| Objective:The pain after craniotomy is often ignored,and neurosurgery patients are prone to consciousness disorder,so it is difficult to accurately evaluate the degree of pain.Scalp nerve block has a good effect on the postoperative pain of patients with craniotomy,but there is no report about the application of dexmedetomidine combined with scalp nerve block in craniotomy at present.Therefore,this study uses dexmedetomidine combined with scalp nerve block to compare and analyze the differences between dexmedetomidine combined with scalp nerve block and single scalp nerve block in intraoperative and postoperative indexes,and evaluate the differences between dexmedetomidine combined with scalp nerve block and single scalp nerve block.The purpose of this study is to optimize the postoperative pain management program and better guide the clinical work.Method:80 patients with craniotomy were selected.The risk of operation before anesthesia was classified into grade I ～ II.They were randomly divided into two groups: group A,dexmedetomidine + ropivacaine group(n = 40 cases),and group B,ropivacaine group(n = 40 cases).Recording the indexes of all patients such as heart rate,mean arterial pressure,before anesthesia induction(T0),5 min after anesthesia induction(T1),before the head frame used(T2),the moment of the head frame used(T3),the moment of the skin cutted(T4),the moment of the incision sutured(T5)and5 min after extubation(T6).Recording the postoperative restlessness of each group of patients,as well as the visual analog scale and ramsay sedation score at 2h,6h,12 h,and 24 h postoperatively,and recording the severity score of delirium at 48 h postoperatively.The simple mental state scale was scored on the first day before the operation,and on the first day or the seventh day after the operation.beside,the number of nausea or vomiting,and other adverse reactions at each time point after the operation were also recorded.ELISA was used to detect those inflammation indexes of TNF-α,IL-1 and IL-6 at the time of before anesthesia,and the end of the operation or 24 hours after the operation in the serum of the two groups.Result:At the 6 time points after T1 anesthesia induction,the heart rate and mean arterial pressure of group A were more stable than those of group B(P<0.05).The pain score of group A was significantly lower than that of group B(P<0.05).There were no obvious symptoms of nausea and vomiting after operation both the two groups,and there was no significant difference in ramsay sedation score between the two groups(P>0.05).The MMSE score of group A was significantly higher than that of group B(P<0.05).Dexmedetomidine combined with ropivacaine was better to the recovery of mental state and reduce the incidence of postoperative delirium.The levels of TNF-α、IL-1、IL-6 and Hs-CRP in group A were significantly lower than those in group B(P<0.05)at 24 hours after the operation.Conclusion:The effect of dexmedetomidine combined with local anesthetics was better than that of local anesthetics alonely.The duration of postoperative analgesia of dexmedetomidine combined with ropivacaine was longer than that of ropivacaine alonely,and the incidence of adverse reactions such as nausea and vomiting was low,which was very suitable for postoperative analgesia of craniotomy.Dexmedetomidine combined with ropivacaine can reduce the level of inflammatory factors in patients with scalp nerve block,although the score of postoperative DRS showed that there was no significant difference in delirium status between the two groups,but the ability of postoperative pain relief and MMSE cognitive score were significantly improved compared with the group of ropivacaine alonely,which has a certain preventive effect on the postoperative cognitive declining earlily. |
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