Effect Of Continuous Erector Spinae Plane Block With Dexmedetomidine As Adjuvant On Postoperative Pain And Sleep Quality In Patients Undergoing Uniportal Thoracoscopic Surgery

Objective:Acute postoperative pain in thoracic surgery can cause sleep disorders,which can affect the rapid recovery of patients.As a new technique of fascial space block,erector spinae plane block provides a new idea for perioperative analgesia in thoracic surgery.Dexmedetomidine,as an adjuvant of nerve block,can improve the analgesic effect and has the effect of sedation and hypnosis.The purpose of this study was to observe the effect of dexmedetomidine combined with ropivacaine on pain and sleep quality in patients undergoing uniportal thoracoscopic surgery.Methods:In this study,60 patients with lung cancer undergoing uniportal thoracoscopic surgery under general anesthesia were included.Included in the standard vertebra:age between 18-65 years old,no limitation of gende,BMI 19-25kg/m~2;ASA level 1-2;patients whose operation time does not exceed 3 hours,and signed the informed consent.Patients included in the experiment were divided into three groups,20 cases in each group.After entering the operating theatre,all the patients in the three groups received ultrasound-guided erector spinae plane block at the T5 level of the affected side.0.5%ropivacaine was used for 20 ml in total,and a catheter was placed in the fascia plane between the erector spinae muscle and the transverse process to connect the postoperative analgesia pump.The total volume of analgesia pump was 250ml.Group D1:0.2%ropivacaine+1ug/kg dexmedetomidine;Group D2:0.2%ropivacaine+2ug/kg dexmedetomidine;the control group C:0.2%ropivacaine.VAS scores and Los scores were recorded at 6h,12h,24h and 48h after operation.At the same time,the AIS scores and subjective sleep time of the day before operation and the operative day,the postoperative day one and postoperative day two and postoperative day three were recorded.The times of effective self-control of analgesic pump,the times of using remedial analgesic drugs,and the incidence of adverse reactions such as nausea and vomiting were recorded.Results:There were no significant differences in gender,age,ASA grade,BMI and operation time among the three groups.Compared with group C,the VAS scores of D2 group was lower at 6h,12h,24h,48h when the patient at rest and coughing;compared with group D1,the VAS scores of D2 group was lower at 6h,12h,24h when the patient resting,and it’s lower at 6h,12h with coughing;compared with group C and D1,the number of effective self-control pressing and additional analgesic remedy of D2 group was less,the difference was statistically significant.There was no significant difference between group C and group D1 in the above VAS scores.There was no significant difference between the three groups in AIS scores and subjective sleep time before the operation,but they have varying degrees of changes after surgery which was most significant on the day of operation.Compared with group C and group D1,the AIS scores of group D2 was lower on the day of operation and 3 days after operation,and the subjective sleep time was longer,the difference was statistically significant.There was no significant difference in Los scores,nausea,vomiting,pruritus,drowsiness,delirium,urinary retention,puncture-related complications,severe hypotension and bradycardiaand and other adverse reactions among the three groups.Conclusion:0.2% ropivacaine combined with 2ug/kg dexmedetomidine has a good analgesic effect after uniportal thoracoscopic surgery,and it can improve the quality of short-term sleep,extend the subjective sleep time,without serious adverse reactions.It can provide a reference for the postoperative analgesia of department of thoracic surgery.