Effect Of Dexmedetomidine On Anxiety And Postoperative Analgesia In Patients Undergoing Gynecologic Endoscope Surgery

Background Pain is an unpleasant sensation,an emotional experience caused by actual or potential tissue damage.With the development of pain,people have come to realize that pain is a multi-dimensional phenomenon that includes feelings,emotions,motivation,environment,and cognitive components.Domestic and foreign literature reports:There is a linear relationship between anxiety and pain.The more serious the anxiety,the higher the sensitivity of the patient to pain and the lower the pain threshold of the body.Concerns about changing lifestyles,worrying about missing parts of the body,etc.are all common sources of stress caused by preoperative anxiety.How to slow down the anxiety caused by surgery and improve the patient’s psychological response ability is getting more and more attention.A large amount of literature shows that dexmedetomidine can relieve patients’anxiety and increase their comfort.Purpose To observe the effect of dexmedetomidine on angst and postoperative pain in patients undergoing gynecologic surgery.Method The study was approved by the hospital’s ethics committee（No.201704）and informed consent was obtained from the patients and their families.The third affiliated hospital of Zhengzhou University was selected from March 2016 to March 2017 and 120 patients undergoing laparoscopic total hysterectomy and uterine myomectomy under elective general anesthesia,randomly divided into three groups of D₁ group（n=40）,intraoperative 0.2μg/kg/h continuous intravenous pump dexmedetomidine;postoperative patient-controlled intravenous analgesia pump:2μg/kg sufentanil+physiological Saline;D₂ group（n=40）,intraoperative 0.2μg/kg/h continuous intravenous infusion of dexmedetomidine;postoperative venous connection controlled analgesia pump:2μg/kg sufentanil+200μg dexmetol Miding+normal saline;C group（n=40）,intraoperative continuous intravenous infusion of saline at the same dose;postoperative patient-controlled intravenous analgesia pump:2μg/kg sufentanil+saline.The changes of MAP,HR and SpO₂ were observed and recorded before anesthesia（T0）,20 min after pneumoperitoneum（T1）,at extubation（T₂）,24 h after operation（T₃）and 48 h after operation（T₄）;Recovery time（anesthesia end to call open eyes）,extubation time（end of anesthesia to remove the tracheal tube）and cough score;The anxiety scores of preoperative and postoperative1 d,2 d anxiety scores,as well as postoperative 2 h,6 h,24 h,48 h sedation score（Ramsay score）,analgesic score（VAS）,analgesia pump press number,6 h and 24 h Sufentanil dosage.Results Three groups of MAP,HR:compared with D₁,D₂ group,C group T₁,T₂was significantly higher（P<0.05）.Three groups of patients awake time and extubation time:there was no statistically significant difference（P>0.05）.Three groups of coughing occurred during extubation:Compared with group C,the incidence of D₁,D₂ group was lower than that of group C（P<0.05）.The three groups of anxiety scores:Compared with preoperative,the anxiety scores of the three groups were lower than those before surgery on the 1st and 2nd days（P<0.05）;compared with the C group,the anxiety scores of the D₁ and D₂ groups were lower than the C group（P<0.05）;D₂ group is lower than D₁ group（P<0.05）.Three groups of postoperative sedation scores:compared with group C,D₁,D₂ group was higher than group C,;and postoperative 6 h,24 h time point D₂ group was higher than D₁ group,the difference was statistically significant（P<0.05）;there was no significant difference between D2 group and D₁ group at 2 h and 48 h（P>0.05）.Three groups of postoperative analgesia scores:compared with C group,D₁,D₂ group was lower than C group（P<0.05）;and D2 group was lower than D1 group at 6h and 24h after operation,and the difference was statistically significant（P<0.05）;There was no significant difference between D₂ group and D₁ group at 2h and 48h（P>0.05）.Three groups of analgesic pump compression times:compared with group C,postoperative D1,D2group was less than group C（P<0.05）;6h,24h,48h time point D₂ group was lower than D₁ group,the difference was statistical Significance（P<0.05）;There was no significant difference between D2 group and D1 group at 2h（P>0.05）.Three groups of sufentanil dose:Compared with group C,D1 and D2 groups were less than C at 6 and24 hours after operation（P<0.05）;and D2 group was less than D1 group（P<0.05）.Conclusion Perimenopausal application of dexmedetomidine can effectively reduce the stress response during the extubation period,enhance postoperative analgesia,relieve postoperative anxiety,reduce opioid use,and have no significant adverse effects.Continued use of dexmedetomidine during and after surgery can significantly relieve the patient’s anxiety.