Clinical Efficacy Of Lidocaine Combined With Dexamethasone On Postoperative Nausea And Vomiting In Patients Undergoing Lobectomy

Objective:To observe whether lidocaine combined with dexamethasone and ondansetron could reduce the incidence of PONV in patients undergoing lobectomy compared with ondansetron alone.Methods:From May 2018 to February 2019,to select 96 patients（41males and 55 females）who underwent thoracoscopic lobectomy with ASA grade I、II,age 20 to 75 years and BMI value ranging from 18.5 to 28Kg/m².They were randomly divided into three groups（A,B and C groups）according to the digital table method:lidocaine、dexamethasone and ondansetron group（group A）,dexamethasone and ondansetron group（group B）and ondansetron group（group C）.Each group had 32 patients.After the patients were monitored in the operating room,the radial artery was punctured and catheterized under local anesthesia to continuously monitor the invasive arterial pressure.All anesthetized patients were induced by midazolam:0.05 mg/kg,propofol 1.5-2.5 mg/kg,sufentanil 0.4 ug/kg,homeopathic atracurium 0.15 mg/kg,patients in group A continuously received intravenous pumping of lidocaine(2 mg·kg^-1·h^-1)after a loading doses（1.5 mg/kg）until the end of the operation,while group B and group C of patients received normal saline with the same volume.Then dexamethasone 4 mg was given intravenously in group A and group B,while normal saline with the same volume was given in group C.When the muscle relaxation,double-lumen endotracheal tubes was intubated.After positioning by fiber bronchoscope,the ventilator parameters of one-lung ventilation were set:pure oxygen（oxygen flow 2L/min）,tidal volume 6～8mL/kg and ventilation frequency 10～13 times/min.The respiratory parameters were adjusted to maintain the end-tidal partial pressure of carbon dioxide(P_ETCO₂)between 35 and 45 mmHg.Norepinephrine and nicardipine were used to maintain blood pressure in the range of±20%in the surgery.To maintain BIS value between 40 and 60.30 minutes before the end of the operation,all the patients in three groups received ondansetron 4mg and flurbiprofen 50 mg.All patients were not use postoperative intravenous controlled analgesia（PCIA）,after returning to the ward,the analgesic flurbiprofen（50 mg,2 times/d）was intravenously given for 3 days.If VAS score is more than 4,then intramuscular injection of pethidine hydrochloride（75 mg/time）.To record general data,intraoperative condition,PONV condition and the first time of patients with intestinal passing gas.Visual analogue scale（VAS）pain score,intraoperative and postoperative opioid dosage and overall satisfaction rate of the patients were observed and recorded.Results:1.There were no significant differences in gender composition,age,height,BMI and Apfel risk score between the three groups（P﹥0.05）;2.Compared with group B and group C,the intraoperative sufentanil consumption significantly decreased in the group A,the difference was statistically significant（P<0.05）;3.The incidence of PONV and the number of remedies and antiemetics of the group A and group B was significantly lower than that of the group C（P<0.05）;but there were no significant differences in the above two aspects between the group A and group B;4.In group A,The first time of patients with intestinal passing gas was shorter than that in group B and group C,the difference was statistically significant（P<0.05）;5.Compared with group B and group C,the VAS scores of group A at 6h and 24h after surgery was reduced,and the amount of additional Pethidine was decreased at 24h postoperatively,the difference was statistically significant（P<0.05）.6.In terms of the overall satisfaction rate within 24 hours after the operation,group A was better than group B and group C,and the difference was statistically significant（P<0.05）.Conclusion:Compared with ondansetron alone,the combination of lidocaine,dexamethasone and ondansetron could reduce the incidence of PONV in patients undergoing thoracoscopic lobectomy,release postoperative pain and increase postoperative satisfaction.