Effects Of Different Doses Of Dexmedetomidine Combined With Ropivacaine Transversus Abdominis Plane Block On Stress Response In Patients Undergoing Laparoscopic Surgery

Objective:Objective to investigate the efficacy and safety of different doses of dexmedetomidine combined with ropivacaine in transverse abdominal muscle block(TAPB)in laparoscopic inguinal herniorrhaphy.By observing and comparing the changes of perioperative hemodynamics、the effect of postoperative analgesia 、 the determination of plasma cortisol(Cor)、interleukin-6(IL-6)and whole blood glucose(Glu),the changes of stress response were compared,so as to explore the internal relationship and mechanism,so as to optimize the perioperative anesthesia and pain management of laparoscopic inguinal herniorrhaphy,so as to provide a certain theoretical basis for the prognosis,so as to apply to the clinic better and help patients to recover quickly after operation.Methods:80 patients who underwent elective laparoscopic inguinal hernia repair in our hospital from January 2020 to September 2020 were randomly divided into four groups: ropivacaine group(group R)and ropivacaine combined with DEX group(group D1-3,n = 20/group).Each group received ultrasound-guided bilateral TAPB,with 0.25% ropivacaine in group R,each side 20 m L before anesthesia induction.Group D1 was given 0.5μg/kg dexmetomidine(DEX)+ 0.25% ropivacaine,group D2 was given 1μg/kg DEX+0.25% ropivacaine,group D3 was given 1.5μg/kg DEX+0.25% ropivacaine,each side was 20 m L.To observe and compare the hemodynamic data of four groups at different time points [including mean arterial pressure(MAP)and heart rate(HR)before TAP block(T1),before pneumoperitoneum(T2),0.5 h after pneumoperitoneum(T3),10 min after tracheal extubation(T4)]、Stress reaction [including plasma Cor、IL-6 and whole blood Glu levels at each time point of T1-T4] and the incidence of intraoperative adverse reactions [including hypertension、hypotension、tachycardia、bradycardia,etc.].Visual analogue scale(VAS)was used to measure the pain intensity at 6 h,24 h and 48 h after operation,and the times of analgesia pump pressing within 48 h after operation were recorded.The time of extubation of endotracheal tube,the first time of getting out of bed after operation,the first time of anal exhaust,nausea and vomiting were observed and compared.Result:1.Comparison of hemodynamics among different groups.The results showed that there was no significant difference in MAP and heart rate at T1 in R、D1、D2 and D3 groups(P>0.05),but MAP and HR in D1、D2and D3 groups at T2、T3 and T4 were significantly lower than those in R group(P<0.05);MAP and heart rate in D3 groups were significantly lower than those in D1、D2 group at T2、T3 and T4(P<0.05).2.Comparison of the changes of plasma Cor、IL-6 and whole blood GLu levels during operation in each group.There was no significant difference in plasma Cor、IL-6 and whole blood Glu levels among R、D1、D2 and D3 groups at T1 time(P>0.05),but there were significant differences in plasma IL-6,Cor and whole blood Glu levels between D1、D2 and D3 groups at T2、T3 and T4 time points compared with R group(P<0.05).Compared with T1 time,the levels of plasma Cor、IL-6 and whole blood Glu in R and D1 groups increased significantly at T2,T3 and T4(P<0.05),while the levels of plasma Cor、IL-6 and whole blood Glu decreased significantly in D3 groups at T2、T3 and T4(P<0.05).3.Comparison of VAS resting score and analgesic pump pressing times within48 hours after operation in each group.The VAS score in D1、D2 and D3 groups was lower than that in R group at 6hours after operation(P<0.05),and the VAS score in D2 and D3 groups was lower than that in R group at 24 hours after operation(P < 0.05),but there was no significant difference in VAS scores among the four groups 48 hours after operation.According to the statistics of analgesia pump pressing times within 48 hours after operation,the times of analgesia pump in R group was significantly more than those in D1、D2 and D3 groups(P < 0.05).4.Comparison of early postoperative rehabilitation.Compared with R group,the time of awakening and extubation in D1、D2 and D3 groups was significantly shorter(P < 0.05).Compared with R and D1 groups,the first time of getting out of bed and the first time of anal exsufflation in D2 and D3 groups were earlier(P < 0.05).Compared with R group,vomiting in D1、D2 and D3 groups decreased significantly(P < 0.05).5.Comparison of intraoperative adverse reactions.The incidence of hypertension and tachycardia in R group was higher than that in other groups(P < 0.05),and the incidence of hypotension and bradycardia in D3 group was higher than that in other groups(P < 0.05).Conclusion:In laparoscopic inguinal herniorrhaphy,transverse abdominal muscle block with dexmetomidine combined with ropivacaine can definitely inhibit stress reaction,reduce the release of inflammatory factors,promote the hemodynamics of patients undergoing inguinal herniorrhaphy in a relatively stable state,reduce pain scores and adverse reactions,and promote the early rehabilitation of patients after operation.1ug/kg is the appropriate dose of dexmetomidine.