Objective To investigate clinical application and safety evaluation of sedative demulcent anesthesia in therapeutic endoscopic retrograde cholangiopancreatography (ERCP).Methods Totally 1660 patients underwent ERCP at the First Hospital of Lanzhou University were prospectively divided into two groups: venous sedative demulcent group (n=800, using sufentanil and midazolam and propofol continuing infusion) and conventional sedative demulcent group (n=860, using common medicine). The heart rate (HR), respiration (R), blood pressure (BP) and peripheral oxygen saturation (SpO2) of pre-anesthesia, post-anesthesia, during operation and after analepsia in every group were detected. The narcotism was evaluated by Ramsaymin grading method and the related adverse reactions such as cough, restlessness, harmful memory, and abdominal pain after operation were recorded. Results Compared with conventional sedative demulcent group, vital signs of patients in venous sedative demulcent group were more stable. For postoperative adverse reactions, abdominal pain, abdominal distension and nausea and vomiting were respectively 4.4%(35/800), 2.6%(21/800) and 3.6%(29/800) in venous sedative demulcent group, which were respectively higher of the incidence of 36.3%(312/860), 49.0%(421/860) and 53.0%(456/860) in conventional sedative demulcent group (P＜0.01). The postoperative satisfaction and adverse reactions recall between venous sedative demulcent group and conventional sedative demulcent group was respectively significant different (96.9% vs. 2.9%, 4.8% vs. 97.9%, P＜0.01). Conclusion Sufentanil and midazolam and propofol continuing infusion have good effect of sedative demulcent anesthesia, which can be widely used.
ObjectivesTo systematically evaluate the efficacy and safety of dezocine combine with sufentanil (DS) versus sufentanil (S) for postoperative analgesia.MethodsCNKI, WanFang Data, VIP, PubMed, Wiley Online Library and ScienceDirect databases were searched online to collect randomized controlled trials (RCTs) of DS versus S for postoperative analgesia from January 2011 to July 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using Stata13.0 software.ResultsA total of 39 RCTs were included. The results of meta-analysis showed that: DS group had higher scores on VAS at 2 h, 6 h, 12 h, 24 h and 48 h points than S group at the dezocine level of 0.2 mg/kg. At the dezocine level of 0.3 mg/kg, there were no significant differences in scores on VAS at 2 h and 4 h. However, DS group had higher scores at 6 h, 12 h, 24 h and 48 h points. At the dezocine level of 10 mg/kg, there were no significant differences in scores on VAS at each time point in both groups. DS group was superior to S group in " excellent rate” and " good rate” of the analgesic satisfaction of patients. For safety, the incidence of postoperative nausea and vomiting of DS group was lower than S group.ConclusionsThe current evidence shows that dezocine combine with sufentanil have more effects of postoperative analgesia than sufentanil alone, and its incidence of adverse reactions is lower. Due to limited quality and quantity of the included studies, more high-quality studies are needed to verify above conclusions.
【摘要】 目的 觀察不同劑量的舒芬太尼用于剖宮產術后硬膜外自控鎮痛的效果比較。 方法 將2009年4-11月60例硬膜外麻醉下行剖宮產手術術后的患者隨機分為三組，術后鎮痛液A組采用0.125%羅哌卡因復合0.3 μg/mL舒芬太尼；B組為0.125%羅哌卡因復合0.4 μg/mL舒芬太尼；C組0.125%羅哌卡因復合0.5 μg/mL舒芬太尼，觀察三組患者的術后鎮痛效果（視覺模擬法評分，即VAS評分）及不良反應。 結果 A組VAS評分高于B組和C組，B組VAS評分高于C組（Plt;0.05）。三組患者術后惡心嘔吐、運動阻滯、嗜睡及腸蠕動抑制等并發癥無統計學差異（Pgt;0.05）。 結論 0.125%羅哌卡因復合0.5 μg/mL舒芬太尼以4 mL/h持續輸注用于剖宮產術后患者自控硬膜外鎮痛術后疼痛VAS評分最小，患者鎮痛滿意度最高。【Abstract】 Objective To observe the effect of postoperative patient-controlled epidural analgesia (PCEA) with three different doses of sufentanil combined with 0.125% ropivacaine after cesarean section. Methods Data was collected from April 2009 to November 2009. Sixty patients after cesarean section under continuous epidural anesthesia were randomly divided into three different groups.Group A was given sufentanil 0.3 μg/mL and 0.125% ropivacaine for PCEA, group B was given sufentanil 0.4 μg/mL and 0.125% ropivacaine, group C was given sufentanil 0.5 μg/mL and 0.125% ropivacaine. The analgesia effects were evaluated by the visual analogue scales (VAS). Side effects were also recorded. Results The VAS scores were significantly the highest in group A than that in group B and group C, the VAS scores in group B were higher than that in group C (Plt;0.05). The incidence of side effects, such as postoperative nausea and vomiting, lethargy, and pruritus, was not significant among the three groups (Pgt;0.05). Conclusion 0.5 μg/ mL sufentanil and 0.125% ropivacaine recommended for PCEA with background 4 mL/h is safe and effective for patients after cesarean section.
【摘要】 目的 比較舒芬太尼與等效劑量芬太尼在髖關節置換術后患者硬膜外鎮痛的臨床效果。 方法 2006年11月-2008年9月收治的50例硬膜外麻醉下髖關節置換術患者，隨機分為兩組（n=25）。芬太尼組（A組）:芬太尼0.75 mg加0.894%甲磺酸哌卡因20 mL加生理鹽水至100 mL；舒芬太尼組（B組），舒芬太尼75 μg加0.894%甲磺酸哌卡因20 mL加生理鹽水至100 mL硬膜外鎮痛。其中，A組患者于手術結束時，靜脈滴注格拉司瓊3 mg。持續劑量2 mL/h，單次給藥量（PCA）0.5 mL/次，鎖定時間15 min。觀察兩組的鎮痛效果，惡心、嘔吐次數，記錄脈搏血氧飽和度、心率、呼吸的變化。 結果 鎮痛泵開機后，B組各時段鎮靜評分，2分以上者明顯多于A組，鎮痛評分明顯低于A組，有統計學意義（Plt;0.05），兩組術后惡心、嘔吐發生率都較低，組間差異無統計學意義（Pgt;0.05）。兩組4、12、24 h的呼吸頻率和脈搏血氧飽和度差異有統計學意義（Plt;0.05），但48 h的呼吸頻率和脈搏血氧飽和度無統計學意義（Pgt;0.05）。 結論 在等效劑量下，髖關節置換術后患者硬膜外鎮痛，舒芬太尼明顯優于芬太尼。【Abstract】 Objective To compare the clinical effect of epidural analgesia with sufentanil and fentanyl in an equivalent dose after hip replacement. Methods From December 2006 to September 2008, fifty cases of epidural anesthesia after hip replacement were randomly divided into two groups, each group had 25 cases. Group A (fentanyl group): fentanyl mesylate 0.75 mg+0.894% ropivacaine 20 mL+0.9% sodium chloride solution to 100 mL; group B (sufentanil group): sufentanil 75 μg+0.894% ropivacaine mesylate 20 mL+0.9% sodium chloride solution to 100 mL epidural analgesia. Patients in group A received intravenous infusion of granisetron 3 mg at the end of surgery. Continuous dose was 2 mL/h, with the volume of single dose (PCA) 0.5 mL per time and lockout time of 15 minutes. The analgesic effect, nausea, and vomiting frequency were observed, and the pulse oxygen saturation, heart rate, and breathing changes were recorded. Results After boot analgesia, S sedation scores for each phase and pain score in group B were significantly different compared with those in group A (Plt;0.05). Both groups had low incidence of nausea and vomiting, and the difference was not statistically significant (Pgt;0.05). The difference of respiratory rate and pulse oxygen saturation at 4 h, 12 h, 24 h was statistically significant between two groups (Plt;0.05), but at 48 h the difference was not significant (Pgt;0.05). Conclusion In the equivalent dose, epidural analgesia with sufentanil in the patients with hip replacement is superior to fentanyl.
ObjectiveTo evaluate the efficacy and safety of dexmedetomidine combined with dezocine for patient-controlled intravenous analgesia (PCIA) in patients after radical operation for abdominal tumor.
MethodsBetween September 2012 and May 2013, 60 patients (aged 40-60, American Sociaty of Anesthesiologists physical statusⅠ-Ⅱ) undergoing abdominal tumor surgery and asking for PCIA pumps voluntarily were randomly divided into two groups (group D and group DF) with 30 in each group. Patients in group D were given sufentanil 0.25 μg/kg+ dezocine 0.4 mg/kg, which were added into 100 mL 0.9% normal saline, while in group DF, the patients received dexmedetomidine 1.5 μg/kg+ sufentanil 0.15 μg/kg+ dezocine 0.4 mg/kg, which were added into 100 mL 0.9% normal saline. The changes of mean arterial pressure (MAP), heart rate (HR), respiratory rate (RR), the visual analog scale (VAS), Ramsay sedation scale, Bruggrmann analgesia scale (BCS), the efficacy of postoperative analgesia and adverse effects were observed and recorded at the preoperative time (T0), and 2 (T1), 4 (T2), 8 (T3), 24 (T4) and 48 hours (T5) postoperatively.
ResultsHemodynamics in group DF was more stable than that in group D (P<0.05). There were no statically significant differences in terms of VAS and BCS between the two groups at each time point (P>0.05). The Ramsay sedation scale of group DF was better than group D, and the difference was statistically significant (P<0.05). The efficient number of pressing within 48 hours in the two groups was not significantly different (P>0.05). The incidence of nausea, vomiting and drowsiness in group D was more than that of group DF (P<0.05).
ConclusionDexmedetomidine combined with dezocine can provide effective postoperative analgesia with less adverse effects for patients after radical surgery of abdominal tumor, which provides higher satisfaction to the abdominal surgery patients.
