| Objective:To investigate the effect of epidural injection of dexmedetomidine as adjuvant on postoperative analgesia and early recovery of gastrointestinal function in patients with colorectal cancer.Methods:From December 2021 to December 2022,62 patients aged65～80 years,ASAⅠ～Ⅲ,BMI 18.5～23.9 kg/m2underwent elective laparoscopic radical resection of colorectal cancer in the First Affiliated Hospital of Hebei North University were selected.The patients were randomly divided into two groups（n=31）,control group（Group C）and experimental group（Group D）.After entering the room,epidural puncture was performed in the L1-2 gap in both groups.After successful puncture,3ml of 1%lidocaine test was given to the patients to test the lower limb block.After tracheal intubation,0.25%ropivacaine was injected into epidural space in Group C,7.5 ml each time,with an interval of 45 minutes.Group D received epidural injection of 0.5μg·kg-1 dexmedetomidine combined with 0.25%ropivacaine 7.5 ml at the same time,other operations are the same as Group C.Postoperative patients controlled intravenous analgesia were used in both groups.Heart rate and mean artery pressure were monitored at the time of admission（T0）,intubation（T1）,skin incision（T2）,5min after pneumoperitoneum（T3）,6 h after operation（T4）and 24 h after operation（T6）.The time of first postoperative flatus and first postoperative meal intake,the incidence of postoperative abdominal distension,VAS scores at T4,12 h（T5）,T6,48 h（T7）and 72 h（T8）,plasma cortisol concentration on the day of operation（TA）and the first day of operation（TB）,the second day of operation（TC）and the third day of operation（TD）,postoperative hospital stay and complications were recorded.Results:（1）There was no significant difference in age,sex and BMI between the two groups（P>0.05）.Compared with group C,the dosage of remifentanil in group D decreased,and the difference was statistically significant（P<0.05）.（2）Compared with T0,HR and MAP decreased at T1-T5 in the two groups,and the difference was statistically significant（P<0.05）.Compared with group C,MAP decreased at T3-4,and HR decreased at T2-5 in group D,the difference was statistically significant（P<0.05）.（3）Compared with TA,the plasma cortisol concentration of TB and TC in the two groups decreased,and the difference was statistically significant（P<0.05）.Compared with group C,the plasma cortisol concentration in group D decreased in TB,and the difference was statistically significant（P<0.05）.（4）Compared with T4,the VAS score of group C increased at T5and T6,and the VAS score of group D increased at T6（P<0.05）.Compared with group C,the number of patients with VAS score of 4-6 at T5 and T6 in group D decreased,and the difference was statistically significant（P<0.05）.The actual pressing times of PCIA in the two groups were different（P=0.05）.There was no significant difference in the total dose of remedial analgesics used in the two groups three days after operation（P>0.05）.（5）Compared with group C,the first exhaust time and the first feeding time in group D were shortened,and the difference was statistically significant（P<0.05）.（6）Compared with group C,the probability of nausea and vomiting in group D was significantly lower,and the difference was statistically significant（P<0.05）.There were 4 cases of skin itching in group C and no skin itching in group D（P<0.05）.There was no significant difference in other complications（P>0.05）.Conclusion:This study with the dexmedetomidine as adjuvant postoperative epidural injection of laparoscopic colorectal cancer radical gastrointestinal functional recovery and analgesic effect and the influence of hemodynamic,the conclusion is as follows:1.Epidural injection with 0.5μg·kg-1 dexmedetomidine combined with0.25%ropivacaine can reduce the incidence of nausea and vomiting in patients undergoing laparoscopic colorectal cancer radical,promote early gastrointestinal functional recovery.2.Epidural injection with 0.5μg·kg-1 dexmedetomidine combined with 0.25%ropivacaine will restrain stress reaction,reduce postoperative pain in patients with situation,to maintain hemodynamic stability. |
