Effect Of Dexmedetomidine Combined With Transversus Abdominis Plane Block On Postoperative Recovery In Elderly Patients Undergoing Laparoscopic Radical Gastrectomy

Objective:To investigate the effects of intravenous infusion of dexmedetomidine and local application of ropivacaine adjuvant combined with transversus abdominis plane block on postoperative recovery of elderly patients undergoing laparoscopic radical gastrectomy.Methods:Ninety elderly patients who underwent laparoscopic radical gastrectomy under elective general anesthesia were randomly divided into three groups.0.33% ropivacaine TAPB group(Group P),0.33% ropivacaine mixed with dexmedetomidine 0.4 μg/kg TAPB group(Group D),dexmedetomidine 0.4 μg/kg continuous intravenous pumping for 1h,0.33% ropivacaine TAPB group(Group V),30 cases in each group.All patients underwent bilateral TAPB with 15 m L of drug on each side and received intravenous controlled analgesia(PCIA)after surgery.The general data of the three groups were recorded.The VAS scores of resting and exercise(cough)at 2h,6h,12 h and 24 h after operation were recorded.The 15 postoperative recovery quality scale(Qo R-15)scores were recorded at 1 day after surgery.The heart rate and mean arterial pressure of the patients were recorded at the time of entering the room(T1),after TAPB(T2),5min after pneumoperitoneum(T3)and immediately after awakening(T4).Postoperative PCIA use : the time of first need for analgesics,the number of effective PCIA compressions and the amount of sufentanilwithin 24 hours,.The incidence of perioperative adverse reactions was observed.Results:The heart rate and mean artery at T2,T3 and T4 in group D and group V were lower than those in group P(P< 0.05).The resting VAS scores of group P at 12 h and 24 h after operation were higher than those of group D and group V(P< 0.05).The sports VAS scores of group D and group V at each time after operation were lower than those of group P,and the sports VAS score of group D at 24 h after operation was lower than that of group V(P< 0.05).The Qo R-15 scores of group D and group V were higher than those of group P(P< 0.05),but there was no significant difference between the two groups(P> 0.05).Compared with group P,the time of first need for analgesics was prolonged,the dosage of sufentanil and the effective pressing times of PCIA were significantly decreased in group D and group V(P< 0.05).The time of first need for analgesics in group V was shorter than that in group D,and the effective pressing times were more than those in group D(P< 0.05).There was no significant difference in the incidence of nausea and vomiting among the three groups.Conclusion:The application of dexmedetomidine combined with ropivacaine TAPB in laparoscopic radical gastrectomy for elderly patients can improve the quality of postoperative recovery.As an adjuvant of local anesthetics,topical administration has a stronger analgesic effect and duration than intravenous pumping and reduce the use of postoperative PCIA analgesics,with high safety.