Effects Of Intravenous Dexmedetomidine Combined With Lidocaine On The Postoperative Fast Track And Inflammatory Cytokines In Patients After Abdominal Hysterectomy With General Anesthesia

Objective: The present study was designed to evaluate the effects of dexmedetomidine alone,lidocaine alone and their combined infusion on postoperative fast track and inflammatory cytokines in patients undergoing abdominal hysterectomy with general anesthesia.Methods: Part 1: We enrolled 240 women with American Society of Anesthesiologists(ASA)physical status I and II,aged 40-65 years,and scheduled for elective abdominal hysterectomy with general anesthesia from March 2013 to August 2014.The patients were randomly assigned into four groups(n=60 each group): group CON received normal saline infusion,group LIDO received lidocaine infusion(1.5 mg/kg loading,1.5 mg/kg/h infusion),group DEX received dexmedetomidine infusion(0.5 ?g/kg loading,0.4 ?g/kg/h infusion)and group LIDO+DEX received lidocaine(1.5 mg/kg loading,1.5 mg/kg/h infusion)and dexmedetomidine infusions(0.5 ?g/kg loading,0.4 ?g/kg/h infusion).The four groups received an IV bolus infusion of normal saline,lidocaine,dexmedetomidine and lidocaine combined with dexmedetomidine respectively,over 10 minutes before induction of anesthesia,followed by a continuous IV infusion of normal saline,lidocaine,dexmedetomidine and lidocaine combined with dexmedetomidine until abdominal wound closure,respectively.Duration of anesthesia,perioperative dose of propofol and remifentanil,time to first bowel sounds and flatus,lidocaine total dose and dexmedetomidine total dose were recorded.In addition,postoperative visual analogue scores(VAS)and postoperative fentanyl requirement were also recorded at different time points: 1,4,8,12,24,and 48 hours after surgery.Adverse effects were also recorded after surgery.Part 2: We enrolled 80 women with American Society of Anesthesiologists(ASA)physical status I and II,aged 39-68 years,and scheduled for elective abdominal hysterectomy with general anesthesia from October 2014 to August 2015.The patients were randomly assigned into four groups(n=20 each group): group CON received normal saline infusion,group LIDO received lidocaine infusion(1.5 mg/kg loading,1.5 mg/kg/h infusion),group DEX received dexmedetomidine infusion(0.5 ?g/kg loading,0.4 ?g/kg/h infusion)and group LIDO+DEX received lidocaine(1.5 mg/kg loading,1.5 mg/kg/h infusion)and dexmedetomidine infusions(0.5 ?g/kg loading,0.4 ?g/kg/h infusion).The four groups received an IV bolus infusion of normal saline,lidocaine,dexmedetomidine and lidocaine combined with dexmedetomidine respectively,over 10 minutes before induction of anesthesia,followed by a continuous IV infusion of normal saline,lidocaine,dexmedetomidine and lidocaine combined with dexmedetomidine until abdominal wound closure,respectively.Interleukin-6 and tumor necrosis factor-? levels in serum were measured at different time points: before administration of drugs(T1),the end of surgery(T2),postoperative 2 hour(T3)and postoperative 24 hour(T4).Resuts: Part 1: The VAS scores were significantly lower in groups LIDO and DEX at 4,8,and 12 hours compared to group CON after surgery(P<0.01).The VAS scores were also significantly lower in group LIDO+DEX at 1,4,8,12,and 24 hours compared to other three groups after surgery(P<0.01).Postoperative fentanyl requirement was also significantly lower in group LIDO+DEX at 1,4,8,12,24,and 48 hours compared to other three groups after surgery(P<0.01).Time to first bowel sounds and flatus was significantly shorter in groups LIDO and LIDO+DEX than groups CON and DEX(P<0.01),respectively.Postoperative fentanyl requirement was significantly lower in group LIDO at 1 and 4 hours and in group DEX at 1,4,8 hours compared to group CON after surgery(P<0.01).Propofol and remifentanil consumption was significantly lower in groups LIDO,DEX and LIDO+DEX compared to group CON(P<0.01).Propofol and remifentanil total dose was lower in group LIDO+DEX compared to other three groups(P<0.01).Remifentanil total dose was significantly decreased in group DEX compared to group LIDO(P=0.001).Part 2: Interleukin-6 and tumor necrosis factor-? level in serum were higher at T2,T3 and T4 in the four groups.Compared to the group CON,Interleukin-6 and tumor necrosis factor-? levels in serum in group DEX and DEX+LIDO were significantly decreased at T2,T3 and T4(P<0.05).Compared to the group LIDO,tumor necrosis factor-? level in serum in group DEX was significantly decreased at T3 and T4,interleukin-6 level in serum in group DEX was significantly decreased at T2,T3 and T4(P < 0.05).Interleukin-6 and tumor necrosis factor-? levels in serum in group DEX+LIDO were the lowest compared to other three groups at T2,T3 and T4(P<0.05).Recovery time and extubation time were significantly prolonged between group DEX and group DEX+LIDO(P<0.05).Conclusion: Part 1: Dexmedetomidine combined with lidocaine infusion significantly improved postoperative pain and opioid-sparing effects compared to lidocaine and dexmedetomidine infusion alone undergoing abdominal hysterectomy.Furthermore,their combined infusion enhanced recovery of bowel function after abdominal hysterectomy.Part 2: Dexmedetomidine combined with lidocaine infusion significantly decreased postoperative cytokine response compared to lidocaine and dexmedetomidine infusion alone undergoing abdominal hysterectomy.This may be attributed to the anti-inflammation effects of dexmedetomidine and lidocaine.