Clinical Observation Of Dexmedetomidine Combined With Ultrasound Guided Thoracic Paravertebral Nerve Block In Thoracoscopic Surgery

Background and ObjectiveThoracic surgery usually involves important organs in the chest and abdomen,which seriously interferes with the function of the patient’s breathing and circulatory system,causing a strong stress response,while painful stimulation and inflammatory response often cause respiratory insufficiency,lung infection,and atelectasis during the perioperative period.Painful stimulation and inflammatory response is the root cause of complications.Good perioperative analgesia can significantly reduce the irritation caused by surgical operations,reduce inflammation,improve oxygenation of the body,reduce postoperative complications,shorten the hospital stay and reduce hospital costs,improve patient satisfaction and avoid postoperative chronic pain.Therefore,during the perioperative anesthesia management of thoracic surgery,good perioperative analgesia is very important.There are various treatment methods for perioperative analgesia during thoracoscopic surgery.At present,the clinically commonly used perioperative analgesia methods include intravenous automatic analgesia device,thoracic paravertebral nerve block,intercostal nerve block,erector spinae subfascial block and epidural analgesia,etc.Commonly used analgesia Drugs include non-steroidal anti-inflammatory analgesics,acetaminophen,opioids and dexmedetomidine.Among them,ultrasound-guided thoracic paravertebral nerve block is an analgesic technique with significant analgesic effect,high operation success rate,and least adverse reactions,and is favored by anesthesiologists;Dexmedetomidine is a new type of high-efficiency α2 adrenal gland,it has a wide range of action and has good analgesic and sedative effects.It produces "physiological sleep" while not inhibiting respiratory function.It greatly reduces the dosage of opioids and reduces the incidence of adverse reactions.It is sedated in the perioperative period.We think it has great application value in pain treatment.A large number of medical literatures prove that ultrasound-guided paravertebral nerve block can be safely and effectively applied to the perioperative analgesia management of thoracoscopic surgery,and dexmedetomidine is a commonly used sedative and analgesic drug during the perioperative period.It has a certain auxiliary effect on other analgesic techniques.This study aims to observe the clinical effect of low dose dexmedetomidine combined with ultrasound-guided paravertebral nerve block in thoracoscopic surgery,and provide the basic for its clinical application.Materials and MethodsNinety-two patients undergoing thoracoscopic surgery were selected and randomly divided into experimental group and control group.After entering the room,both groups were given ultrasound-guided paravertebral nerve block,the experimental group was given dexmedetomidine pump before anesthesia,and the control group was given the same amount of normal saline.Record the hemodynamic parameters heart rate(HR)and mean arterial pressure(MAP)of 2 groups before anesthesia(T1),post-intubation(T2),one hour after the operation(T3),end of operation(T4)and 2 hours after operation(T5),and draw blood for measurement Inflammatory factors C-reactive protein(CRP),interleukin 6(IL-6)and tumor necrosis factor(TNF)levels,record the pain and vision of two groups at 2 h,6 h,12 h,and 24 h after surgery The analog scale(VAS)score,the Ramsay sedation scale score,and the occurrence of adverse reactions in two groups were recorded.Statistical analysis was performed on the obtained data using SPSS 13.0 professional software.The comparison of measurement data between the two groups in accordance with the normal distribution was expressed as(mean ± standard deviation)(x±s),and P<0.05 was used as the test standard for statistically significant differences.Results1.There was no statistically significant difference in age,weight,height,and body mass index between the two groups(P>0.05).2.There was significant difference in MAP and HR levels at T1,T2 between the two groups,and the experimental group was lower than the control group(P<0.05).There was no statistically significant difference in MAP and HR levels at T3,T4,T5.3.The levels of inflammatory factors CRP,IL-6,and TNF at T2,T3,T4,and T5 was significantly different between the two groups,and the experimental group waslower than the control group(P<0.05);CRP,IL-6,and TNF levels at T1 The difference was not statistically significant.4.There was no significant difference between the two groups of VAS scores and Ramsay sedation scores at different time points after surgery(P>0.05).5.There was no significant difference in the incidence of adverse reactions such as hypotension,respiratory depression,nausea and vomiting,and lethargy between the two groups(P>0.05).ConclusionsLow dose dexmedetomidine combined with ultrasound-guided thoracic paravertebral nerve block can reduce the intubation reaction,reduce the production of inflammatory factors,and do not increase the incidence of adverse reactions.It can be used for clinical application savely.