Xiang Xiaobing, Yuan Xiaohong, Lian Yanhong, Fang Jun, Wu Yingli
Zhejiang Cancer Hospital, Hangzhou, Zhejiang, China.
Medicine (Baltimore). 2018 Feb;97(7):e9911. doi: 10.1097/MD.0000000000009911.
Problems like postoperative pain are still common phenomena after general anesthesia. Oxycodone hydrochloride is a semisynthetic opioid with a safe and excellent therapeutic effect on visceral pain. Flurbiprofen axetil has the efficacy of targeted analgesia. We hypothesize that different doses of oxycodone hydrochloride combined with flurbiprofen axetil would generate great results on postoperative intravenous analgesia in lower abdominal patients.
In the clinical trial, 90 American Society of Anesthesiologists I or II patients scheduled for elective general anesthesia were randomly divided into 3 groups, 30 cases in each group. Group I: oxycodone hydrochloride 0.5 mg/kg + flurbiprofen axetil 150 mg, group II: oxycodone hydrochloride 0.75 mg/kg + flurbiprofen axetil 150 mg, group III: oxycodone hydrochloride 1.0 mg/kg + flurbiprofen axetil 150 mg. Dilute them with 0.9% saline to 150 mL, respectively, with the background dose of 2 mL/h, patient-controlled analgesia 2 mL per time, with an interval of 10 min, and the loading dose of 0.1 mL/kg. Record the preoperative situation, 24 h (T0) before surgery, postoperative situation, 1 h (T1), 4 h (T2), 8 h (T3), 12 h (T4), 24 h (T5), 48 h (T6), 72 h (T7) after the surgery, including the mean arterial pressure, heart rate, saturation of pulse oximetry, static and dynamic pain rating (NRS) and Ramsay sedation score, effective pressing and total pressing ratio (referred to as the pressing ratio), patient satisfaction, and occurrence of adverse reactions.
There was no significant statistic difference in mean arterial blood pressure, heart rate, arterial oxygen saturation, and adverse reactions among the 2 groups at each time point (P > .05). Compared with group I, the static NRS rating in group II and group III were significantly lower than that in group I (P < .05) from T1 to T5. The dynamic NRS rating of group II from T1 to T4 and that of group III from T1 to T5 were significantly lower (P < .05). The effective pressing and total pressing ratio was significantly higher (P < .05). There was no significant statistic difference between group II and group III in NRS rating and the effective pressing and total pressing ratio (P > .05). Compared with group III, the Ramsay sedation scores of group I and group II were significantly lower from T1 to T4 (P < .05).
The dose of 0.75 mg/kg oxycodone hydrochloride combined with flurbiprofen axetil can provide safe and effective postoperative analgesia for lower abdominal patients, with fewer adverse reactions.
术后疼痛等问题仍是全身麻醉后常见的现象。盐酸羟考酮是一种半合成阿片类药物,对内脏疼痛具有安全且良好的治疗效果。氟比洛芬酯具有靶向镇痛的功效。我们假设不同剂量的盐酸羟考酮联合氟比洛芬酯对下腹部手术患者术后静脉镇痛会产生良好效果。
在该临床试验中,将90例拟行择期全身麻醉的美国麻醉医师协会(ASA)分级为I或II级的患者随机分为3组,每组30例。I组:盐酸羟考酮0.5mg/kg + 氟比洛芬酯150mg;II组:盐酸羟考酮0.75mg/kg + 氟比洛芬酯150mg;III组:盐酸羟考酮1.0mg/kg + 氟比洛芬酯150mg。分别用0.9%生理盐水稀释至150mL,背景剂量为2mL/h,患者自控镇痛每次2mL,间隔10min,负荷剂量为0.1mL/kg。记录术前情况、手术前24h(T0)、术后情况,即术后1h(T1)、4h(T2)、8h(T3)、12h(T4)、24h(T5)、48h(T6)、72h(T7),包括平均动脉压、心率、脉搏血氧饱和度、静息和动态疼痛评分(NRS)以及Ramsay镇静评分、有效按压次数与总按压次数之比(简称按压比)、患者满意度和不良反应的发生情况。
两组在各时间点的平均动脉血压、心率、动脉血氧饱和度及不良反应方面均无显著统计学差异(P>0.05)。与I组相比,II组和III组在T1至T5时段的静息NRS评分显著低于I组(P<0.05)。II组在T1至T4时段的动态NRS评分及III组在T1至T5时段的动态NRS评分均显著更低(P<0.05)。有效按压次数与总按压次数之比显著更高(P<0.05)。II组和III组在NRS评分及有效按压次数与总按压次数之比方面无显著统计学差异(P>0.05)。与III组相比,I组和II组在T1至T4时段的Ramsay镇静评分显著更低(P<0.05)。
0.75mg/kg盐酸羟考酮联合氟比洛芬酯可为下腹部手术患者提供安全有效的术后镇痛,且不良反应较少。