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Observation of Postoperative Analgesia Effects of Patient-controlled Intravenous Analgesia Combined Intercostal Nerve Block after Esophageal Carcinoma Operation

Author: SunPeng
Tutor: WangHuShan
School: Jilin University
Course: Clinical
Keywords: patient-controlled intravenous analgesia intercostal nerve block postop- erative analgesia effects visual analogue scales
CLC: R614.3
Type: Master's thesis
Year: 2011
Downloads: 36
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Abstract

Observation of postoperative analgesia effects of atient-controlled intravenous analgesia combined intercostal nerve block after esophageal carcinoma operationObjective: The aim of this study is to observe the effect of patient- controlled intravenous analgesia combined intercostal nerve block after esophageal carcinoma operation.Methods: Selected 28 patients ASA I ~ II, aged 43 to 69 years old with normal pulmonary function and no basis for pain, undergoing elective thoracic surgical resection of esophageal cancer were randomized into patient-controlled intravenous analgesia group(A group)and patient-controlled intravenous analgesia combined intercostal nerve block group(B group), 14 patients in each group. Intercostal nerve block with mixture 5ml of 1% Ropivacaine 1.6ml and 1%methylene blue 1ml was completed by the thoracic surgeons before the end of the operation, which Including the range of intercostals space of surgical incision and drainage tube and one each in the upper and lower. Postoperative pain management was the same in both groups with patient-controlled intravenous analgesia with sufentanil. Patients were observed after 1 hour, 6 hours, 12 hours, 24 hours and 48 hours of blood pressure, heart rate, blood pressure, pusle oxygen staturation, forced vital capacity, forced expiratory volume in one second, PCA total press times, nausea, vomiting and other adverse reactions and patients satisfaction with analgesia, especially exercise and at rest VAS visual analogue scores.Results: There were no significant differences between the two groups in age, weight, operative time. The VAS scores of group B were lower than that of group A at each time point; The VAS scores of group B at movement were significantly lower than the group A at 1、6 and 12 hours ; then of rest at 1 and 6 hours (P <0.01); The VAS scores of movement of group B at 24 hours, then of rest at 12 hours were significantly lower than those of group A (P <0.05); There were no signifleant differences between the two groups of the VAS scores at other times(P> 0.05). The forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) of group B at 1 hour, 6 hours, 12 hours of were significantly higher than those of group A (P<0.05); There were no signifleant differences between the two groups of FVC and FEV1 at other times and pusle oxygen staturation at all times(P> 0.05). The systolic blood pressure(SBP), diastolic blood pressure(DBP) and heart rate(HR) of group B at 1 hour was significantly lower than those of group A (P <0.05); There were no signifleant differences between the two groups of SBP, DBP and HR. There was only one case of adverse reaction in group B compared with four cases in group A. The group B adverse reaction rate (7.0%) was obviously lower than the group A (28.5%). The PCA total press times during 48 hours of group B was obviously less than that of group A. The analgesic effect of group A evaluated with excellent, good, moderate and poor were 1, 4, 6, 3; compared with group B were 7, 5, 2, 0. The analgesic effect of group B was better than that of group A.Conclusion: The intercostal nerve block with ropivacaine and methylene blue combined patient-controlled intravenous analgesia with sufe- ntanil was significantly improved the analgesic effect of acute posto- perative pain and reduced the total opioid analgesic use. It had a positive effect for early recovery by improving the respiratory function and reducing the incidence of adverse reactions of patients.

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