Effects Of Dexmedetomidine Combined With Ropivacaine For Ultrasound-guided Erector Spinae Plane Block On Perioperative Analgesia In Thoracoscopic Lobectomy Surgery

Objective To investigate effects of dexmedetomidine combined with ropivacaine for ultrasound-guided erector spinae plane block on analgesic effect and immune function in thoracoscopic lobectomy surgery.Methods Eighty patients of both sexes,aged 18-79yr,of American Society of Anesthesiologists physical statusⅡorⅢ,normal cognitive function,approved by the medical ethics committee of hospital and provided informed consent,scheduled for elective thoracoscopic lobectomy surgery,were divided into 4 groups n=20,each using a random number table:Group A:blank control group,no ESPB;Group B:ESPB with 30ml0.5%ropivacaine and saline;Group C:ESPB with 30ml 0.5%ropivacaine plus 0.5μg/kg dexmedetomidine;Group D:ESPB with 30ml 0.5%ropivacaine and saline,and 0.5μg/kg dexmedetomidine intravenously administered.Mean arterial pressure MAP and heart rate HR were recorded at induction,tracheal intubations,skin cut and tracheal extubation.The total consumption of sufentanil and remifentanil during the surgery,the recovery time,the pain score of visual analogye scale VAS and bruggrmann comfort scale BCS at rest and at cough were evaluated at 1,6,24,48h after operation.The time to the first request of PCA after surgery,the consumption of sufentanil within 24h and 48h after operation,respectively.The number of successfully PCA delivered doses and the number of PCA demand within 24h and 48h after operation were recorded.Venous blood was collected to measure the CD4~+、CD8~+levels before anesthesia,after operation,24,48 h after operation,then calculate CD4~+/CD8~+,respectively.The incidence of adverse reactions,the length of stay and the patient satisfaction were also recorded.Results 1.There were not significantly different about the basic characteristics in those four groups P>0.05.2.During the tracheal intubation actions,MAP and HR were significantly decreased in goup D P<0.05 when compared with the other three goups.And the MAP and HR at skin cut time point of group B,group C and group D were lower than group A P<0.05.3.The consumption of sufentanil and remifentanil in group B,group C and goup D within 24h and 48h after operation were reduced than goup A P<0.05.And when compared with group B,the consumption of sufentanil and remifentanil in group C and goup D within 24h and 48h after operation were significant decreased P<0.05.However,the consumption of sufentanil and remifentanil in goup D were increased than in group C.4.The time to the first request of PCA after surgery in group B,group C and group D were later than goup A P<0.05.When compared with goup B,the time to the first request of PCA were longer in goup C and goup D P<0.05.And the time in group D were much earlier than group A P<0.05.The number of PCA demand in group B,group C and group D were less than in group A P<0.05.When compared with group B,the number of PCA demand in group C and group D were significantly decreased P<0.05.And the demand in group D were increased than the demand in group C P<0.05.5.The levels of CD4~+、CD4~+/CD8~+in 24 and 48 hours after the surgery in group B,group C and group D were increased,compared to group A P<0.05.The levels of CD4~+、CD4~+/CD8~+in group B were significant decreased than the levels in group C and group D at each time point.When compared with group C,the levels of CD4~+、CD4~+/CD8~+levels were reduced significantly in group D P<0.05.Moreover,the CD8~+levels of group B,group C and group D were lower than group A P<0.05.The CD8~+levels of group C and group D were decreased than group B P<0.05,and when compared with group C,the CD8~+levels of group D were significant increased P<0.05.6.The VAS were decreased in group B,group C and group D at rest and at cough,when compared with group A P<0.05.And the VAS of group C and group D were significantly reduced than the VAS of group B.The BCS of group B,group C and group D at 48h after operation were significant less than the group A.The BCS in group C and group D,compared to group B,were significantly decreased.And the VAS and BCS in group D failed to reach the significance compared with the group C at 48h after operation.7.The extubation time was measured,however,this did not demonstrate a significant difference P>0.05.The time of getting out of bed after surgery and the duration of hospital stays in group B were shorter than group A P<0.05,the time of the group C were decreased than group B,and the time of group D were significantly reduced than group C P<0.05.8.We evaluated the rate of rescue analgesia after surgery administration,the rate of group B was lower than group A P<0.05,and the rescue analgesia rate of group C and group D was decreased than group B P<0.05.When compared with group A,the occurrence of dizziness in group B,group C and group D were significant declined P<0.05,the occurrence of other adverse reactions did not reach the significance between each groups P>0.05.Conclusion Dexmedetomidine combined with ropivacaine for ultrasound-guided erector spinae plane block reduces the consumption of opioid drugs,prolongs the postoperative analgesia time,enhances the postoperative analgesia effect and improve the postoperative immune function in patients undergoing thoracoscopic lobectomy surgery.It is showed that the local dexmedetomidine combined with ropivacaine achieved better efficacy.