Opioid-sparing Anesthesia For Laparoscopic Surgery

Objective:To investigate the effects of dexmedetomidine combined with low concentration epidural anesthesia on opioid-sparing anesthesia for laparoscopic surgery.Method:120 patients who underwent laparoscopic gastrointestinal surgery,with age under 75 years old,body weight index between 18 to 32 kg/m²,ASA1-3 level,randomly allocated to general anesthesia group（G group）,epidural anesthesia group（E group）,dexmedetomidine group（D group）or epidural anesthesia plus dexmedetomidine group（ED group）,n=30 for each group.Introperative opioid consumption,hemodynamic responses and postoperative adverse reactions were recorded.Results:1.Opioids Consumption Compared with G group,the consumption of sufentanil in E group（38±12.4μg vs.58±17.6μg,P=0.001）,D group（48±15.5μg vs.58±17.6μg,P=0.01）and ED group（34± 12.3μg vs.58±17.6μg,P=0.001）were significantly decreased. Moreover,the consumption of sufentanil in E group（38±12.4μg vs. 48±15.5μg,P=0.009）and ED group（34±12.3μg vs.48±15.5μg, P=0.001）further decreased when compared with D group.Compared with G group,the consumption of remifentanil in E group（1.0±0.77 mg vs.2.0±0.90mg,P=0.001）and ED group（0.5±0.63 mg vs.2.0 ±0.90 mg,P=0.001）were decreased significantly.Howeve,the consumption of remifentinl between patients in G group and D group（1.7±0.85 mg vs.2.0±0.90mg,P=0.118）had no differance. Patients in E group（1.0±0.77 mg vs.1.7±0.85 mg,P=0.001）and ED group（0.5±0.63 mg vs.1.7±0.85 mg,P=0.001）consume less remifentanil in compared with patients in D group.In addition, compared with patients in E group,the consumption of remifentanil further decreased of patient in ED group（0.5±0.63 mg vs.1.0±0.77mg,P=0.015）.2.Hemodynamic Response Compared with G group,dexmedetomidine combined with low concentration epidural anesthesia effectively inbited the increased blood pressure caused by endotracheal intubation (T_3-1:-3.04±8.42 mmHg vs.3.76±5.97 mmHg,P=0.002),pneumoperi- toneum and surgical operations(T_7-6:-0.16±3.99 mmHg vs.5.89±6.17 mmHg,P=0.001:T_8-6:0.08±12.39 mmHg vs.9.75±13.58mmHg,P=0.004:T_10-6:4.67±10.94 mmHg vs.10.18± 10.84mmHg,P=0.001:T_11-6:-0.60±12.75 mmHg vs.11.68± 13.54mmHg,P=0.001)and tracheal extubation(T_22-21:3.13±11.14 mmHg vs.14.07±17.10mmHg,P=0.002).The usage rate of atropineand vasopressor had no difference among these 4 group during intraoperative stage,P>0.05.3.Postoperative Adverse Reactions Compared with patients in G group, the ratio of postoperative nausea and vomiting were remarkably decreased in patients of D group（13.8%vs.48.3%,P=0.01）and ED group（13.3%vs.48.3%,P=0.009）.The ratios of rescue analgesic requirements in the first 12 h after surgery were significantly lower in the E group（26.7%vs.58.6%,P=0.013）,D group（31%vs.58.6%, P=0.035）and ED group（23.3%vs.58.6%,P=0.006）than the G group.The recovery time of patients in E group（38±24.8 min vs.69±34.9 min,P=0.001）and ED group（38±24.8 min vs.69±34.9 min,P=0.015）were significantly shorter than patients in G group. Compared with G group,the ratio of prolonged postoperative ileus （PPOI）were less in E group（13.3%vs.39.3%,P=0.03）,D group （10.3%vs.39.3%,P=0.021）and ED group（6.73%vs.39.3%, P=0.004）.Other postoperative adverse reactions such as hypotension, hypertension,shiver,agition and retention of urine in these groups had no statistically significant,P>0.05.Conclusion:Dexmedetomidine combined with low concentration epidural anesthesia for laparoscopic surgery is a perfect opioid-sparing strategy which markedly decerased the comsumption of opioids with stable hemodynamics and less postoperative adverse reactions.