Dissertation > Medicine, health > Surgery > Surgical operation > Anesthesiology

Clinical Observation of Postoperative Intravenous Analgesia with Flurbiprofen Axetil Injection Combined with Low-Dose Fentanyl Underwent Gastrointestinal Surgery

Author YangZhenDong
Tutor LiGang
School Shandong University
Course Anesthesiology
Keywords Flurbiprofen axetil Fentanyl Postoperative analgesia
CLC R614
Type Master's thesis
Year 2009
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Purpose gastrointestinal surgery analgesic medication generally opioids mainly due to fentanyl from the rapid onset of analgesic effect, is commonly used opioid analgesic drugs, but also nausea, vomiting, drowsiness, respiratory depression adverse reaction. Flurbiprofen axetil injection is a new type of non-steroidal anti-inflammatory analgesic drugs, the analgesic effect by inhibition of prostaglandin synthesis, rapid onset, and by intravenous injection, significantly lower incidence of gastrointestinal damage in other similar drugs. In this study, observed flurbiprofen axetil combined with small doses of fentanyl after gastrointestinal surgery can provide analgesic effects and adverse reactions. The American Society of Anesthesiologists (ASA) grade I - II level, endotracheal intubation general anesthesia for elective gastrointestinal surgery 90 patients (including 26 patients with gastric cancer, 24 cases of colon cancer, 18 cases Gastrojejunostomy 22 cases of intestinal resection), 52 males and 38 females, aged 18-75 years, 45 - 81 kg of body weight. Except for the following cases: severe peptic ulcer bleeding, severe liver, kidney and blood system dysfunction who have a history of asthma, a history of allergy to the components of preparations, are using norfloxacin, enoxacin, Los Lomefloxaxin three quinolone antibiotics, breastfeeding and pregnant women. All patients were randomly divided into three groups of 30 cases. Burglary, routine monitoring of ECG (Electrocardiogram ECG), noninvasive mean arterial pressure (MeanArterial Pressure MAP), heart rate (HR), pulse oximetry (SpO2). All patients underwent preoperative conventional intramuscular injection of the luminal sodium 10 mg and atropine 0.5 mg were inhalation anesthesia. Induction of general anesthesia: midazolam 0.03 to 0.04 mg / kg propofol 1 to 2 mg / kg, fentanyl 2 to 4μg/kg vecuronium 0.1 mg / kg. Maintenance of anesthesia: the micro pump continuous infusion of vecuronium, propofol, remifentanil, and continued with isoflurane, surgery is no longer fentanyl. Surgery, intravenous injection of the antiemetic tropisetron of Qiong 5 mg. Surgery were randomly divided into A, B, C group, n = 30 cases depending on the method of administration. Group A: fentanyl 1.0mg 0.9% sodium chloride solution to 100 mL; B Group: flurbiprofen axetil 100 mg fentanyl 1.0 mg 0.9% sodium chloride solution to 100 mL; C Group: flurbiprofen ester 100 mg fentanyl 0.5 mg, 0.9% sodium chloride solution to 100 mL. Three groups of surgery, intravenous loading dose of fentanyl 50 ug reconnect PCIA pump. Analgesia pump parameter settings: continuous infusion volume of 2 mL / h, a single pressing dose volume of 0.5 mL, lock time to 15 minutes. OUTCOME MEASURES record three groups of patients, the general situation, the follow-up observation and recorded after 2, 4, 8, 12 and 24 h of the indicators: 1) at rest (supine for 15 min) and cough (cough continuously ) pain visual analog scale (visual analogue scales, VAS) score; 2) recorded 24 h analgesia pressing times; 3) record nausea and vomiting, drowsiness, respiratory depression, adverse reactions such as abnormal bleeding. Results 1. General three groups of patients in gender, age, weight, operation time was no significant difference (P> 0.05), there was no patient interrupted due to ineffective analgesia or sedation analgesia. (2) at each time point of the postoperative VAS score difference among the three groups was not statistically significant (P> 0.05), the pain got worse after coughing, VAS score and time points resting difference was not statistically significant. (3) within 24 h after a median number of compressions A group 13, group B 9, C 11, no statistically significant difference among the three groups (P> 0.05). (4) Comparison of the incidence of adverse reactions after the group C patients within 24 h nausea, sleepiness were significantly lower than A, B, and the difference was statistically significant (P <0.05), and A group 2 patients respiratory depression, and three groups of patients had no abnormal bleeding and other adverse reactions. Conclusion We flurbiprofen axetil combined with fentanyl for postoperative PCIA, results showed that the dosage of fentanyl significantly reduced, but compared to the analgesic effect of fentanyl alone group, and complications significantly less than the separate fentanyl group; has more advantages in reducing the gastrointestinal tract and respiratory depression; PCIA fentanyl can significantly reduce the dosage to avoid opioid consumption due to increased nausea and vomiting, lethargy and even respiratory depression the incidence and improve the quality of postoperative analgesia. Relative to the separate application of fentanyl, flurbiprofen axetil combined with small doses of fentanyl used in gastrointestinal surgery postoperative analgesia the same effect, but can be effective in reducing the amount of fentanyl, reduce the incidence of adverse reactions.

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