Analgesic effect of dexmedetomidine combined with flurbiprofen in patient controlled analgesia after radical resection of esophageal cancer

Chen Liang; Wu Xuemin

doi:10.3760/cma.j.issn.1673-4777.2016.06.015

Abstract：Objective To explore the analgesic effect of dexmedetomidine combined with flurbiprofen in patient controlled analgesia (PCA) after radical resection of esophageal cancer.Methods One hundred and twenty patients undergoing radical resection of esophageal cancer were randomly divided into group A,B and C (40 cases in each group).In group A,50 mg flurbiprofen was given 30 min before the end of operation,2.5 μg/kg sufentanil +2 mg tropisetron added in 0.9％ sodium chloride was given in PCA;in group B,50 mg flurbiprofen was given 30 min before the end of operation,2.0 μg/kg sufentanil + 150 mg flurbiprofen + 2 mg tropisetron added in 0.9％ sodium chloride was given in PCA;in group C 50 mg flurbiprofen was given 30 min before the end of operation,1.5 μg/kg sufentanil + 150 mg flurbiprofen + 2.0 μg/kg dexmedetomidine + 2 mg tropisetron added in 0.9％ sodium chloride was given in PCA.The PCA pumps were adjusted as a standard of 100 ml volume,continuous perfusion rate of 2 ml/h,single bolus of 2 ml and lockout time of 15 min.The heart rate (HR),mean artery blood pressure (MAP),oxygen saturation (SpO2),respiratory rate (RR),visual analog scale (VAS) and Ramsay sedation score were recorded before operations (T0),2 h (T1),4 h (T2),8 h (T3),24 h (T4),48 h (T5) after operation;the usages of intraoperative analgesic drugs (including sufentanila and ruifentanyl) and postoperative remedial analgesia drugs were recorded;the pressing times of PCA pump and adverse reactions within 48 h after operation were compared among groups.Results The MAP at T1-T3,the HR at T1-T5 were significantly higher than those at T0 in group A [(89 ± 8),(83 ± 8),(82 ± 7) mmHg vs (77 ± 6) nunHg,(88 ± 10),(87 ±9),(86 ±9),(85 ±8),(83 ±8) times/min vs (79 ±7) times/min] (all P＜0.05);in group B,the MAP at T1-T2 [(79 ± 7),(78 ± 7) mmHg],the HR at T1-T5 [(80 ± 8),(79 ± 8),(79 ± 8),(77 ± 7),(77 ± 7) times/min] were all significantly lower than those in group A at the same time point (all P ＜ 0.05);in group C,the MAP at T1-T3[(78 ±7),(77 ±8),(76 ±7) mmHg] were significantly lower than those in group A at the same time point,the HR at T1-T5[(70 ±8),(69±7),(71 ±7),(71 ±7),(72±7) times/min] were significantly lower than those at T0[(79 ±8) times/min] (all P ＜ 0.05) and those in group A and B at the same time points (all P ＜ 0.05).The RR at each time point after surgery had no significantly differences among groups (P ＞ 0.05).The VAS scores and Ramsay sedation scores in group B and C were significantly lower than those in group A at T1-T3 [VAS scores:(2.8 ±0.5),(2.3 ±0.5) scores vs (3.5 ±0.7) scores;(2.9 ±0.6),(2.4 ± 0.5) scores vs (3.6 ± 0.7) scores;(2.4 ± 0.5),(2.0 ± 0.4) scores vs (2.7 ± 0.6) scores;Ramsay sedation scores:(2.43 ± 0.43),(1.63 ± 0.29) scores vs (3.22 ± 0.51) scores;(2.22 ± 0.28),(1.54 ± 0.42) scores vs (2.82 ± 0.44) scores;(2.02 ± 0.33),(1.48 ± 0.32) scores vs (2.41 ± 0.50) scores],in addition,they were significantly lower in group C than those in group B (all P ＜ 0.05);the VAS scores and Ramsay sedation scores at T4 and T5 were not significantly different among groups (all P ＞ 0.05).The usages of intraoperative analgesic drugs and postoperative remedial analgesia drugs were not significantly different among groups.The pressing time of PCA in group B and C were significantly lower than that in group A within 48 h after operation [(20.4 ±2.2),(14.9 ± 1.2) times vs (26.6±4.2) times],and was significantly less in group C than that in group B (all P ＜ 0.05).The incidence of adverse reactions in group B and C were significantly lower than that in group A [25.0％ (10/40),12.5 ％ (5/40) vs 42.5％ (17/40)] (P ＜ 0.05),but there was no significant difference between group B and C (both P ＞ 0.05).Conclusion Flurbiprofen combined with dexmedetomidine has good analgesic effect after radical resection of esophageal cancer,with less adverse reaction and higher safety.