Effect of different doses remifentanil on gynecologic laparoscopic postoperative hyperalgesia / 中国医师进修杂志

ABSTRACT

Objective To explore the effect of different doses remifentanil on hyperalgesia and the analgesic effect of gynecological laparoscopic operation.Methods Ninety gynecologic laparoscopic operation patients were divided into A group,B group and C group by random digits table method with 30 cases each.The anesthesia induction in A group and B group was intravenous injection remifentanil 1.5 μ g/kg,propofol 2 mg/kg,cisatracurium 0.2 mg/kg,and in C group was intravenous injection fentanyl 3 μ g/kg,propofol 2 mg/kg,cisatracurium 0.2 mg/kg.The maintenance of anesthesia in A group was infusion of remifentanil 0.3 μ g/ (kg· min),in B group was infusion of remifentanil 0.2 μ g/ (kg· min),and in C group was infusion of fentanyl 2 μ g/kg.The operation time,anesthesia time,time to extubation,intraoperative doses of propofol and remifentanil (A group and B group) were recorded.The visual analogue score (VAS) before operation and 15,30,60,120,240 min after extubation were recorded.The analgesia time,number of analgesia and adverse reaction after extubation were observed.Results There were no statistical differences in operation time and anesthesia time among 3 groups (P ＞ 0.05).The extubation time in A group and B group was significantly shorter than that in C group:(5.9 ± 2.7) and (6.1 ± 2.3) min vs.(9.6 ± 3.3) min,the dose of propofol in A group was significantly lower than that in B group and C group:(461.3 ± 69.7) mg vs.(543.4 ± 101.9) and (552.5 ± 93.8) ng,the dose of remifentanil in A group was significantly higher than that in B group:(1.12 ± 0.33) mg vs.(0.71 ± 0.1 l) mg,there were statistical differences (P＜ 0.05).The VAS 15,30,60,120,240 min after extubation in 3 groups were significantly higher than those before operation,A group:(7.3 ± 1.2),(7.4 ± 1.3),(6.5 ± 0.8),(4.5 ± 0.6),(4.1 ± 0.3) scores vs.(1.2 ± 0.3) scores,B group:(6.4 ± 1.5),(6.6 ± 1.1),(5.3 ± 0.4),(4.6 ± 0.3),(4.0 ± 0.4) scores vs.(1.5 ± 0.4) scores,C group:(3.4 ± 0.5),(4.2 ± 0.8),(4.1 ± 0.6),(3.8 ± 0.7),(3.8 ± 0.6) scores vs.(1.4 ± 0.2) scores,there were statistical differences (P ＜ 0.05).The VAS 15,30,60 min after extubation in A group were significantly higher than those in B group,and the VAS 15,30,60,120 min after extubation in A group and B group were significantly higher than those in C group,there were statistical differences (P ＜ 0.05).There was no statistical difference in VAS 240 min after extubation among 3 groups (P ＞ 0.05).The number of analgesia in A group,B group and C group were 28,29 and 3 cases,and the analgesia time were (16.1 ± 4.6),(17.9 ± 5.8) and (68.5 ± 10.l) min,there were statistical differences (P＜ 0.05),there were no statistical differences between A group and B group (P＞ 0.05),and there were statistical difference between A group,B group and C group (P ＜ 0.05).There was no statistical difference in adverse reaction among 3 groups (P ＞ 0.05),and there was no respiratory depression in 3 groups.Conclusion The degree of hyperalgesia is related to the dose of remifentanil during gynecologic laparoscopic operation.