Effects of different concentrations of nalbuphine hydrochloride mixed with sufentanil for postoperative patient-controlled intravenous analgesia on inflammatory response in patients undergoing gynecological tumor laparotomy

Abstract

Objective To evaluate the effects of different concentrations of nalbuphine hydrochloride mixed with sufentanil for postoperative patient-controlled intravenous analgesia (PCIA) on inflammatory response in the patients undergoing gynecological tumor laparotomy. Methods One hundred and twenty-five patients, aged 22-64 yr, weighing 50-75 kg, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, undergoing elective laparotomy for gynecologic tumors, were divided into 5 groups (n=25 each) by a random number table method: sufentanil 1 μg/ml group (group S), sufentanil 0.75 μg/ml + nalbuphine 0.25 mg/ml group (group N1), sufentanil 0.5 μg/ml + nalbuphine 0.5 mg/ml group (group N2) , sufentanil 0.25 μg/ml + nalbuphine 0.75 mg/ml group (group N3), and nalbuphine 1 mg/ml group (group N4). Postoperative PCA (granisetron 9 mg was added, the PCA solution was diluted to 150 ml in normal saline, a loading dose of 2 ml, background dose of 2 ml/h, a self-controlled dose of 1 ml/time, and a lockout interval of 15 min) was performed.Flurbiprofen 50 mg was intravenously injected for rescue analgesia, maintaining a static visual analog scale score ≤ 4 and a dynamic (cough) visual analog scale score ≤ 6.Venous blood samples were collected from the upper extremity before induction (T1), at 1 h after incision (T2), at the end of operation (T3), and at 24 and 48 h after operation (T4, 5) for determination of serum concentrations of interleukin-6(IL-6), tumor necrosis factor-alpha and IL-10.The effective pressing times of PCIA, requirement for rescue analgesia, development of nausea and vomiting and somnolence, and postoperative anal exhaust time were recorded within 24 h after surgery. Results Compared with group S, the concentrations of IL-6 and tumor necrosis factor-alpha in serum were significantly decreased, and the concentration of IL-10 was increased at T4, 5 in N1 and N2 groups, the anal exhaust time was significantly shortened, and the incidence of nausea and vomiting was decreased in the other groups, the effective pressing times of PCIA and requirement for rescue analgesia were significantly decreased in group N2, and the incidence of somnolence was significantly increased in group N4 (P<0.05). Conclusion Sufentanil 0.5 μg/ml plus nalbuphine hydrochloride 0.5 mg/ml provides good PCIA, effectively reduces inflammatory responses and decreases the occurrence of adverse reactions in the patients undergoing gynecological tumor laparotomy. Key words: Nalbuphine; Sufentanil; Femininity; Neoplasms; Analgesia, patient-controlled; Inflammation