Effect Of Perioperative Infusion Of Dexmedetomidine Combined With Sufentanil On Quality Of Postoperative Analgesia In Patients Undergoing Laparoscopic Nephrectomy

Background and ObjectivePostoperative pain is one of the most common symptoms after surgery, which brings physical discomfort to patients. In addition, it may cause a series of complications, which prolong the length of stay and affect the prognosis. Opioids is one of the most common postoperative analgesic drugs that play a strong analgesic effect. At the same time, its adverse reactions such as severe respiratory depression and gastrointestinal adverse reactions are also very obvious. As a highly selective alpha-2 adrenergic receptor agonist, dexmedetomidine (DEX) has sedative, analgesic and anxiolytic properties. What’s more, its influence on the respiratory system is small, and it can decrease the incidence of postoperative nausea and vomiting. Currently, it has been widely used as auxiliary medicine for anesthesia in operation, but its postoperative application and effect of laparoscopic nephrectomy still lack systematic research. The purpose of this research is to observe the effect of infusion of dexmedetomidine combined with sufentanil on quality of postoperative analgesia in patients undergoing laparoscopic nephrectomy during the perioperative period, so as to validate its effectiveness and safety.Materials and methodsWe chose 90 patients undergoing laparoscopic surgery in this trial, ASA Ⅰ-Ⅱ, and according to a computer generated random numbers, they were randomly assigned for sufentanil group (group C), low dose of DEX combined sufentanil group (Group D1) and high dose of DEX combined sufentanil group (group D2). Before the anesthesia induction, each patient was given an intravenous constant speed infusion of test drug (D1 and D2 groups with 0.5 μg/kg DEX, group C with 0.9% NS),10 minutes to lose after the injection. The propofol, sufentanil and rocuronium were given for anesthetic induction. After LMA intubation, an arterial cannula was placed in the left radial artery. Anesthesia was maintained with sevoflurane (end-tidal concentration 1-2%), dexmedetomidine (0.9%NS in group C,0.2μg/kg/h in group D1 and 0.4μg/kg/h in group D2), and rocuronium was given to provide a satisfactory degree of muscle relaxation. Dexmedetomidine was stopped approximately half an hour prior to the end of surgery. The blood pressure was regulated by the application of vasoactive drugs.The mean arterial blood pressure (MAP), heart rate (HR) and arterial oxygen saturation (SpO2) were recorded respectively at the following time intervals:5min after entering the OR (T0),5min after induction of anesthesia (T1),5min (T2) and 1h (T3) after establishment of pneumoperitoneum,5min after stop sevoflurane (T4) and 5min after extubation (T5). At the end of surgery, the patient-controlled intravenous analgesia (PCIA) (Group C with sufentanil 0.02μg/kg/h; Group D1 with both sufentanil and DEX 0.02μg/kg/h; group D2 with sufentanil 0.02μg/kg/h and DEX 0.04μg/kg/h)was started up.Numerical rating scale both at rest (NRSr) and with movement (NRSm) were recorded in patients to observed postoperative pain intensity. The amount of self-administered sufentanil, level of sedation (LOS), Bruggrmann comfort scale (BCS) and functional activities score (FAS) were also recorded. Meanwhile, we observed the first time of flatus and defecation after the operation, the incidence of adverse reactions (including nausea and vomiting, severe abdominal pain and distention, shiver, delirium, and serious respiratory depression SRD) and postoperative stay in hospital.Results1.The basic features of patients, intraoperative vital signs, general features of anesthesia, LOS, BCS, FAS after surgery and postoperative stay in hospital among the three groups had no significant differences (P> 0.05).2. At 8 hours after surgery, the NRSr in group D1 was significantly lower than that of the group C (P< 0.05), while compared with group D2 and group C. there were no significant differences. At 1h,2h,4h,8h,24h,48h after surgery, the NRSm in group D1 and group D2 were both significantly lower than that in group C (P<O.05).Within the postoperative 8h, the dorsage of sufentanil in group D1 and D2 were significantly lower than that of group C (P< 0.05), in addition, patients that needed additional self-administered sufentanil within 48h after surgery in group D1 (10 cases) and group D2 (11 cases) were significantly lower than that in group C (20 cases) (P< 0.05). Between group D1 and D2, there were no significant differences (P> 0.05). No patients needed rescue analgesia in all the three group in 48 hours after surgery. Patients in D2 group had more drowsiness than patients in group D1 and C (P<0.05). Other adverse reactions had no significant differences among the 3 groups (P>0.05).3. The first flatus and defecation time after surgery of patients in group D1 (39.57±9.74 and 73.33±14.65) and D2 (41.86±8.88 and 80.50±21.65) were significantly shorter than group C (49.73±14.11 and 101.19±30.72) (P< 0.05). And the function of postoperative bowel movement between group D1 and D2 did not exist significant differences (P>0.05).ConclusionsDEX used for postoperative analgesia combined with sufentanil can reduce postoperative pain, promote the recovery of intestinal function, and bring less adverse reactions. Compared two DEX groups, the effect on analgesic effects after surgery had no significant difference, but high dose DEX can increase the incidence of drowsiness. As a result, we suggested to use low dose of DEX combined with sufentanil on postoperative analgesia in patients undergoing laparoscopic nephrectomy.