| Objective:To observe the sedative analgesic effect and safety of dexmedetomidine combined with local anesthesia in patients of osteoporotic fractures undergoing percutaneous vertebroplasty(PVP) surgery during monitored anesthesia care(MAC).Methods:A totel of 40 patients, aged 65-80 years old, American Society of Anesthesiologists Physical statusⅡor Ⅲ, undergoing elective PVP surgeries were randomized into dexmedetomidine group(Group D) and the control group(Group C) with 20 cases in each: Group D received loading dose of intravenous pump infusion of dexmedetomidine 0.8 ug/kg(200ug+0.9% physiological saline diluted to 50ml) for 10 min before operation, and followed by 0.4ug·kg-?·h-? until the end of operation; Group C received equivalent volume of 0.9% physiological saline. 1% lidocaine 20 ml was administered for local infiltration anesthesia in both two groups.The Systolic blood pressure(SBP), diastolic blood pressure(DBP), Mean arterial pressure(MAP), heart rate(HR), pulse oxygen saturation(Sp O2), VAS pain score were recorded at T0(before intravenous pump infusion), T1(10 minutes after intravenous pump infusion), T2(injecting local anesthetic), T3(the puncture needle getting to a side of the vertebrae), T4(the puncture needle getting to the other side vertebrae), T5(injecting bone cement), T6(the end of operation). The time,dose, probability of administered dezocine for additional analgesia were observed during operation. It was evaluated that Ramesay sedation score of the patients in quiet state and awakening quality score in operation. Adverse reactions were observed such as: nausea, vomiting, dizziness, hypotension, bradycardia, respiratory inhibition after administration, and cognitive dysfunction, delirium after operation.Survey the satisfaction and comfort for 2 groups of patients after operation. Results:1. At T0, there is no statistically significant difference in all aspects between the two groups(P>0.05).2. At T1~ T6, the VAS Pain Scores in group D were lower than those of group C(P<0.05).3. At T1 ~ T5, the Ramsay Sedation Scores in group D were higher than those of group C(P <0.05).4. At T1, the awakening quality score in group D was lower than that of group C(P <0.05), but there is no statistically significant difference between the two groups at T2~T6(P>0.05).5. The probability of additional administered dezocine in group D was lower than that of group C(P <0.05).6. At T1~T6, the mean arterial pressure and heart rate in the group D were lower than those of group C(P <0.05).7. At T1~T6, there is no statistically significant difference in pulse oxygen saturation between the two groups(P>0.05). No significant adverse reactions occurred in the two groups during and after the operation.The satisfaction and comfort with D group were significantly higher than group C after the operation. Conclusion:1. In our study, the two research methods are all practicable for percutaneous vertebroplasty(PVP) surgery during monitored anesthesia care(MAC). No significant adverse reactions occurred in the two groups during and after the operation. But the sedative analgesic effect of group D(dexmedetomidine) is better than that of group C. The probability of additional administered analgesic in group D was lower than that of group C, and awakening quality during the operation did not have statistically significant difference between the two groups. The circulatory function is more stable, blood pressure and heart rate fluctuation minor, the heart rate is slower and relatively stable, and the hemodynamic response is smaller to surgical stimulation in group D, so it is more security.2. A loading dose of intravenous pump infusion of dexmedetomidine 0.8 ug/kg for 10 min, followed by 0.4ug·kg-?·h-? until the end of the operation, and combined with lidocaine local infiltration anesthesia can significantly enhance the effects of analgesia and sedation in PVP operation. It has no significant adverse impact on older patients, and can be widely applied in clinical practice. |
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