| Objective To analyze the effect of dexmedetomidine(Dex)at different doses combined with ropivacaine on the analgesic effect of thoracic paravertebral nerve block(TPVB)in the elderly who underwent thoracoscopic surgery,and to explore the optimal dose of Dex as a TPVB adjuvant drug in theelderly patients.Methods A total of 125 patients who underwent selective thoracoscopic surgery in Yanbian University Affiliated Hospital from May 2019 to February 2021 were selected and randomly divided into groups with 25 cases in each group,consisting of five groups.The patient underwent unilateral thoracic paravertebral block under ultrasound guidance immediately after the operation: group A,no nerve block;group B,0.375% ropivacaine alone 20 ml;group C,0.375% ropivacaine combined with0.5 μg/ kg Dex,total 20 ml;group D,0.375% ropivacaine combined with 1.0 μg/kg Dex,total 20 ml;group E,0.375% ropivacaine combined with 1.5 μg/kg Dex,total 20 ml.All patients underwent general anesthesia induction and maintenance according to a uniform standard;after entering the post anesthesia care unit(PACU)after the operation,the sensory block level was measured and the patient-controlled intravenous analgesia(PCIA)of the same formula was connected.Main observation indicators:Record the visual analog scale(VAS)of the patients at different time points in the rest and cough state at 2h,6h,12 h,24h,and 48 h after the operation.Secondary observation indicators: Record the patient’s Ramsay sedation scale(RSS)at each time point;PCIA first compression time and the number of compressions;PACU stay time;48h patient satisfaction score;the number of remedial analgesia;postoperative adverse reactions: such as the incidence of nausea and vomiting,hypotension and bradycardia;whether the thoracic paravertebral block has occurred Complicationsandsoon.Results(1)The VAS scores of cough and rest in group A were markedly higher than those in the remaining groups within 12 and 24 h postoperatively(P < 0.05).At 12 h,the VAS scores of group B was higher than that of group C(P < 0.05).Within 24 h after surgery,the VAS scores of rest and cough in group B and C were markedly higher than those in groups D and E(P < 0.05).No statisticallysignificantdifferencewasrevealed between groups D and E(P > 0.05).(2)Within 6h after surgery,the Ramsay scores of groups Aand B were lower than those of groups D and E(P < 0.05).And the Ramsay scores of group D was lower than that of group E(P <0.05).The PACU retention time in groups Aand B was shorter than that in groups C,D and E(P <0.05).The retention time ingroup C and D was markedly shorter thanthat ingroups E(P < 0.05).Andno significantdifferencewas revealedbetween groups C and D(P > 0.05).(3)Compared with group A,the first PCIApress time in the remaining groups was later with less number of press(P < 0.05).The first PCIA press time in groups D and E was later than that in groups A,B and C,andthenumberofpresswas decreased(P < 0.05).(4)The number of patients with remedial analgesia in groups D and E was markedly lower than that in groups A and B(P < 0.05).Compared with group A,the satisfactory scores of patients in groups B,C,D and E werehigherthanthoseingroup A(P < 0.05).(5)The probability of postoperative nausea and vomiting was 24% in group A,8% in groups B and E,and 4% in groups C and D.But no statistically significant difference was revealed among the groups(P > 0.05).The probability of bradycardia and hypotension in group E was higher than thatoftherestgroups(P < 0.05).(6)No case was reported the occurrence of complications of respiratory depression and nerve block.Conclusions(1)The elderly patients underwent thoracoscopic surgery combined with TPVB had better postoperativeanalgesiceffectthanthoseaccepted PCIAalone.(2)In TPVB,all 0.375% ropivacaine combined with Dex(0.5-1.5 μg/kg)improved the duration and quality of analgesia,reduced the demand for opioids,minimized the occurrence of side effects,and increased patients’ satisfaction.Among them,0.375% ropivacaine combined with 1.0 μg/kg Dex wasconsideredas anoptimal protocol. |
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