| Objective: To observe the analgesic effect of chest wall fascial plane block in ultra-fast-track right axillary minimally invasive cardiac surgery;To investigate the different doses of dexmedetomidine in chest wall fascial plane block on the effects of analgesia and postoperative rapid recovery in patients undergoing ultra-fast-track right axillary minimally invasive cardiac surgery.To investigate the safety and feasibility of ultra-fast-track cardiac anesthesia assisted by chest wall fascial plane block in right axillary minimally invasive cardiac surgery.Methods: From November 2021 to November 2022,122 patients who planned to undergo right axillary minimally invasive cardiac surgery in Zhejiang Provincial People’s Hospital were selected.The patients were randomly divided into four groups:control group with 0.9% saline 40 m L(group A),0.375% ropivacaine 40 m L group(group B),1μg/kg dexmedetomidine combined with 0.375% ropivacaine 40 m L group(group C)and 1.5μg/kg dexmedetomidine combined with 0.375% ropivacaine 40 m L group(group D).All patients underwent pectoral nerves Ⅰ、Ⅱ combined with serratus anterior plane block after anesthesia induction.The additional amount of sufentanil after extubation,the amount of sufentanil used within 24 hours after surgery,the number of pressing of analgesic pump,the amount of oxycodone used as rescue analgesic,and the number of times of VAS pain score ≥3 within 48 hours after surgery were recorded.The time of extubation,the length of stay in intensive care unit,the length of postoperative hospital stay,and the level of plasma hs-CRP,PCT and NSE in all patients were measured at D1,D2,D3.and D4 The incidence of postoperative nausea and vomiting,subcutaneous hematoma at the puncture site,infection at the puncture site,Postoperative atelectasis,postoperative massive bleeding,secondary intubation,secondary surgery and in-hospital death were also monitored and recorded.All patients at T1,T2,T3 and T4,3m L of venous blood was drawn through the internal jugular vein catheter.IL-1β,IL-4,IL-6,IL-8,IL-10,and TNF-α were measured after centrifugation.Results: The intraoperative consumption of remifentanil,the additional amount of sufentanil after extubation and the amount of sufentanil used within 24 hours after operation in group A were significantly higher than those in groups B,C and D(P(27)0.05);The amount of oxycodone used as rescue analgesic within 24 hours after operation,the times pressing of analgesic pump within 24 hours after operation and the times of VAS pain score ≥3 within 48 hours after operation in groups A and B were significantly higher than those in groups C and D(P(27)0.05).At the same time,there was no significant difference in postoperative analgesic effect between groups C and D(P(29)0.05);.The length of stay in ICU of group A was significantly longer than that of group B,C and D(P(27)0.05).The length of stay in hospital of group A and B was significantly longer than that of group C and D(P(27)0.05).;There was no significant difference in the incidence of postoperative nausea and vomiting,pruritus,subcutaneous hematoma and infection at the puncture site among the four groups(P(29)0.05);The incidence of postoperative atelectasis in group A was significantly higher than that in groups B,C and D(P(27)0.05).;There was no significant difference in the incidence of secondary intubation,massive bleeding,secondary surgery and in-hospital death among the four groups(P(29)0.05).The serum level of IL-6 in group C and D was significantly lower than that in group A and B after surgery(P(27)0.05).Conclusion: A single dose of 0.375% ropivacaine for pectoral nerves Ⅰ 、 Ⅱcombined with serratus anterior plane block has a good intraoperative analgesic effect in ultra-fast-track right axillary minimally invasive cardiac surgery;Both 1μ g/kg and1.5 μ g/kg dexmedetomidine as a nerve block adjuvant combined with 0.375%ropivacaine for pectoral nerves Ⅰ、Ⅱ combined with serratus anterior plane block can improve postoperative analgesia and promote rapid postoperative recovery after right axillary minimally invasive cardiac surgery,but 1.5μg/kg dexmedetomidine does not have obvious advantages of postoperative analgesic;Both 1 μ g/kg and 1.5 μ g/kg dexmedetomidine added to the nerve block solution of pectoral nerves Ⅰ、Ⅱ combined with serratus anterior plane block can reduce the level of plasma IL-6 in patients after ultra-fast-track right axillary minimally invasive cardiac surgery.;Pectoral nerves Ⅰ、Ⅱcombined with serratus anterior plane block assisted ultra-fast-track cardiac anesthesia is safe and feasible in right axillary minimally invasive cardiac surgery. |
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