| Objective: To observe the efficacy and safety of dexmedetomidinecombined with tramadol in preventing post-anesthetic hyperalgesia induced byremifentanil.Method:80ASA physical1and2patients were scheduled for selectivelaparoscopic surgery. The patients were randomly divided into4groups: controlgroup （Group C）, tramadol group （Group T）, dexmedetomidine group （Group D）and dexmedetomidine combined with tramadol group （Group DT）,20patients ineach group. After the patients entering operating room, routine monitoring wereapplied. All patients were taking intravenous anesthesia. Anesthesia wasmaintained with continuous infusion of remifentanil at0.2μg/（kg min） combinedwith propofol.30minutes before the end of surgery, Group T was givenintravenous tramadol1mg/kg; Group D was continuous infusion ofdexmedetomidine0.5μg/kg for10minutes; Group DT was given intravenoustramadol1mg/kg and continuous infusion of dexmedetomidine0.5μg/kg for10minutes. Observed and recorded:①Duration of surgery, remifentanil dosage;②HR and MAP at10min after patients entering operating room （T0）, extubating（T1）,5minutes （T2） and10minutes （T3） after extubation;③Awakening time;④Trachea extubation time;⑤The VAS pain scores of patients received mechanicalpain test before surgery （S0） and at1hour （S1）,2hours （S2）,6hours （S3）,12hours （S4）,24hours （S5） after surgery;⑥The number of patients receivedadditional analgesics within24hours after surgery;⑦Nausea, vomiting, chills,agitation and other adverse reactions occurred within24hours after surgery.Result:①There was no significant difference in age, weight, gender,duration of surgery and remifentanil dosage （P>0.05）;②The HR and MAP of Group C and T at T1T3were significantly higher than Group D and DT（P<0.05）;③There was no significant difference in awakening time and tracheaextubation time （P>0.05）;④The VAS scors of Group C at S1S5weresignificantly higher than that at S0（P<0.05）, the VAS scors of Group T, D and DTat S1S5were significantly lower than Group C, the VAS scors of Group DT atS1S5were significantly lower than Group T and D;⑤The number of patientsreceived additional analgesics within24hours after surgery in Group DT wassignificantly lower than that in Group C, T and D after surgery （P<0.05）, therewas no significant difference in the incidence of nausea, vomiting and chillswithin24hours after surgery （P>0.05）; the number of agitated patients in GroupD and DT were significantly lower than that in Group C and T （P<0.05）.Conclusion:30minutes before the end of surgery, intravenous tramadol1mg/kg and continuous infusion of dexmedetomidine0.5μg/kg for10minutescan better prevent post-anesthetic hyperalgesia induced by remifentanil, andprovide good sedation and analgesia, stable hemodynamics during extubation. |
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