Application effect of opioid-free postoperative patient-controlled analgesia strategy in thoracic endoscopic surgery
Objective To explore the application effect of opioid-free postoperative patient-controlled analgesia strategy in thoracic endoscopic resection of lung lesions.Methods This study is a single center,double-blind,prospective,open label,randomized controlled trial.Ninety patients with lung surgery under thoracic endoscope in the Second Affiliated Hospital of Chongqing Medical University were selected from November 2021 to April 2023,and divided into three groups,according to the random number table method including esketamine and dexmedetomidine(esKDex group,n=30),sufentanil and dexmedetomidine(sFDex group,n=30)and tramadol and dexmedetomidine(TraDex group,n=30).The incidence of postoperative nausea and vomiting(PONV),vital signs related indicators,visual analogue scale(VAS)score,Ramsay sedation(RSS)score,Bruggrmann comfort scale(BCS)score and mini-mental state examination(MMSE)score were compared among the 3 groups within 48 hours after surgery.Results Within 48 h after surgery,the incidence of PONV in esKDex group was lower than that in sFDex group and TraDex group[10.0%(3/30)vs.20.0%(6/30)vs.20.0%(6/30),P<0.001].The VAS scores in esKDex group and sFDex group at 2 h and 4 h after surgery were lower than those in TraDex group(2 h after surgery:P=0.001,0.001;4 h after surgery:P=0.027,0.024).The VAS scores at 24 h and 48 h after surgery were higher than those in TraDex group(24 h after surgery:P=0.008,0.029;48 h after surgery:P=0.005,0.005).The BCS scores of esKDex group and sFDex group at 24 h and 48 h after surgery were lower than those in TraDex group(24 h after surgery:P=0.017,0.007;48 h after surgery:P=0.005,0.007).There was no significant difference between Ramsay scores and MMSE scores among the three groups within 48 h after surgery(P>0.05).Conclusion The strategy of opioid-free postoperative patient-controlled analgesia(esketamine and dexmedetomidine)can reduce the incidence of PONV under the premise of satisfying the sedation and analgesia of patients after thoracic endoscopic surgery.
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