| Objective:The purpose of this experiment was to investigate the beneficial effects ofperioperative lidocaine and dexamethasone on postoperative pain,gastrointestinalmotility and inflammatory response on laparoscopic gallbladder surgery surgery, in orderto use the anti-inflammatory drug treatment and prevention of postoperative ileus morereasonable.Methods:A total number of eighty ASA I-II patients undergoing laparoscopic gallbladdersurgery were randomly divided into four groups: lidocaine group （L）, and dexamethasonegroup （D group）, Lidocaine composite dexamethasone group （L&D group） and controlgroup （the saline group,C group）, Twenty patients in each group. Select the same surgery,same anesthesia machine, the same batch of drugs. Group L and group L&D in the10minutes before induction of general anesthesia,an intravenous lidocainebolus（1.5mg/kg）was administered followed by a continuous lidocaine infusion(0.5mg kg-1. hr-1)until48hours postoperatively.Group D, group L&D in the10minutes beforeinduction of general anesthesia,an intravenous dexamethasone bolus（0.1mg/kg）wasadministered followed by a continuous dexamethasone infusion(0.004mg kg-1.hr-1)until48hours postoperatively.Patients in the contrast group received an equalvolume of saline. Each group was induction with midazolam0.05mg/kg, sufentanil0.5ug/kg, Cisatracurium Besilate0.1mg/kg,propofol1.5mg/kg. Anesthesia Wasmaintained with propofol,remifentanil and Sevoflurane. Intravenous Cisatracurium Besilate intermittently in order to maintain muscle relaxation.The PCIA pressing times of6hours,12hours,24hours,48hours postoperatively; VAS score at rest or cough of6hours,12hours,24hours and48hours postoperatively, flatus time and defecation time;were recorded.Results:The amount of remifentanil which was used in L,D,L&D and C group were7.11±0.78ug·kg-1.hr-1,8.07±0.61ug·kg-1.hr-1,6.61±0.72ug·kg-1.hr-1and8.59±0.58ug·kg-1.hr-1.L&D group, the two groups had no significant difference; C, D group, the two groupsalso had no significant differences. Patients in L and L&D group required lessremifentanil than those in group D and group C. L, L&D group, two groupssignificantly reduced （P <0.05）. The PCIA pressing times of6hours,12hours,24hourspostoperatively are obvious different between the four groups, but no statisticaldifference among groups PCIA pressing times postoperative24-48hours. VAS scores atrest L and L&D group of6hours,12hours,24hours postoperatively was significantlylower than the control group; the difference between VAS scores at cough of L&Dgroup and C group was significantly in the first postoperative day（lower）; the VASscores at cough of dexamethasone is relatively lower but notsignificant in the firstpostoperative day, the VAS scores of the second postoperative day were not statisticallysignificant. The flatus time of L, D, L&D and C group was23.40±7.72h,28.65±8.56h,22.45±7.42h and29.50±9.11h, L, L&D group had no difference; C group and Dgroup also had no difference. Patients in L and L&D group required less time thangroup C. L, L&D group, two groups significantly reduced （P <0.05）.; the defecationtime of L, D, L&D and C group was48.25±15.51h,53.10±13.65h,46.20±15.28h55.55±15.39h;L and L&D group had statistically significant difference with group C （P<0.05）,.Conclusions:1. Pefioperative lidocaine and dexamethasone infusion undergoing laparoscopicgallbladder surgery led to a significant reduction in requirement of fentanyl and isoflurane in anesthesia,and it also improved the quality of postoperative analgesia withless Opioids consumption2.Intravenous infusion of anti-inflammatory drugs can accelerate laparoscopiccholecystectomy postoperative recovery of bowel function.3.Small dexamethasone does has some analgesic effect, but it can not speed uplaparoscopic cholecystectomy in patients with postoperative recovery of bowel functionas well as lidocaine.4. Long-time infusion of small doses of dexamethasone no significant adverse reactions;relatively safe. |
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