Effect Of Dexmedetomidine On The Postoperative Analgesia With Tramadol Through Preemptive Analgesia And Postoperative Analgesia

ObjectiveTo investigate the effect of dexmedetomidine on the postoperativeanalgesia in abdominal gynecological surgery through preemptive analgesiaand auxiliary analgesia. The “tramadol-sparing” effect of dexmedetomidinewas also observed.Methods90patients scheduled for abdominal gynecological surgery wereincluded. Inclusion criteria: age25-60yrs, body weight45-75kg, height:153-170cm, ASA I-II. All the patients were randomly allocated to theregroups(T,TD1,TD2) with30ones in each group. All the patients used patientscontrol intravenous analgesia postoperatively. Group T: tramadol15mg/kg+Granisetron3mg in100ml normal saline. Group TD1: the loading dose ofdexmedetomidine (1μg/kg) was infused10min before induction anddexmedetomidine infusion was continued in speed of0.5μg·kg-1·h-1till theend of operation, and the PCIA was set to be same to group T. Group TD2:tramatol15mg/kg+dexmedetomidine4μg/kg+Granisetron3mg in100mlnormal saline. The PCIA of all patients were set as follows: continuousinfusion rate was1.5ml/h, PCA was1ml, lock time was10min. The VAS,BCS and RSS were accessed at4h(T1),8h(T2),12h(T3),24h(T4),48h(T5) after operations respectively. The effective PCA, use of tramadol andincidence of adverse event were also recorded.ResultThe VAS at T1, T2, T3in group T was significantly higher than TD1andTD2（P<0.05）while they were not different between TD1and TD2(P>0.05),and it was lower in TD2than that in T or TD1at T4and T（5P<0.05）while theywere not different between T and TD1(P>0.05). The BCS at T1, T2, T3ingroup T was significantly lower than TD1and TD2（P<0.05）while they werenot different between TD1and TD2(P>0.05), and it was higher in TD2thanthat in T or TD1at T4and T5（P<0.05）while they were not different betweenT and TD1(P>0.05). The RSS in group TD2was the highest among the3groups, and that was higher in group TD1than in group T in time T1(P<0.05).From T2to T5，RSS was higher in group TD2than in group T and TD1(P<0.05), and there were no difference between T and T D1(P>0.05). Theeffective PCA was highest in group T with24h postoperatively (P<0.05)while they were not different between TD1and TD2(P>0.05), and it waslowest in group TD2during24-48h postoperatively (P<0.05) while they werenot different between T and TD1(P>0.05). The doses of tramadol weresignificantly higher in group T than in group TD1or TD2(P<0.05）while theywere not different between TD1and TD2(P>0.05). The incidence of vomitingand nausea was lower in TD1and TD2（P<0.05）while there were nodifference in hyperhidrosis, dazzling and bradycardia(P>0.05). ConclusionThe preemptive and auxiliary analgesia of dexmedetomidine bothenhanced the postoperative analgesia effect of intravenous tramadol inabdominal gynecological surgery. The effective PCA and dose of tramadolwere also reduced as well as the incidence of nausea and vomiting. Theauxiliary analgesia of dexmedetomidine seemed better.