Effect Of Dexmedetomidine On Postoperative Sleep Quality In Patients Undergoing Gynecological Laparoscopic Surgery

Objective:To investigate the effect of continuous intraoperative and postoperative pumping of dexmedetomidine on postoperative sleep quality in patients undergoing gynecological laparoscopy.Methods:In this study,a randomized,double-blind,placebo-controlled design was used to include patients(18-60 years old)who were expected to undergo gynecologic laparoscopic surgery under elective general anesthesia for ≤3 h and were randomly assigned to either the dexmedetomidine group(DEX group)or the placebocontrolled group(CON group).In the DEX group,dexmedetomidine was pumped intravenously with standard body weight for 10 minutes(0.5μg/kg)before anesthesia induction,and then the speed was adjusted to 0.2μg/kg/h to 30 minutes before the end of surgery,and dexmedetomidine 2μg/kg/48h was added to PCIA.Patients in the CON group were pumped with an equal volume of normal saline.Sample size estimation anticipated the inclusion of 90 patients,with the primary outcome indicator being the incidence of postoperative sleep disturbance(PSD)on postoperative days 1 and days 3.Secondary outcome indicators included sleep quality(PSQI)at 1 month postoperatively,quality of postoperative recovery(QoR-15),postoperative pain level using the visual analogue scale(VAS),time to extubation,PACU stay,and time to postoperative gastrointestinal distension,perioperative adverse events were also recorded.One-way logistic regression analysis was used as an initial step to identify possible predictors of PSD,and variables with P<0.1 in this analysis were included in a multi-factor logistic regression analysis with forced entry to explore independent risk factors for PSD.Results:A total of 90 patients were included,one patient in each of the DEX and CON groups requested to withdraw from the study after surgery,one patient in the CON group had data censored,44 patients in the DEX group and 43 patients in the CON group completed the final study.10 patients(22.7%)in the DEX group and 21 patients(48.8%)in the CON group developed PSD on postoperative day 1(OR=0.580,95%CI 0.3 86～0.871,P=0.011),the AIS scores of patients in the DEX group were lower than those in the CON group(3.5(2-5)vs 5(3-8),P=0.017).There were 8 patients(18.2%)in the DEX group and 9 patients(20.9%)in the CON group who developed PSD on postoperative day 3(OR=0.917,95%CI 0.552～1.526,P=0.747).There was no statistical difference in the AIS(Athens Insomnia Scale)scores between the two groups(4(3-5)vs 3(2-5),P=0.354),and the PSQI scores were higher in the DEX group than in the CON group at 1 month postoperatively(6(4-7)vs 4(2-6),P=0.001).The resting pain VAS scores at 24h and 48h postoperatively were lower in the DEX group than in the CON group(24h postoperatively:1(1-2)vs 2(2-5),P=0.001;48h postoperatively:0(0-1)vs 1(1-2),P<0.001).The PACU stay time was longer in the DEX group than in the CON group(46.5±17.4 vs 39.0±13.2,P=0.025).The postoperative flatulence time in the DEX group was shorter than that in the CON group(<12h postoperatively:9.3%vs 29.50,12～24h:76.7%vs 63.6%,>24h:14.0%vs 6.8%,P=0.046,and the incidence of intraoperative hypotension was higher in the DEX group than in the CON group(22.7%vs 7.0%,P=0.039).No significant differences were seen in QoR-15 scores,time to extubation and perioperative variables between the two groups.Multivariate logistic regression analysis showed that patients’ preoperative anxiety status was an independent risk factor for PSD(OR=18.862,95%CI 4.309-82.554,P<0.001),and continuous intraoperative and postoperative pumping of dexmedetomidine was a protective factor for PSD(OR=0.179,95%CI 0.042-0.760,P=0.02).Conclusions:Continuous intraoperative and postoperative pumping of dexmedetomidine was effective in reducing the incidence of PSD in patients undergoing gynecological laparoscopy,but may affect the quality of patients’ sleep 1 month after surgery.Preoperative anxiety status was highly correlated with PSD,continuous intraoperative and postoperative pumping of dexmedetomidine reduced the degree of postoperative pain and shortened the duration of postoperative gastrointestinal distension in patients,but increased the risk of PACU stay and perioperative hypotension.