Clinical trial of ropivacaine combined with sufentanil in the treatment of patients undergoing thoracoscopic lobectomy
Objective To observe the effects of whole-course epidural analgesia with ropivacaine injection and sufentanil injection on hemodynamics,stress response and postoperative pain in patients undergoing thoracoscopic lobectomy.Methods Patients who underwent thoracoscopic lobectomy were divided into the treatment group and the control group according to the cohort method.Both groups underwent epidural puncture and catheterization before surgery.The control group was given bolus injection of 10 mg of 0.125％ropivacaine hydrochloride injection and 0 9％NaCl injection(8 mL in total)via epidural catheter.The treatment group was given bolus injection of 10 mg of 0.125％ropivacaine hydrochloride injection and 4 μg of 0.5 μg·mL-1 sufentanil citrate injection(8 mL in total)via epidural catheter.Analgesia was maintained with the same concentration of drugs during the surgery.The epidural analgesia pump was used before closing the pleura.The analgesic formula for the control group consisted of 400 mg of 0.125％ropivacaine hydrochloride injection,and the analgesic formula for the treatment group consisted of 400 mg of 0.125％ropivacaine hydrochloride injection and 0.5 mg of 0.5 μg·mL-1 sufentanil citrate injection.Changes in hemodynamic indicators[heart rate(HR),mean arterial pressure(MAP)],serum epinephrine(E),norepinephrine(NE)and cortisol(Cor)during surgery,occurrence of postoperative acute pain,postoperative remedial analgesia,and chronic pain were compared between the two groups.Safety was evaluated.Results A total of 80 patients were enrolled in the study,with 38 in the control group and 42 in the treatment group.The heart rates(HR)of the treatment and control groups were(80.35±9.62)and(88.24±10.35)beat·min-1 at immediate tracheal intubation(T1);and their mean arterial pressures(MAP)were(95.07±8.51)and(98.46±9.05)mmHg respectively.At skin incision(T2),HR of the treatment and control groups were(75.33±9.21)and(80.65±10.63)beat·min-1,respectively;MAP were(94.33±8.43)and(99.06±6.58)mmHg,respectively.Post-operation(T4),serum levels of E in the treatment and control groups were(53.17±9.79)and(60.79±8.58)ng·L-1;NE levels were(52.33±8.22)and(59.96±8.89)ng·L-1;Cor levels were(22.75±4.63)and(28.64±5.02)mg·L-1.At 24 hours post-operation(T5),serum levels of E in the treatment and control groups were(54.27±9.15)and(62.28±8.33)ng·L-1;NE levels were(55.34±9.18)and(62.07±9.58)ng·L-1;Cor levels were(24.19±4.52)and(30.57±4.79)mg·L-1.The incidences of agitation post-operation were 7.14％(3 cases/42 cases)and 23.68％(9 cases/38 cases),and the time to patient controlled epidural analgesia(PCEA)press was(13.67±2.74)and(11.35±2.28)h,respectively.The cumulative rescue analgesic dose within 72 h post-operation were(120.73±34.36)and(156.35±36.79)mg,respectively.Statistical analysis showed significant differences between the treatment and control groups in all these indicators(all P＜0.05).The total incidences of adverse drug reactions in the treatment group and the control group were 30.95％(13 cases/42 cases)and 23.68％(9 cases/38 cases),without statistically significant difference between the groups(all P＞0.05).Conclusion Applying ropivacaine combined with sufentanil in whole-course epidural analgesia for patients undergoing thoracoscopic lobectomy is conducive to maintaining perioperative hemodynamic stability,alleviating surgical stress and postoperative pain,and reduce the incidence of postoperative agitation.
万方数据
维普
