Clinical Observation Of The Analgesic Effects Of Dexmedetomidine For In Patients Underwent Thoracic Surgery By Intercostal Nerve Block

[Objective]To evaluate the analgesic effects of dexmedetomidine combined with ropivacaine in patients underwent thoracoscopic surgery under ultrasound-guided intercostal nerve block.[Methods]Sixty patients underwent thoracoscopic pulmonary surgery under general anesthesia at selected time were selected,with ASA grade ?-?,age ranging from 25 to 65 years old,and no gender restriction;BMI:18 to 24 kg/m2.Patients enrolled in the study were divided into two groups(30 cases in each group)using a computerized random number table:(1)ropivacaine group(R group):20 mL of 0.375%ropivacaine for intercostal nerve block;(2)dexmedetomidine combined with ropivacaine group(RD group):a total of 20 mL of 0.375%ropivacaine+dexmedetomidine 1 ug/kg for intercostal nerve block.Intercostal nerve block was performed under the guidance of b-ultrasound 30min before anesthesia induction and local anesthetics were given to R group or RD group.Recorded the basic information of patients in the two groups;Recorded the onset time of intercostal nerve block in both groups;Recorded the hemodynamic changes(MAP,HR)of patients in the two groups in resting state(T0),15min after intercostal administration(T1),at once of intubation induction(T2),end of incision(T3),at once of extubation(T4);Moreover,recorded the amount of disoprofol and remifentanil used during the surgery.Recorded the VAS scores at 2,6,12,24,36 and 48 h after surgery at resting and coughing time in patients in both groups;Recorded the duration of the analgesic effects of the intercostal nerve block(from the end of the intercostal nerve block to the first postoperative use of PCI A);Recorded the amount of sufentanil and the number of compressions of analgesic pump for 48 h after surgery were recorded in the two groups;Recorded the conditions of the postoperative adverse reactions(with or without hematoma,hypotension,bradycardia,nausea and vomiting,dizziness,agitation,neurotoxicity(whether there is paresthesias or anaesthesia in the block area.[Results]1.There was no statistical difference in the general situation and basic conditions of patients in the two groups(P>0.05).2.Compared with the group R,the intercostal nerve block in the RD group had a faster onset time(P<0.05).3.In the group R,compared with T0,the MAP of T2 to T4 was significantly increased(P<0.05),and the HR of T2 to T4 was significantly increased(P<0.05);Compared with T1,the MAP and HR of T2 to T4 were significantly increased(P<0.05);in the RD group,compared with T0,the MAP and HR of T2 to T4 were significantly increased(P<0.05);compared with T1,the MAP and HR of T2 to T4 were significantly increased(P<0.05).There was no statistical difference between the R group and the RD group at T0(P>0.05).Compared with the R group,the MAP and HR in the RD group decreased significantly at T1 to T4,and the difference was statistically significant(P<0.05).There was no significant difference in the amount of disoprofol and remifentanil used during the operation(P>0.05).4.Compared with the R group,the duration of the analgesic effects in the RD group was significantly longer(P<0.001),the total amount of sufentanil used after surgery reduced(P<0.05),and the number of the compressions of analgesic pump postoperative decreased(P<0.05).Two hours after operation,the VAS scores of patients in R group at the resting and coughing states had no statistical difference compared with those in the RD group.At 6 and 12 hours after surgery,the VAS scores of patients in the RD group at the resting and coughing states were significantly lower than those in the R group(P<0.001).At 24 hours,36 hours,and 48 hours after operation,there was no significant difference in VAS scores between patients in the R group and the RD group at the resting and coughing states.5.There were no significant differences in the incidence of postoperative adverse reactions such as hypotension,bradycardia,nausea and vomiting,dizziness,agitation,neurotoxicity.[Conclusion]Compared with ropivacaine alone,dexmedetomidine combined with ropivacaine for intercostal nerve block can effectively shorten the onset time and prolong the duration of analgesia after thoracoscopic pulmonary surgery,reduce the amount of sufentanil used after surgery,increase the intensity of postoperative analgesia.