Clinical Effect Of Ropivacaine Combined With Dexmedetomidine For Thoracolumbar Interfascial Plane Block In Patients Undergoing Lumbar Interbody Fusion

Objective: To observe the clinical effect of ropivacaine combined with dexmedetomidine(DEX)for thoracolumbar interfascial plane block(TLIPB)in patients undergoing posterior midline approach lumbar interbody fusion,including the influence on the dosage of general anesthesia drugs,the quality of recovery period and the effect of postoperative analgesia.Methods: Sixty patients who were scheduled to undergo posterior median approach lumbar fusion were randomly divided into three groups(n=20): PCIA group without TLIPB(Group P),TLIPB combined with PCIA group(Group TP)and DEX applied to TLIPB combined with PCIA group(group TD).Patients in Group TP and group TD were subjected to TLIPB before operation,Group TP where subjects received 0.5% ropivacaine(a total volume of 40 ml,20 ml each side);Group TD where subjects received 0.5% ropivacaine+0.5μg/kg Dex(a total volume of 40 ml,20 ml each side).No TLIPB was performed in Group P.MAP and HR were recorded at each time point: anesthesia induction(T1),tracheal intubation(T2),the beginning of operation(T3),1h after the beginning of operation(T4),the end of operation(T5),at the time of extubation(T6),2 min after extubation(T7);the total volume of propofol and remifentanil during the operation was recorded;the maximum Ricker sedation-restlessness score and the time of extubation were observed and recorded;the rest VAS and cough VAS scores of 1 h(PT1),6 h(PT2),24 h(PT3)and 48 h(PT4)after the operation were recorded;the analgesia rate and postoperative adverse reactions were recorded within 48 h after the operation.Results: Compared with Group P and Group TP,the MAP in Group TD at the time of extubation and 2 minutes after extubation,the maximum Ricker sedation-restlessness score in Group TD decreased significantly(P<0.05).Compared with Group P,the scores of rest VAS and cough VAS in Group TP and Group TD decreased significantly(P < 0.05)at the time of 1h and 6h after operation.Compared with Group P and Group TP,the scores of rest VAS in group TD significantly decreased at the time of 6h and 24 h after operation(P < 0.05).There was no significant difference in the total amount of propofol and remifentanil,the time of extubation,the rate of analgesia and postoperative adverse reactions(P > 0.05).Conclusions: The addition of 0.5 μg/kg Dex to ropivacaine for TLIPB can reduce postoperative restlessness and maintain the stability of blood pressure during the recovery period of general anesthesia.And enhance the effect of ropivacaine after the operation,but it has no effect on the dosage of general anesthesia drugs during operation.