Effect Of S-ketamine Combined With Dexmedetomidine In Laparoscopic Cholecystectomy

Objective:To observe the effects of S-ketamine combined with dexmedetomidine on postoperative pain and side effects in patients undergoing laparoscopic cholecy stectomy.Methods:Eighty patients with ASA grade I-II and age ≥18 years who underwentelective laparoscopic cholecystectomy in Xuancheng Central Hospital from October 2021 to October 2022 were selected and divided into two groups using the random number table method,40 patients in each group: group S(S-ketamine group)and group SD(S-ketamine + dexmedetomidine group).In SD group,0.5 μg/kg dexmedetomidine was injected intravenously 10 min before anesthesia induction,and then continued intravenously at a rate of 0.3 μg/kg/h,which was stopped at the time of suture,and 0.5mg/kg S-ketamine was injected intravenously before Trocar placement.Patients in group S were injected with normal saline at the same rate as those in group SD 10 minutes before anesthesia induction,and 0.5 mg/kg S-ketamine was injected intravenously before Trocar placement.After surgery,when NRS≧4,0.05 mg/kg oxycodone was injected intravenously,which could not be relieved after 10 min,and the patient was given an additional 1 mg injection,which was repeated when necessary.NRS scores of rest and cough were recorded after PACU,4h,8h,and 24 h after surgery.Ramsay sedation score after admission to PACU,2h,4h and 6h after surgery;First remedial analgesia time;Total dose of oxycodone 24 hours after operation;Postoperative patient satisfaction and complications.Results:There were no significant differences in general information and intraoperative conditions between the two groups(P > 0.05).The resting NRS score of SD group was lower than that of S group at 4,8 and 24 h after surgery,and the difference was statistically significant(P<0.05).Ramsay score of SD group was lower than that of S group at 4 and 6h after surgery,and the difference was statistically significant(P<0.05).The number of patients in SD group who did not need remedial analgesia after surgery was significantly higher than that in S group,and the duration of remedial analgesia was significantly longer than that in S group [9h vs 4h,P<0.0001,HR(95%CI):0.399(0.233,0.682)],24 h postoperative oxycodone requirement was(6.91±3.12)mg in the S group and(4.73±3.36)mg in the SD group.The dosage in the SD group was reduced by31.55%,and the difference was statistically significant(P=0.004).The incidence of PONV in SD group was significantly lower than that in S group(P=0.016).The satisfaction of anesthesia in SD group was significantly better than that in S group(P<0.05).Conclusion:Compared with S-ketamine alone,S-ketamine combined with dexmedet-omidine can significantly improve the degree of postoperative pain in patients w-ith laparoscopic cholecystectomy,reduce the need for postoperative analgesic drug-s,and reduce the incidence of postoperative nausea and vomiting.