Clinical Observation Of Dexmedetomidine Combined With Ropivacaine For Four-point Nerve Block In Laparoscopic Liver Tumor Surgery Under General Anesthesia

Objective: To observe the clinical effect of dexmedetomidine combined with ropivacaine for four-point nerve block in laparoscopic liver tumor surgery under general anesthesia.Methods:(1)Ninety patients undergoing laparoscopic liver tumor surgery under general anesthesia in our hospital from August 2021 to July 2022 were randomly divided into dexmedetomidine + ropivacaine group(group A),ropivacaine group(group B)and simple general anesthesia group(group C),with 30 patients in each group.(2)All the three groups received general anesthesia combined with postoperative patient-controlled intravenous analgesia(PCIA).Group A and B received general anesthesia combined with nerve block;Group C received only general anesthesia without nerve block.(3)To observe and record the changes of hemodynamics in the three groups.The mean arterial pressure was measured before induction of anesthesia(T0),5 min before skin incision(T1),5 min after skin incision(T2),at the time of hepatic portal vein occlusion(T3),at the time of hepatectomy(T4),when the hepatic portal vein was opened(T5)and when the skin was sutured(T6).The amount of remifentanil and propofol used during the operation,and the number of times the analgesia pump was effectively pressed 48 hours after the operation in the three groups;Visual analogue scale(visual analogue scale,VAS)of resting and moving state at different time points(2 h,6h,12 h,24 h and 48 h)in three groups;Resuscitation and early recovery of the three groups,including recovery time,extubation time,recovery time of eating,first exhaust time,ambulation time and length of hospital stay;The incidence of postoperative adverse reactions in the three groups.Results:(1)Comparison of hemodynamics in the three groups: MAP(compared with T1 before skin incision)was significantly increased at T2 after skin incision in the three groups.There was a significant difference at T2 after skin incision in group B(P < 0.05),and there was a significant difference at T2 and T6 in group C(P < 0.05);HR(compared with T1 before skin incision): T4 at hepatectomy,T5 at hepatic portal vein patency and T6 at skin suture were increased in group a(P < 0.05),while T5 at hepatic portal vein patency and T6 at skin suture were increased in group B(P < 0.05);In group A,MAP was lower than that in group C at T4,T5 and T6(P < 0.05),and HR was lower than that in group C at T1 and T2(P< 0.05),and there was no significant difference between group B and group C(P > 0.05).There was no significant difference between group A and group B at different time points(P >0.05).(2)Comparison of VAS scores at rest and exercise within 48 hours in the three groups:compared with group C,the VAS scores at 2 h,6 h,12 h and 48 h after operation in group A decreased(P < 0.05),while those at 2 h and 6 h after operation in group B decreased(P <0.05);Compared with group B,the VAS score of group A was lower at 6 h and 48 h after operation(P < 0.05).Compared with group C,the VAS score of group A was lower at 2 h and6 h after operation(P < 0.05),and that of group B was lower at 2 h after operation;There was no significant difference between group A and group B(P > 0.05).(3)The effective pressing times of analgesia pump in group A and group B were lower than those in group C 48 hours after operation(P < 0.05),and there was no significant difference in the amount of anesthesia used in the three groups(P > 0.05);(4)The recovery time,extubation time and the first time of getting out of bed in group A were shorter than those in group C(P < 0.05),and those in group B were shorter than those in group C,but the difference was not statistically significant(P > 0.05).(5)There was no significant difference among the three groups in the first time of passing gas,the time of recovering food and the length of hospital stay(P > 0.05);(6)There was no significant difference in the adverse reactions such as dizziness,lethargy,nausea and vomiting,and skin pruritus among the three groups(P > 0.05).Conclusion:(1)Dexmedetomidine combined with ropivacaine four-point nerve block is used in laparoscopic liver tumor surgery under general anesthesia,and the blood pressure and heart rate are more stable during the operation,which is beneficial to reducing the occurrence of high hemodynamic events and improving the safety of the operation;(2)Dexmedetomidine combined with ropivacaine four-point nerve block is used in laparoscopic liver tumor surgery under general anesthesia,and can provide more perfect upper abdominal analgesia effect;(3)Dexmedetomidine combined with ropivacaine four-point nerve block for laparoscopic liver tumor surgery is conducive to early postoperative rehabilitation,which has great practical value in clinical practice and is worth recommending.