Effect Of Dexmetomidine Combined With Transversus Abdominis Plane Block On Postoperative Enteroparalysis After Radical Resection Of Colon Cancer

Objective:To observe the effect of dexmedetomidine combined with transversus abdominis plane block on postoperative ileus after radical resection of colon cancer.Methods:Eighty patients with elective general anesthesia underwent radical laparoscopic colon cancer surgery were randomly divided into four groups（20 patients in each group）:generalanesthesiagroup（A）,dexmedetomidinegroup（B）,transversus abdominisplaneblock（C）,dexmedetomidine+transversusabdominisplane block（D）.After the induction of anesthesia,group B and D received dexmedetomidine administeration at an infusion rate of 0.5μg·kg^-1·h^-1to 30 min before the end of surgery,group C and D were given 0.25%ropivacaine combined with 0.5%lidocaine20ml for bilateral TAP block under B ultrasound guidance.Record HR and MAP before infusion of dexmedetomidine（T0）,10 minutes after intubation（T1）,10 minutes after TAP block（T2）,10 minutes after CO₂ insufflation（T3）,1 hour after CO₂insufflation（T4）,10 minutes after CO₂ desufflation（T5）and 10 minutes after extubation（T6）;VAS scores for resting and cough pain at 6h,12h,24h,36h,48h（T7to T11）after surgery.The plasma concentrations of epinephrine（E）,norepinephrine（NE）and interleukin-6（IL-6）were determined at T0,T3,T5,T9andT11.To record the dosage of propofol and remifentanil,the intraoperative fluid volume,operation time and intraoperative blood loss,the number of PCA self-administered doses within 48hours,and record the first time to fart.The incidence of adverse reactions such as nausea,vomiting,and syncope in postoperative patients was counted.Results:There were no significant differences in gender,age,BMI,operation time,intraoperative blood loss and intraoperative fluid volume between the four groups（P>0.05）.The doses of propofol in the B and D groups were significantly lower than those in the A and C groups（P<0.05）.There was no significant difference between the B group and the D group,the A group and the C group（P>0.05）;The dosage of fentanyl was significantly lower than that of A,B and C groups（P<0.05）.The number of PCA compressions in group C and D was significantly less than that in group A and B.Group C and group D,group A and group B There was no significant difference between them（P>0.05）;the exhaust time of group D was significantly shorter than the other three groups（P<0.05）.Hemodynamic comparison:Compared with T0,at T3-T5,the dim sum rate of group B and D decreased significantly（P<0.01）;at T1-T5,the blood pressure heart rate of group D decreased significantly（P<0.01）.Compared with group D,the heart rate of A,B and C groups increased at T2-T6（P<0.05）.Compared with group A and C,the heart rate of group B was lower at T3（P<0.01）.However,it was higher than group D（P<0.05）.Plasma E,NE and IL-6 comparison:Compared with T0,plasma levels of E,NE and IL-6 in four groups of T3,T5,T9 and T11 were increased（P<0.05）.At time T11,group D Significantly lower than the A and C groups（P<0.05）.Compared with group D,the A,B,and C groups had a significant increase in resting and cough VAS scores at T7-T9（P<0.01）..Conclusion:Intraoperative infusion of dexmedetomidine can stabilize intraoperative hemodynamics in patients undergoing radical resection of colon cancer,reduce the amount of anesthetic drugs,and shorten the time of intestinal paralysis;combined with transversus abdominis plane block can further reduce the amount of opioids,elevate satisfactory analgesia,reduce abdominal inflammation,and promote the recovery of postoperative bowel movements.