Application Of Dexamethasone Combined With Ropivacaine ESP Block In Analgesia After Thoracoscopic Surgery

Objective:To analyze the analgesic effect of dexamethasone combined with ropivacaine in the treatment of ultrasound-guided erector spinae plane block(ESP)after thoracoscopic surgery.Methods:Sixty patients who underwent elective thoracoscopic surgery were selected,with ages 25-65 years old,ASA grade I or II,and body mass index(BMI)of 18-30kg/m2.Patients or their families voluntarily signed the written informed consent.Randomly divided into two groups,ropivacaine group(R group)and dexamethasone combined with ropivacaine group(RD group),30 cases in each group.After intravenous access,the two groups were given the same standard anesthesia induction and maintenance:anesthesia induction injection of midazolam 0.05 mg/kg,etomidate injection of 0.3 mg/kg,substantial injection of 0.25 ug/kg,calligraphic for injection of 0.15 mg/kg.Anesthesia was maintained by giving 1.5%sphalerite inhalation,intravenous infusion of propofol injection at 4 mg/(kg.h),regimentals for injection at 3 ug/(kg.h),plus 4 mg contraction per hour to maintain muscle relaxation.Postoperatively,both groups of patients received the same dose of PCIA pumps,including 100 ug of sweetening and 10 mg of association,totaling 100 ml.Immediately after the operation,a planar block of erector spine muscle was performed at the 5th level of the chest under thoracic ultrasound.Patients in the R group were given 20 ml of 0.5%ropivacaineon each side,a total of 40 ml on both sides.Patients in the RD group were given 0.5%ropivacaine+5 mg dexamethasone,20 ml on each side,and 40 ml on both sides.Two groups of patients with postoperative 2 h,4 h,8 h,12 h,24 h resting at each time point and coughing when Visual Analogue Scale(Visual Analogue Scale,VAS),after 2 h,4 h,8 h,12 h,24 h calm at each time point(Ramsay)score,postoperative analgesia pump for the first time press time,postoperative analgesia pump effective press number within 24 h,24 h additional analgesics remedy(30 mg tromethamine)number;Postoperative adverse reactions(such as nausea and vomiting).Results:Both groups of patients successfully completed the clinical trial,local anesthetic drug diffusion is good.1.There was no statistically significant difference in general data(P>0.05).2.VAS score at 2 h,4 h,8 h,12 h and 24 h after surgery in the RD group was lower than those in the R group(P<0.05).3.Ramsay score of the RD group at 2 h,4 h,8 h,12 h and 24 h after surgery was significantly higher than those of the R group(P<0.05).4.The first compression time of postoperative analgesia pump in the RD group was significantly later than that in the R group.5.The total number of effective compression of the analgesic pump in the RD group within 24 h after surgery was less than that of the R group.6.In the RD group,the number of additional analgesic remedies(30 mg of tromethamine)within 24 h after surgery was lower than that of the R group.7.There was no significant difference in the incidence of postoperative adverse reactions between the two groups(P>0.05).Conclusion:The application of dexamethasone combined with ropivacaine in ultrasound-guided ESP block can effectively increase the action time of ropivacaine,providing a reference for clinical thoracoscopic postoperative analgesia.