Effect of butorphanol combined with dexmedetomidine on postoperative hyperalgesia induced by remifentanil / 中华麻醉学杂志

ABSTRACT

Objective To evaluate the effect of butorphanol combined with dexmedetomidine on postoperative hyperalgesia induced by remifentanil in patients.Methods One hundred and twenty patients,of ASA physical status Ⅰ or],aged 20-64 yr,weighing 45-88 kg,undergoing elective gynecological laparoscopic surgery,were randomly allocated into 4 groups (n =30 each) using a random number tablecontrol group (group C),butorphanol group (group B),dexmedetomidine group (group D) and dexmedetomidine + butorphanol group (group B+D).In group D,dexmedetomidine 1.0 μg/kg was infused at 10 min before induction of anesthesia,followed by continuous infusion at 0.7 μg·kg 1·h-1 until the end of operation.In group C,the equal volume of normal saline was given instead before skin incision.In group B,butorphanol 20 μg/kg was injected immediately before skin incision.In group B+D,dexmedetomidine 0.5 μg/kg was infused at 10 min before induction of anesthesia,followed by continuous infusion at 0.5 μg· kg-1 · h-1 until the end of operation,and butorphanol 15 μg/kg was injected immediately before skin incision.Anesthesia is induced with iv midazolam 0.05 mg/kg,sufentanyl 0.2-0.3 μg/kg,rocuronium 0.7 mg/kg and propofol 2.0 mg/kg.After tracheal intubation,all the patients are mechanically ventilated,and PETCO2 was maintained at 35-45 mmHg.Anesthesia was maintained with iv infusion of remifentanil 0.3 μg · kg-1 · min 1 and propofol 4-6 mg·kg 1·h-1 and intermittent iv boluses of rocuronium 0.3 mg/kg.BIS value was maintained at 40-60.Patient-controlled intravenous analgesia (PCIA) with sufentanil was used after operation,and VAS score was maintained ≤ 3.At 30 and 60 min and 6,12,24 and 48 h after operation,the sufentanil consumption was recorded.The development of bradycardia and hypotension during operation and postoperative nausea and vomiting,dizziness and somnolence was recorded.Results Compared with group C,the sufentanil consumption and incidence of nausea and vomiting were significantly decreased in B,D and B+D groups,the incidence of dizziness and somnolence was increased in group B,and the incidence of bradycardia and hypotension was increased in group D.There was no significant difference in sufentanil consumption between B,D and B+D groups.The incidence of dizziness and somnolence was significantly lower in group B + D than in group B.The incidence of bradycardia,hypotension and somnolence was significantly lower in group B + D than in group D.Conclusion Butorphanol combined with dexmedetomidine provides better efficacy than either alone in reducing postoperative hyperalgesia induced by remifentanil in patients.