The Influence Of Dexmedetomidine On The Multimodal Analgesia Effect Of Flurbiprofen Axetil In Patients With Radical Resection Of Rectal Carcinoma

Objective 1.To evaluate the effect of dexmedetomidine on the analgesic effect of flurbiprofen axetil multimodal-analgesia in patients with rectal cancer radical surgery.2.To observe the influence of dexmedetomidine on the sedative effect of flurbiprofen axetil multimodal-analgesia in patients with rectal cancer radical surgery.3.To investigate the influence of dexmedetomidine on stress and inflammatory response in patients with flurbiprofen axetil multimodal-analgesia.4.To investigate the effect of dexmedetomidine on the adverse effects of flurbiprofen axetil in patients with multimodal-analgesia.Methods:90 patients who had undergone abdominal resection of rectal carcinoma have been selected and randomly divided into 3 groups with 30 patients in each.Patients in group A and B were intravenously injected with 1mg/kg flurbiprofen axetil 30 minutes before operation for preemptive analgesia,and patients in group C were pretreated with 5ml lipid emulsion through intravenous injection.Anesthesia induction: intravenous injection of midazolam 0.03 mg / kg,sufentanil 0.3?g / kg,propofol 2mg / kg,rocuronium 0.6mg / kg,then tracheal intubation.After connecting the anesthesia machine to control breathing,adjust the breathing parameters and maintain PETCO235~45mm Hg.Anesthesia maintenance: intraoperative constant infusion of propofol,remifentanil to maintain the depth of anesthesia,to maintain the BIS value of 40 to 60.Patients were sent to the PACU after the surgery,blood glucose was monitored after 30 min,the patients were sent to the ward after their indicators meet the standard.Patient-controlled analgesia pump was prepared as following: 2mg/kg flurbiprofen axetil+2?g/kg Dexmedetomidine+2?g/kg Sufentanil for group A;2mg/kg flurbiprofen axetil+2?g/kg Sufentanil for group B and 2?g/kg Sufentanil+10ml lipid emulsion for group C.The three groups were all added with saline to the final volume of 100 ml.The flow rate of analgesic pump was 1ml/h with single press amount of 1ml and lock time of 15 minutes.Visual analogue scale(VAS)while coughing and Ramsay sedation score were respectively recorded at 4h(T1),8h(T2),12h(T3),24h(T4)and 48h(T5)after operation.The effective pressing times and the dosage of sufentanil 24 hours after operation,blood glucose level 30 minutes before and after operation,C-reactiveprotein(CRP)48 hours before and after operation were respectively monitored.The numbers of patients with enhanced analgesia and adverse reactives(nausea and vomiting,dizziness,headache,itchy skin,urinary retention,respiratory depression and bradycardia)were recorded 48 hours after operation.Results :1.The VAS scales at T1,T2 and T3 while coughing,the effective pumping times of analgesic pump,post-operational blood glucose level,sufentanil consumption and CRP of group A were obviously lower than group B and C(P<0.05).No significant difference was found in enhanced analgesia among the three groups.2.The Ramsay sedation scores at T1 and T2 of group A were higher than those of group B and C.3.The postoperative blood glucose level and CRP of group A were obviously lower than group B and C(P<0.05).4.The number of adverse reactives in group A and B showed no significant difference,but were significantly lower than group C(P<0.05).Conclusion:The multimodal analgesia using dexmedetomidine in combination with flurbiprofen axetil could enhance the analgesia and sedative effect,reduce stress response and inflammation reactive,and decreased incidence of adverse reactives.