| Purpose:To compare the effects of dexmedetomidine combined with quadratus lumborum block on postoperative analgesia and anxiety status of patients undergoing gynecological laparoscopy.Method:Sixty patients undergoing gynecologic laparoscopic surgery in China-Japan Union Hospital of Jilin University were randomly selected.ASA score I-II;age between 25-65 years;BMI between 18.5-24;no history of relevant drug allergy;no history of psychiatric disease;no history of relevant drug abuse;no history of cardiac arrhythmia;consent to postoperative PCIA;consent to regional nerve block.Patients were divided into three groups A,B and C by randomized number table method,20 cases in each group,and PCIA drugs were dispensed from 0.9% saline to 100 ml in all three groups,with background infusion of 2 ml/h and self-controlled dose of 0.5 ml/time,and locking time of 15 min until 48 h postoperatively.anterior lumbar square muscle block was performed after induction of general anesthesia in groups B and C(Quadratus Lumborum Block,QLB).Control group(group A,n=20): static inhalation composite general anesthesia + PCIA(sufentanil 150μg + flurbiprofen ester 100mg);experimental group 1(group B,n=20): static inhalation composite general anesthesia + PCIA(sufentanil 100μg + flurbiprofen ester 100 mg + 1μg/kg dexmedetomidine);experimental group 2(group C,n=20): static inhalation composite general anesthesia + lumbar square muscle block + PCIA(sufentanil 100μg + flurbiprofen ester 100 mg + 1μg/kg dexmedetomidine).The operating time,anesthesia time,bleeding volume,total amount of intraoperative sufentanil and remifentanil were recorded;heart rate(HR)of patients in three groups at five time points: skin incision(T1),extubation(T2),6h postoperatively(T3),24 h postoperatively(T4),and 48 h postoperatively(T5);resting pain scores(VAS scores),anxiety scores(SAS anxiety self-rating scale);the number of self-controlled shock analgesia within 48 h of using PCIA;the amount of remedial analgesic drugs within 48 h of postoperative period;and the number of related adverse reactions within 48 h of using PCIA.Result:The results of the comparison of general information,operating time,anesthesia time,and intraoperative bleeding of the three groups obeyed normal distribution,and the results showed that no difference was found in the general information of the three groups(P>0.05).Sufentanil and remifentanil dosage between the three groups was tested by oneway ANOVA and the results indicated that there was a statistically significant reduction in sufentanil and remifentanil dosage in group C compared with groups A and B.There was no significant difference in sufentanil and remifentanil dosage between groups A and B and the difference was not statistically significant(P>0.05).Heart rate among the three groups: heart rate in group C was lower than that in groups A and B at time points T1 and T2,and the difference was statistically significant(P<0.05);heart rate in group A was higher than that in groups B and C at time points T3,T4 and T5,and the difference was statistically significant(P<0.05);heart rate in groups B and C did not differ significantly.There was no significant difference in heart rate between the three groups at each time point: there was no statistically significant difference in heart rate in group C(P>0.05),and it can be considered that there was no significant change in their heart rate at each time point.there was a significant difference in heart rate between groups A and B in the intra-group comparison,and the difference was statistically significant(P<0.05).VAS scores in the three groups: VAS scores at the same time points in T3,T4,and T5 were greater in group A than in group B and group B than in group C.The differences were statistically significant(P<0.05).Various time points within the three groups: VAS scores in Group A,Group B,and Group C were different at various time points and gradually decreased,with statistically significant differences(P<0.05).Comparison of the incidence of adverse reactions among the three groups: the incidence of adverse reactions in group A was higher than that in groups B and C,and the difference was statistically significant(P<0.05);no significant difference was seen between groups C and B,and the difference was not statistically significant(P>0.05).Among them,the incidence of nausea and vomiting was higher in group A,with 6 cases,and the occurrence of skin pruritus was 3 cases,1 case of bradycardia and 1 case of nausea and vomiting in group B,and 1 case of bradycardia in group C.Comparison of the number of postoperative analgesic pump presses between the three groups: the number of presses in group A was significantly greater than those in groups B and C,and the difference was statistically significant(P<0.05);compared with group C,the number of presses in group B was significantly greater,and the difference was statistically significant(P<0.05).SAS anxiety scores were significantly different among the groups at the T5(48 h postoperative)time point,and the anxiety scores in group A at T5(48 h postoperative)were greater than those in groups B and C,with a statistically significant difference(P<0.05).group B was greater than group C,with a statistically significant difference(P<0.05).There was no significant difference in preoperative anxiety scores,and the difference was not statistically significant(P>0.05),which can be interpreted as the three groups of patients with similar preoperative anxiety status.None of the patients in the three groups used remedial analgesics postoperatively.Conclusion:Dexmedetomidine combined with lumbar square muscle block in gynecologic laparoscopic patients has a precise perioperative analgesic effect with fewer adverse effects,providing safer and more effective analgesia while reducing the application of opioids.At the same time,the combined effect of dexmedetomidine and lumbar square muscle block with multimodal analgesia can,to a certain extent,relieve patients’ anxiety and tension,improve the satisfaction of perioperative analgesia,and accelerate patients’ recovery. |
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