphanol alone, butorphanol mixed with hydromorphone is helpful in reducing maternal pain and improving the overall satisfaction, with fewer adverse reactions.Butorphanol 0.24 mg/kg mixed with hydromorphone 0.09 mg/kg is recommended.