Study On The Effect Of Dexmedetomidine Added To Ropivicaine For Transversus Abdominis Plane Block Combined With Rectus Sheath Block During Peritoneal Dialysis Catheter Placement

Objective:This study investigated the effect of dexmedetomidine added to ropivicaine for transversus abdominis plane block(TAPB)combined with rectus sheath block(RSB)during peritoneal dialysis catheter placement surgery on anesthetic effects,adverse effects,and oxidative stress,which provides a superior anesthesia for the patients with end-stage renal disease(ESRD)and fits the current medical concept of Enhanced Recovery After Surgery(ERAS)to provide a reliable theoretical basis for the surgical anesthesia for ESRD patients.Methods:Patients with American Society of Anesthesiologists physical status Ⅲ or Ⅳwho underwent elective peritoneal dialysis placement under TAPB combined with RSB from July 2020 to September 2021 in our hospital were selected and randomly divided into two groups:ropivacaine group(group R)and dexmedetomidine combined with ropivacaine group(group DR).Group R was treated with 0.3%ropivacaine 50ml and group DR was treated with dexmedetomidine combined with 0.3%ropivacaine 50ml.The mean arterial pressure(MAP)and heart rate(HR)were recorded at the following time points:baseline(T0),after the TAP and RS blockades(T1),at the beginning of surgery(T2),when a small hole was created in the parietal peritoneum(T3),insertion of the PD catheter(T4),tunnel formation(T5),and end of surgery(T6).The rate-pressure product(RPP)(RPP=systolic blood pressure×HR)was calculated and recorded Non-invasive Respiratory Volume Monitor(RVM)was used to monitor minute ventilation(MV),tidal volume(TV),respiratory rate(RR).Observer’s assessment of alertness/sedation(OAA/S),visual analogue score(VAS)were recorded from T0 to T6.Venous blood was collected at T0,T5 and 24 hours after surgery(T7),and expression levels of malondialdehyde(MDA),glutathione peroxidase(GSH-Px),superoxide dismutase(SOD)were measured by biochemical methods.The time of block onset,duration,analgesia time,intraoperative remedial dosage and the occurrence of adverse effects such as perioperative bradycardia,respiratory depression,hypotension,nausea,local anesthetic toxicity,abdominal organ damage,local hematoma and respiratory depression were recorded.Results:Demographic data and surgical data:there were no statistically significant differences in gender composition,age,weight,ASA classification,and operation time between the two groups(p>0.05).Hemodynamics:there were no significant differences in MAP,HR,RPP over time compared to T0 in both groups,respectively(p>0.05);there were no statistically significant differences in MAP and HR between the two groups at all time points(p>0.05);statistically significant differences in RPP at T3-T6 between the two groups(p<0.05).Respiratory parameters:there were no significant difference in MV,TV and RR over time in both groups compared to that in T0(p>0.05);no statistical differences in MV,TV at all time points in both groups,and a statistical difference in RR in both groups at T4(p<0.05).OAA/S:in OAA/S scores,there was no statistical difference between the two groups at T0(p>0.999);there was a statistical difference between the two groups at T1-T6(p<0.001);Analgesic scores:compared with group R,there was a statistical difference in VAS scores between the two groups at T4(p<0.001);there was no statistical difference between the two groups at the others time points(p>0.05).Anesthesia effect:there was a statistical difference in the degree of abdominal wall muscle relaxation after 5 minutes of block between the two groups(p<0.05);there was a statistical difference in the duration time of blockades between the two groups(p<0.05).Serum indexes:There were no significant differences between groups regarding SOD,MDA,and GSH-Px at baseline(p>0.9999),at T6,there was no statistical difference in serum MDA levels and SOD levels between two groups,and there was a statistical difference in GSH-Px between the two groups(p<0.001);at T7,there was a statistical difference in MDA in serum between the two groups(p<0.05);the two groups SOD and GSH-Px were statistically different(p<0.001);SOD was significantly higher than T0 at T7(p<0.001)and GSH-Px was significantly higher than T0 at T6 and T7(p<0.001)in patients in the DR group.there was no statistical difference in SOD and GSH-Px over time in patients in the R group(p>0.05).Adverse reactions:no adverse reactions such as perioperative bradycardia,respiratory depression,hypotension,nausea and vomiting,local anesthetic toxicity,abdominal organ damage,local hematoma,respiratory depression occurred in both groups(p>0.05).Conclusion:1,lug/kg dexmedetomidine compounded with 0.3%ropivacaine 50ml in TAPB combined with RSB applied in open peritoneal dialysis placement can provide satisfactory sedation and analgesia for ESRD patients and enhance the blocking effect.2,lug/kg dexmedetomidine compounded with 0.3%ropivacaine 50ml in TAPB combined with RSB maintains stable perioperative hemodynamics,reduces myocardial oxygen consumption and has a mild effect on respiration.3,Dexmedetomidine as a local anesthetic ropivacaine adjuvant for TAPB combined with RSB in open peritoneal dialysis placement can relieve perioperative oxidative stress without adverse effects,which can promote rapid recovery of patients.