| ObjectiveTo study the effect of dexmedetomidine combined with ropivacaine under ultrasound-guided thoracic paravertebral nerve block(TPVB)on the quality of early postoperative recovery of patients undergoing modified radical mastectomy for breast cancer.Methods:From June 2020 to December 2020 in the Second Affiliated Hospital of Nanchang University,90 patients with modified radical mastectomy under general anesthesia were selected,aged 40-65 years old,BMI18-28kg/m2,ASA I or II grade.Random number table method was used to divide into control group(N group),ropivacaine group(R group),dexmedetomidine combined with ropivacaine group(RD group),30 cases in each group.15 minutes before the induction of anesthesia,patients in the R group and RD group received ultrasound-guided thoracic paravertebral nerve block.The puncture gap was the thoracic 2 and thoracic 5paravertebral spaces.The R group used 0.5% ropivacaine 40 ml,the RD group used0.5% ropivacaine + dexmedetomidine(1ug/kg)40ml,each block site was 20 ml.Record the amount of remifentanil during the operation,the number of analgesic pump compressions and the amount of sufentanil within 48 hours after the operation;record the patient’s rest and movement at 2h,4h,8h,24 h,and 48 h after the operation(rotation of upper limbs on the operation side)360°)VAS score;record the levels of IL-6 and IL-10 inflammatory factors 1 day before operation,2h after skin incision and 1 day after operation;Qo R-40 scale is used to evaluate patients 1 day before operation,1 day after operation and The quality of postoperative recovery one month after surgery;the postoperative hospital stay,the first anal exhaust time,surgical upper limb edema,nausea and vomiting,puncture complications,bradycardia,etc.were recorded.Results:In the end,each group was selected 28 people1.Comparison of intraoperative remifentanil dosage,analgesic pump compression times,and sufentanil dosage in the three groups of patients.Compared with group N,intraoperative remifentanil dosage and analgesic pump compression in group R and RD The number of times and the amount of sufentanil were reduced(P<0.05).Compared with the R group,the number of analgesic pump compressions and the amount of sufentanil in the RD group were reduced(P<0.05).2.Comparison of the postoperative resting and exercise VAS scores of the three groups of patients.Compared with the N group,the R group and the RD group 2h,4h,8h,24 h,48h postoperative rest and exercise(the upper extremity rotated 360°)VAS The score was significantly lower(P<0.05);compared with the R group,the RD group had a lower VAS score at rest and exercise(with upper limb rotation 360° on the operation side)(P<0.05).3.Comparison of inflammatory factors among the three groups of patients,there was no significant difference in the levels of IL-6 and IL-10 in the three groups one day before surgery(P>0.05);2 hours after skin incision and 1 day after surgery,inflammation in group R and RD The levels of IL-6 and IL-10 were significantly lower than those in the N group(P<0.05).Compared with the R group,the levels of inflammatory factors l L-6 and IL-10 in the RD group were significantly lower(P<0.05).4.Comparison of the Qo R-40 scores of the three groups of patients,there was no significant difference in the total scores of the three groups at 1 day before the operation(P>0.05);1 day and 1 month after the operation,the total Qo R-40 scores of the R group and the RD group were significant Higher than the N group(P<0.05);compared with the R group,the RD group had a higher total Qo R-40 score at 1 day and 1 month after the operation(P<0.05).5.There was no significant difference in postoperative hospital stay,first anal exhaust time,operative upper extremity edema,nausea and vomiting,puncture complications,and bradycardia among the three groups of patients(P>0.05).Conclusion:For patients undergoing modified radical mastectomy for breast cancer,dexmedetomidine combined with ropivacaine thoracic paravertebral nerve block can reduce the amount of intraoperative analgesics,relieve postoperative pain,reduce postoperative inflammation,and improve patients’ early postoperative recovery quality. |
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