The effect of patient controlled analgesia with hydromorphone on enhanced recovery after surgery (ERAS) in patients with resection of rectal cancer under laparoscopy

Objective To investigate the effect of patient controlled analgesia with hydromorphone on enhanced recovery after surgery (ERAS) of patients underwent the resection of rectal cancer under laparoscopy. Methods One hundred and twenty patients with rectal cancer, ASA Ⅱor Ⅲ, aged 52-76 years, scheduled for laparoscopic resection of rectal cancer form June 2017 to December 2018 in the Department of Anesthesiology, the People's Hospital of Tangshan, Affiliated Hospital of North China University of Science and Technology, were randomly allocated to two groups, 60 cases in each group: hydromorphone group (group H) and sufentanil group (group S). All patients were given patient-controlled epidural analgesia (PCEA) after the operation. Patients were given hydromorphone 2.0 mg+ ropivacaine 250 mg in group H, while patients in group S were given sufentanil 0.4 μg/kg+ ropivacaine 250 mg, diluted to 200 ml with normal saline. PCEA pump was set up with a bolus of 1 ml dose, a 30 min lockout interval and background infusion at a rate of 5.0 ml/h. The visual analogue scale (VAS) during rest was recorded at 4, 8, 12, 24, 48 h after the operation. The first time of exhaust and defecation, the total volume of infusion within 48 h and hospitalization days were recorded. First activity time, whether or not assistance needing, activity duration, VAS during activity were recorded. The consumption of analgesia pump within 48 h were documented, so were the numbers of adverse effects. Results There were no significantly differences in VAS during rest at 4, 8 h after the operation between the two groups, but it was lower at 12, 24, 24 h in group H compared with that in group S, and the total consumption of PCEA pump within 48 h was significantly lower in group H than that in group S (P<0.05). The first time of exhaust and defecation was earlier in group H than that in group S (P<0.05), moreover, the hospitalization days and infusion time were shorter in group H (P<0.05). The first time of activity was earlier, the number of assistance needing was less, the activity distance was longer and the VAS during activity was smaller in group H, compared with that in group S (P<0.05). The numbers of postoperative nausea, constipation and dizziness were also lower in group H than that in group S (P<0.05). Conclusion Patient controlled analgesia with hydromorphone is safe and effective on enhanced recovery after surgery (ERAS) of patients underwent the resection of rectal cancer under laparoscopy, with seldom adverse reactions, accelerating intestinal function recovery, promoting early postoperative activity, and shortening hospitalization stays. Key words: Hydromorphone; Sufentanil; Rectal neoplasms; Analgesia, patients controlled; Enhanced recovery after surgery