Ropivacaine Combined With Dexmedetomidine Erector Spinal Plane Block In Patients Undergoing Laparoscopic Cholecystectomy

Background:Biliary tract diseases,including cholecystitis and cholecystolithiasis,are commonly diagnosed in clinical hepatobiliary surgery patients.For the treatment of these diseases,laparoscopic cholecystectomy（LC）is currently the first choice to cure these diseases.LC as a minimally invasive surgical approach,However,in the postoperative follow-up observation,a considerable proportion of patients still believed that they had moderate to severe pain,and the perfect perioperative analgesia treatment can help patients get out of the pain as soon as possible after the operation into the normal work and life.Erector spinal plane block（ESPB）can block both superficial body pain and visceral pain,and it has been reported that ESPB has been applied to LC patients.However,due to ropivacaine（Rop）’s inherent elimination of half-life limit,the analgesic time of a nerve block in the pain area with ropivacaine does not exceed 12 h,while the duration of postoperative acute pain in PATIENTS with LC can reach 24 or even 48 h.So how to prolong the time and effect of local anesthetic? Clinical studies have demonstrated that adding dexmedetomidine（Dex）to local anesthetics increases the effective time of local anesthetics and leads to prolonged inhibition of sensory nerve endings in the blocked area.Therefore,in this study,DEX was added into local anesthetics of ESPB for LC patients to explore its effect and provide a more superior analgesic treatment option for patients in the perioperative period.Objective:To investigate the feasibility of ropivacaine combined with dexmedetomidine ESPB in LC patients and whether it can prolong the block time of ESPB and provide better perioperative analgesia for patients.Methods:67 patients aged between 18 and 65 years old,male and female,were selected from our hospital for elective LC,ASA grade Ⅰ to Ⅱ,BMI between 18 and24kg·m-2.After exclusion,a total of 60 patients were included and randomly divided into two groups,ropivacaine group（Rop group）and ropivacaine-dexmedetomidine mixture group（ROP-DEX group）,with a sample number of 30 in each group（n=30）.Bilateral ESPB was performed before surgery.In THE Rop group,each side of ESPB was administered as follows: 0.375% ropivacaine solution 20 m L;The regimen for each side of ESPB in ro P-DEX group was: 1μg/kg dexmedetomidine + 0.375% ropivacaine solution 20 m L.All patients were induced with the same anesthetic drugs and methods.Intraoperative anesthesia was maintained at a fixed concentration of sevoflurane,and remifentanil was continuously administered by an intravenous micropump.The infusion rate of the micropump was adjusted by the value of the patient’s intraoperative vital signs.Gender,ASA grade,age and BMI were recorded.Operation time and remifentanil consumption were recorded.Visual analogue scale（VAS）scores were recorded at 4h,8h,12 h,24h,and 48 h after surgery at quiet state and cough.The number of patients with parecoxib sodium for postoperative analgesia and the duration of nerve block（from effective to effective）were recorded.We used the Likert scale to assess the sleep quality after the operation and the satisfaction degree anout the use of ESPB.Postoperative nausea and vomiting,lethargy,discomfort at the puncture site,slow heart rate,decreased blood pressure and other side reactions were recorded.Results:1.General information of patients: There were no differences in gender,ASA grade,age and BMI between the Rop group and the Rop-Dex group（P > 0.05）.2.Intraoperative conditions: We did not find out the difference between Rop group and Rop-Dex group in operation time（P > 0.05）;and the does of remifentanil that used during the operation in Rop-Dex group was less than another group（P < 0.05）.3.Postoperative VAS score in quiet state and cough: VAS score in quiet state and cough in 2 groups showed no difference between Rop group and rop-dex group at 4,8and 48h（P > 0.05）;The score of Rop group at 12 and 24 h was higher than that of rop-dex group（P < 0.05）.4.The amount of patients that used the parecoxib after surgery in Rop and Rop-Dex group were not different（P > 0.05）;The time that analgesis in Rop-Dex group was more than the other group（P < 0.05）;The satisfaction of sleep quality and analgesia in experimental group was better than that in control group（P < 0.05）.5.Postoperative adverse reactions: The occurences of nausea and vomiting,dizziness and discomfort at the puncture site in patients were not different（P > 0.05）.No adverse reactions such as slow heart rate and hypotension occurred in both groups,and no complications such as nerve injury,infection or anaesthetic allergy occurred in both groups.Conclusion:Rop combined with Dex can increase the block duration of ESPB,provide better perioperative analgesia for LC patients,and improve their sleep quality and overall satisfaction with surgery.