Application Of Ketorolac Tromethamine Combined With Dexmedetomidine For Preemptive Analgesia In Laparoscopic Cholecystectomy

Objective:The purpose of this study was to observe the effects of preemptive analgesia with ketorolac tromethamine and dexmedetomidine on intraoperative hemodynamics and postoperative recovery quality after laparoscopic cholecystectomy,providing reference for the clinical application of drugs.Methods:Seventy-five patients aged 18-65 years,ASA Grades Ⅰ to Ⅱ,BMI 19～28kg/m2,who were scheduled to undergo laparoscopic cholecystectomy were selected and divided into three groups(Intervention was conducted 10 minutes before induction):ketorolac tromethamine(K)group:intravenous injection of 30 mg ketorolac tromethamine 10 minutes before induction;Ketorolac tromethamine combined with dexmedetomidine(C)group:0.5 μg/kg of dexmedetomidine was pumped on the basis of group K;Normal saline(N)group:give normal saline of the same volume as group K.Total intravenous anesthesia was used.After routine induction,tracheal intubation was performed to control respiration.During the operation,propofol and remifentanil were continuously pumped to maintain the depth of anesthesia,and cisatracurium was intermittently intravenous injected to maintain muscle relaxation levels.Record the mean arterial pressure(MAP)and heart rate(HR)at various time points after entering the operating room(T0),during tracheal intubation(T1),during skin incision(T2),3 minutes after pneumoperitoneum(T3),and during tracheal catheter removal(T4);Record the static and dynamic pain visual simulation scores(VAS scores)and BCS comfort scores at 30 minutes(T5),2 hours(T6),6 hours(T7),12 hours(T8),and 1 day(T9)after extubation;Record the duration of the operation,the amount of propofol and remifentanil used during the operation,and the use of vasoactive drugs;The QoR-15 scale was used to assess the patient’s condition 1 day before surgery(QoR15-Pre),1 day after surgery(QoR15-POD1),and 3 days after surgery(QoR15-POD3);The ratio of neutrophils to lymphocytes(NLR),serum interleukin-6(IL-6),serum interleukin-10(IL-10)and platelet levels were measured after entering the operating room(T0)and 1 day after surgery(T9);Adverse reactions occurred within 48 hours after surgery were observed and recorded,including nausea and vomiting,dizziness and headache,delirium and restlessness,hypotension,and bradycardia.Results:(1)Comparison of general data between three groupsThere were no significant differences in gender,age,BMI,ASA grade,and surgical duration among the three groups(P>0.05).(2)Postoperative pain scores for three groups of patientsIntergroup comparison:Compared with group N,static dynamic VAS scores in group K and group C were significantly lower and BCS scores were significantly higher at each time point T5,T6,T7,T8,and T9(P<0.05);Compared with Group K,the static and dynamic VAS scores of Group C were significantly lower at T5,T6,and T7(P<0.05).There was no statistically significant difference in the static VAS scores of Group C at T8,while the dynamic VAS scores were significantly lower(P<0.05).There was no statistically significant difference in the VAS scores of Group K and at T9.At T5,T6,T7,T8,and T9,compared with Group K,the BCS score of Group C significantly increased(P<0.05).Intragroup comparison:Compared with T8 and T9,the static dynamic VAS scores of the three groups were significantly higher at T5,T6,and T7,while the BCS scores were significantly lower.(3)Postoperative inflammatory level in three groups of patientsIntergroup comparison:Compared with group N,the levels of serum IL-6 and NLR in group K and group C decreased significantly at T9,while IL-10 increased significantly(P<0.05);Compared with group K,the serum levels of IL-6 and NLR in group C decreased significantly at T9,while IL-10 increased significantly(P<0.05).Intragroup comparison:Compared with T0,the serum levels of IL-6,IL-10,and NLR in group C of the three groups were significantly increased at T9(P<0.05).(4)Comparison of QoR-15 scale scores at various time points among three groups of patientsIntergroup comparison:There was no significant difference in preoperative QoR15-Pre scores among the three groups;Compared with Group N,the QoR-15 scores in Group K and Group C were significantly improved on the first(QoR15-POD1)and third(QoR15-POD3)postoperative days(P<0.05),and the QoR15-POD1 scores in Group C were higher than those in Group K.Intragroup comparison:Compared with QoR15-Pre,the QoR15-POD 1 score and QoR15-POD3 score in the three groups were significantly decreased(P<0.01),while the QoR15-POD3 score was significantly increased compared to QoR15-POD1(P<0.01).(5)Comparison of intraoperative hemodynamic parameters among three groups of patientsIntergroup comparison:Compared with group N,MAP and HR in group C were significantly lower at each time point T1,T2,T3,and T4(P<0.01),while MAP in group K was significantly lower at T3(P<0.05);Compared with group K,MAP and HR in group C were significantly lower at each time point T1,T2,and T3(P<0.05).Intragroup comparison:Compared with T0 time point,the MAP and HR values of Group K and Group N decreased significantly at T1(P<0.05),while those of Group C decreased significantly at T1,T2,T3,and T4 time points(P<0.01).(6)Intraoperative maintenance drug use in three groupsCompared with Group N,the dosage of remifentanil in Group K and Group C was significantly lower(P<0.01),and the dosage of remifentanil in Group C was less than that in Group K,with a statistically significant difference(P<0.05).The dosage of propofol in Group C was significantly reduced(P<0.05).(7)Comparison of postoperative adverse reactions among three groupsThe incidence of postoperative nausea was 16%in Group N and 4%in Group C,with a statistically significant difference(P<0.05).There was no significant difference in the occurrence of adverse reactions such as postoperative vomiting,dizziness,headache,bradycardia,and hypotension among the three groups of patients(P>0.05).There was no statistically significant difference in platelet count among the three groups before and after surgery,and there was no significant difference between the groups(P>0.05).Conclusions:Preemptive analgesia with ketorolac tromethamine combined with dexmedetomidine can effectively alleviate pain levels after laparoscopic cholecystectomy,which may be related to its inhibition of inflammatory reactions caused by surgical trauma.In addition,the implementation of preemptive analgesia reduces the use of anesthetic drugs during surgery,reduces the occurrence of postoperative adverse reactions,and improves the quality of postoperative rehabilitation.The feasibility and effectiveness of the clinical use of preemptive analgesia have been confirmed.