Application of different doses of dexmedetomidine combined with ropivacaine thoracic paravertebral block in thoracic surgery

doi:10.11958/20220461

Abstract

Abstract:

Objective To investigate the application of different doses of dexmedetomidine combined with ropivacaine thoracic paravertebral block in thoracic surgery. Methods Thoracic paravertebral block was performed in 157 patients underging elective thoracic surgery. Patients were divided into the four groups. The control group (n=40) was treated with 0.375% ropivacaine, while patients in the low-dose group (n=39), middle-dose group (n=40) and high-dose group (n=38) were treated with 0.5 μg/kg, 1.0 μg/kg and 2.0 μg/kg of dexmedetomidine combined with 0.375% ropivacaine, respectively. Heart rate (HR) and mean arterial pressure (MAP) on entering the room (T₀), at anesthesia induction (T₁), at the beginning of surgery (T₂), at 30 minutes after the beginning of surgery (T₃) and at the end of surgery (T₄) were recorded. Visual Analogue Scale (VAS) scores in resting state and active state, levels of epinephrine and cortisol (Cor) at different time points after surgery were also recorded. Results The intraoperative dosages of propofol and remifentanil, and the times of postoperative patient-controlled analgesia used in the middle-dose group and the high-dose group were lower than those in the control group and the low-dose group, and the times of postoperative patient-controlled analgesia used in the low-dose group was less than that in the control group (P<0.05). HR and MAP at T₂were lower in the high-dose group than those of the other 3 groups. HR at T₃ was lower in the high-dose group than that of the control group and the middle-dose group (P<0.05). Compared with the control group and the low-dose group, the VAS and Cor scores at 12 h, 24 h and 48h after surgery and in resting state and active state were decreased in the middle-dose group and the high-dose group. Epinephrine was decreased at 12 h and 24 h after surgery. The VAS scores and epinephrine levels at 24 h and 48 h after surgery and in resting state, the VAS scores at 12 h and 48 h after surgery and in active state, and Cor level at 24 h after surgery were lower in the low-dose group than those in the control group. The VAS score in resting state at 12 h after surgery was lower in the high-dose group than that in the middle-dose group (P<0.05). Conclusion 1.0 μg/kg of dexmedetomidine combined with ropivacaine thoracic paravertebral block can improve postoperative analgesia effect, reduce stress response and have little influence on hemodynamics in patients undergoing thoracic surgery.

Key words: dexmedetomidine, ropivacaine, thoracic paravertebral block, surgery

CLC Number:

R614

Figures/Tables 5

References 24

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组别	n	男性	年龄（岁）	BMI（kg/m²）
对照组	40	18（45.00）	61.80±9.92	22.76±1.46
低剂量组	39	17（43.59）	61.67±9.45	22.81±1.22
中剂量组	40	18（45.00）	58.23±11.74	22.74±1.41
高剂量组	38	16（42.11）	56.84±12.91	22.85±1.33
χ²或F		0.090	1.967	0.058

组别	n	男性	年龄（岁）	BMI（kg/m²）
对照组	40	18（45.00）	61.80±9.92	22.76±1.46
低剂量组	39	17（43.59）	61.67±9.45	22.81±1.22
中剂量组	40	18（45.00）	58.23±11.74	22.74±1.41
高剂量组	38	16（42.11）	56.84±12.91	22.85±1.33
χ²或F		0.090	1.967	0.058

组别	n	术中给药		术后自控镇痛次数（次）
组别	n	丙泊酚用量（mg）	瑞芬太尼用量（mg）	术后自控镇痛次数（次）
对照组	40	310.81±19.60	1.27±0.08	8.88±0.94
低剂量组	39	303.26±22.53	1.25±0.09	8.08±1.16^a
中剂量组	40	282.13±24.03^ab	1.19±0.11^ab	7.15±1.55^ab
高剂量组	38	285.74±27.91^ab	1.18±0.08^ab	7.13±1.47^ab
F		13.398^＊＊	8.566^＊＊	16.381^＊＊

组别	n	术中给药		术后自控镇痛次数（次）
组别	n	丙泊酚用量（mg）	瑞芬太尼用量（mg）	术后自控镇痛次数（次）
对照组	40	310.81±19.60	1.27±0.08	8.88±0.94
低剂量组	39	303.26±22.53	1.25±0.09	8.08±1.16^a
中剂量组	40	282.13±24.03^ab	1.19±0.11^ab	7.15±1.55^ab
高剂量组	38	285.74±27.91^ab	1.18±0.08^ab	7.13±1.47^ab
F		13.398^＊＊	8.566^＊＊	16.381^＊＊

组别	n	HR（次/min）					MAP（mmHg）
组别	n	T₀	T₁	T₂	T₃	T₄	T₀	T₁	T₂	T₃	T₄
对照组	40	76.33±8.33	72.73±9.09	76.43±8.06	77.75±8.40	76.58±7.92	77.45±5.32	78.60±6.92	79.00±6.94	78.50±5.68	78.58±4.72
低剂量组	39	75.49±7.47	75.33±8.15	74.59±9.37	75.49±8.57	75.67±7.40	77.36±7.16	78.59±3.48	78.69±4.49	78.67±6.96	79.23±5.78
中剂量组	40	77.65±8.04	74.40±8.38	76.75±8.44	76.83±9.18	77.55±7.19	78.48±6.00	80.30±5.75	80.85±5.45	81.05±5.47	80.65±4.54
高剂量组	38	75.74±8.29	74.74±7.80	69.50±7.75^abc	71.79±6.89^ac	77.63±7.38	78.00±5.97	78.18±6.80	72.13±4.63^abc	81.18±5.77	79.66±4.29
F		0.571	0.706	6.096^＊＊	3.833^＊	0.599	0.284	1.006	18.679^＊＊	2.345	1.278