Effects of patient-controlled analgesia with hydromorphone or sufentanil on postoperative pulmonary complications in patients undergoing thoracic surgery: a quasi-experimental study

Abstract

ObjectiveTo compare the analgesic effects of patient-controlled intravenous analgesia (PCA) with hydromorphone and sufentanil after thoracic surgery on postoperative pulmonary complications (PPCs).MethodsA total of 142 patients who were scheduled for thoracic surgery were randomly allocated to receive PCA with hydromorphone (group A: experimental group): hydromorphone 0.2 mg/kg + dezocine 0.5 mg/kg + ramosetron 0.6 mg diluted with normal saline to 200 mL; or with sufentanil (group B: control group): sufentanil 3.0μg/kg + dezocine 0.5 mg/kg + ramosetron 0.6 mg diluted with normal saline to 200 mL. The parameters of intravenous analgesia pump were set as background dose 4 ml/h, PCA dose 1 mL, locking time 15 min. Pain NRS (numerical rating scale), Ramsay sedation score, nausea or vomiting score were evaluated at 0 h, 6 h, 12 h, 24 h, 48 h after operation. The cases of PPCs (atelectasis, pulmonary infection, respiratory failure), CRP (C-reaction protein) and inflammatory cells (white cell count and percentage of neutrophils) and blood gas analysis at 12 h after operation, length of ICU and postoperative stay were recorded for each patient.ResultsData of 136 patients were analyzed. Compared with group B (4[IQR:2,2]), the pain NRS in group A (2[IQR:4,4]) was significantly lower at 6 h after operation (P = 0.000). The CRP in group A (69.79 ± 32.13 mg/L) were lower than group B (76.76 ± 43.42 mg/L) after operation, but the difference was not significant (P = 0.427). No difference of nausea or vomiting was found between group A (7.3%) and group B (5.8%) postoperatively (P = 0.999). The PPCs were happened in 11 patients in group A (16.2%) and 22 patients in group B (32.4%) and the difference between two groups was significant (P = 0.027). Seven patients in group A (10.3%) and eighteen patients in group B (26.5%) had clinical evidence of pneumonia and the difference between two groups was significant (P = 0.014). The length of ICU and postoperative stay in group A were 2.73 h and 1.82 days less than group B respectively but the differences were not significant (P = 0.234, P = 0.186 respectively).ConclusionCompared with sufentanil, hydromorphone may provide better postoperative analgesic effect with less pulmonary complications for patients undergoing thoracic surgery, and it may accelerate patients’ rehabilitation.Trial registrationRandomized Controlled Trials ChiCTR1800014282c. Registered 3 January 2018.

Hydromorphone Protects against CO2 Pneumoperitoneum-Induced Lung Injury via Heme Oxygenase-1-Regulated Mitochondrial Dynamics

“…In addition to exerting analgesic effects, it has been shown that pretreatment with hydromorphone significantly reduces the levels of ROS in mouse glial cells under ischemic conditions and that the μ , δ , κ opioid receptors participate in the antioxidative effects of hydromorphone on glial cells [ 20 ]. Additionally, when used in postoperative pain management, hydromorphone had better anti-inflammatory effects than other sufentanil in patients who received thoracic surgery, as shown by lower levels of C-reactive protein (CRP) in the plasma and fewer pulmonary complications [ 42 ]. To investigate the role of hydromorphone in clinical patients receiving gynecological laparoscopic surgery, we used a dosage of hydromorphone equianalgesic to the dosage of morphine used in other studies [ 43 ].…”

Postoperative analgesia using dezocine alleviates depressive symptoms after colorectal cancer surgery: A randomized, controlled, double-blind trial

“…Dezocine is a partial μ opioid receptor agonist [27,36,37]that is theoretically approximately equipotent with morphine. Clinical studies have also proved it has the same analgesic effect as morphine [38][39][40]. Dezocine is becoming one of the most popular postoperative analgesics in China and is often used in combination with opioids, such as sufentanil [15,27].…”

Microbiological and Physicochemical Stability of Fentanyl, Oxycodone, Hydromorphone, Ketorolac, Ramosetron, and Ondansetron for Intravenous Patient-controlled Analgesia: An In Vitro Study

“…On combining fentanyl, which has a rapid onset time and short duration of action, with oxycodone or hydromorphone-opioids with a slower onset time but a longer duration of action-we can provide analgesia with a rapid onset time and long duration of action. In addition, to reduce the possibility of respiratory depression owing to the use of 2 opioids, we used a lower hourly dose than that commonly used during PCA (hourly dose of opioids in PCA in our hospital and this study: fentanyl, 0.008 mg/h; hydromorphone, 0.04 mg/h; and oxycodone, 0.2 mg/h vs commonly used opioid doses per hour during PCA: fentanyl, 0.015-0.060 mg/h (29)(30)(31); hydromorphone, 0.24-0.26 mg/h (32,33); and oxycodone, 0.3-1.2 mg/h (34)).…”