Clinical Application Of Dexmedetomidine Assisted Low Concentration Epidural Anesthesia In Intervertebral Foramen Surgery

Background:With the development of minimally invasive techniques in modern medicine,percutaneous intervertebral foramen mirror technology(percutaneous transforaminal endoscopic discectomy,PTED)because of its curative effect is distinct injury of small advantages become the mainstream surgical treatment of lumbar intervertebral disc protrusion technology in the world.In order to avoid intraoperative nerve injury and improve the safety of surgery,intraoperative communication and interaction between the operator and the patient are required.Currently,local infiltration anesthesia is generally used for such operations.Local anesthesia effect is often incomplete,however,the height of the patients with intraoperative tension and pull operation operation can cause human body strong perioperative stress reaction,reduce patient pain threshold of pain sensitivity,and the corresponding increase in the incidence of perioperative complications and mortality,even some patients give up for intolerance to intraoperative pain treatment.Low concentration epidural anesthesia can effectively improve the intraoperative pain experience of patients while moving both lower limbs freely.Dexmedetomidine(Dex)is a highly selective alpha 2 adrenergic receptor agonist with sedative and analgesic effects,anti-anxiety,anti-sympathetic activities,no respiratory depression,and can be awakened,which can effectively reduce intraoperative pain and tension in patients and maintain effective circulatory stability.Objective:To observe the efficacy and safety of Dexmedetomidine(DEX)assisted low concentration epidural anesthesia in intervertebral foramen microscopy.Methods:Choose from November 2016 to December 2018 single segment for intervertebral disc herniation during surgical treatment of 90 patients with intervertebral foramen mirror as the research object,aged between 20-70 years,ASA class Ⅰ or Ⅱ,with random number table method is divided into three groups A,B,C,30 cases in each group.Patients in group A received conventional local infiltration anesthesia with 1% lidocaine,and patients in group B and C received epidural anesthesia with 0.25% ropivacaine.Patients in group C received continuous pumping of dexmedetomidine at A rate of 0.2-0.7u g/(kg·h)after epidural anesthesia reached the T8 plane,and the intraoperative sedation goal maintained2-3 points of Ramsay sedation score.Records(T0),when the patient home invasion began to lead wire broken skin surgery(T1),to set up the work when the casing(T2),nerve release when the removal of nucleus pulposus(T3),at the end of surgery(T4),and other times of the mean arterial pressure(MAP),heart rate(HR),respiratory frequency(RR),blood oxygen saturation(Sp O 2),visual analogue scale(VAS),Ramsay score;Record during the surgery patients because of the pain is not caused by a force beyond the control of their own restlessness,severe bradycardia(HR<50 BPM),severe tachycardia(HR>110BPM),respiratory depression(spo2<90%),the occurrence of adverse reactions such as nausea and vomiting,and record the postoperative adverse reactions(headache,dizziness,confusion,nausea,vomiting and respiratory depression)of occurrence;Intraoperative compliance and postoperative satisfaction were recorded.The results:There were no statistically significant differences in general data such as gender composition ratio,age,weight,height and ASA classification among the three groups(P>0.05),which was comparable.2.There was no significant difference in HR,MAP,RR and SPO2 between the three groups at T0 time(P>0.05).3.Compared with T0,MAP in group B and group C was significantly decreased and MAP in group A was significantly increased in t1-t4,and the above differences were statistically significant(P<0.05).There was no significant difference in MAP between groups B and C(P>0.05).4.There was no significant difference in HR between groups A,B and C at T0 and T1(P>0.05).During the t2-t4 period,the HR of patients in group B and C was lower than that in group A,and the HR of patients in group C was significantly lower than that in group B.The above differences were statistically significant(P<0.05).5.The respiratory rate(RR)of patients in group B and group C during t1-t4 period was significantly lower than that of patients in group A(P<0.05).There was no difference in the RR between group B and group C during t1-t4 period(P>0.05).6.In time periods of T1,T2,T3 and T4,Ramsay scores of patients in group C were significantly higher than those in groups A and b.in time periods of t1-t4,VAS scores of patients in group B and C were significantly lower than those in group A,and the above differences were statistically significant(P<0.05).VAS scores between groups B and C were not statistically significant(P>0.05).7.Compared with group A,the proportion of intraoperative tachycardia and restlessness in group B and C was significantly reduced,and the difference between group B and C was statistically significant(P<0.05).There were no obvious respiratory depre-ssion and other adverse reactions in the three groups.8.The intraoperative coordination degree and postoperative satisfaction degree of patients in group C were significantly higher than those in groups A and B,and the difference was statistically significant(P<0.05).Conclusion:Dexmedetomidine assisted epidural anesthesia with 0.25% ropivacaine has a good anesthesia effect in the operation of intervertebral foramen microscopy,which can effectively relieve the body pain and improve the intraoperative coordination and comfort level of patients,and is worthy of promotion in clinical practice.