Efficacy Of Dexamethasone Or Dexmedetomidine Mixed With L-bupivacaine For Transversus Abdominis Plane Block In Patients Undergoing Gynecologic Surgery

Objective:To explore the efficacy and mechanism of decxamethasone or dexmedetomidine mixed with L-bupivacaine for transversus abdominis plane block in patients undergoing gynecologic surgery.Methods:Seventy American Society of Anesthesiologists physical status I or II patients scheduled for elective gynecological laparoscopic ovarian tumor resection under inhalation and intravenous general anesthesia,were randomly divided into 3 groups using a random number table.After the end of the surgery,ultrasound-guided bilateral TAP block was performed in all groups.According to the drugs given,there are three groups:Group A(Control group,n=23):75mg of L-bupivacaine +0.9%physiological saline(20ml)were injected,10ml per side;Group B(dexamethasone group,n=24):75mg of L-bupivacaine containing dexamethasone 8mg in total 20ml were injected,15ml per side;Group C(dexmedetomidine group,n=23):75mg of L-bupivacaine containing dexmedetomidine 0.8μg/kg in total 20ml were injected,10ml per side.At the same time,40mg of parecoxib was intravenous injected.After the block,the patients were observed for 5 minutes.When there was no obvious hemodynamic fluctuation,the patients were sent toPACU(Postanesthesia Care Unit).The patients were admitted to ward When the patients stay awake for 30minutes.Basic vital signs of each time period were recorded.The duration of operation,the recovery time and the satisfaction scores were recorded.The dosage and the frequency of additional analgesic drugs were recorded within 24 hours after surgery.Numerical rating scale(NRS)and Ramsay sedation score were recorded at Oh,2h,4h,6h,8h,12h and 24h after awaking.The occurrence of postoperative nausea and vomiting,and respiratory depression or other adverse events were recorded.Results:Compared with group A,the NRS scores of group B and C were significantly reduced after 4,6,8 and 12 hours after surgery(P<0.05)and the dosage and frequency of analgesic drugs were significantly decreased within 24 hours after surgery(P<0.05).Compared with group B,the NRS score of group C was lower(P<0.05).But compared with group B and C,the Ramsay sedation score of group A were higher(P<0.05).There was no statistical difference between the three groups in NRS scores and Ramsay sedation scores in 0,2,24 hours.There were no significant adverse events in the three groups,and no difference was found in the three groups of patients with postoperative nausea and vomiting and respiratory depression(P>0.05).Conclution:Dexamethasone or Dexmedetomidine mixed with L-bupivacaine for transversus abdominis plane block can improve the analgesic effect in patients undergoing gynecological laparoscopic ovarian tumor resection and reduce the dosage of postoperative drugs,and the efficacy of dexmedetomidine was more obvious.