Abstract: 【Abstract】 Objective To investigate the effects of peri-operative esmolol for patients undergoing laparoscopic radical hysterectomy of cervical cancer on remifentanil-induced hyperalgesia. Methods Fifty patients American Society of Anesthesiology (ASA) Ⅰ-Ⅱ undergoing laparoscopic radical hysterectomy of cervical cancer were randomly assigned by a table of random numbers to two groups(n=25). Before the induction of anesthesia, the group esmolol (group Ⅰ), patients were administered 0.5 mg/kg esmolol, 10 μg·kg-1·min-1 maintained to extubation, and the group control (group Ⅱ) patients received normal saline of the same volume. Anesthesia was induced with remifentanil 2 μg/kg, midazolam 0.05 mg/kg, etomidate 0.2 mg/kg, rocuronium 0.6 mg/kg, maintained with propofol 3 mg·kg?蛳1·h?蛳1?蛳6 mg·kg?蛳1·h?蛳1 and remifentanil 0.15 μg·kg?蛳1·min?蛳1?蛳0.5 μg·kg?蛳1·min?蛳1,cisatracurium besilate for injection 0.1 mg·kg?蛳1·h?蛳1 in both groups. Thirty minutes before the expected end of surgery, 1 μg/kg Fentanyl was administered intravenously. At the end of surgery, patients received fentanyl patient controlled intravenous analgesia(PCIA). Peri-incisional pain thresholds were measured for baseline values before operation, at 24 h and 48 h repeated postoperatively. Pain thresholds were established by an detecting meter for pain threshold. The visual analogue scale (VAS) was assessed at 30 min, 6, 24 h after surgery. Total fentanyl consumption was recorded for 24 h and 48 h after surgery. Results peri-incision region pressure pain thresholds were obviously higher at 24 h [(3.21±0.23) kg/cm2] and 48 h [(3.18±0.19) kg/cm2] postoperatively in group Ⅰ than group Ⅱ [(2.69±0.21), (2.62±0.20) kg/cm2] (P<0.05). In group Ⅰ, pain thresholds were higher at 24 h [(3.21±0.23) kg/cm2] and 48 h [(3.18±0.19) kg/cm2] postoperatively compared with preoperative baseline values [(2.93±0.17) kg/cm2](P<0.05). Pain thresholds in group Ⅱ at 24 h [(2.69±0.21) kg/cm2] and 48 h[(2.62±0.20) kg/cm2] postoperatively were lower compared with preoperative baseline values [(2.91±0.18) kg/cm2]. In group I, the VAS scores at 30 min [(4.56±1.36) score], 6 h [(3.64±1.32) score] and 24 h[(2.52±1.08) score] postoperatively were significantly lower compared with group Ⅱ[(5.84±1.70), (4.68±1.41), (3.20±1.12) score] at all evaluation times(P<0.05). The fentanyl consumption was lower at 24 h[(0.53±0.03) mg] and 48 h [(1.09±0.09) mg] postoperatively compared with group Ⅱ[(0.55±0.04), (1.15±0.08) mg] (P<0.05). Conclusions Peri-operative esmolol for patients undergoing laparoscopic radical hysterectomy of cervical cancer may attenuate remifentanil-induced hyperalgesia and reduce the required dosage of the postoperative fentanyl.
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