Study Of Dezocine Combined With Dexmedetomidine In Perioperative Pediatric Surgery

Objective:To investigate the effect of dezocine alone or combined with dexmedetomidine in perioperative surgery.Methods:This is a prospective, randomized, double-blind, and placebo controlled study. Sixty ASA Ⅰ～Ⅱ pediatric patients, aged (4-10)yrs, weighing (14～40)kg, scheduled for tonsillectomy and adenoidectomy were randomly divided into three groups (n=20each):the control group (group C), multimodal analgesia group (group M) and the dezocine group (group D). Before induction, patients in group M started with intravenous infusion of dexmedetomidine (1μg/kg) for10minutes. After10min, dexmedetomidine (0.5μg-kg-1·h-1) were continually given to patients for50min (in total1h). Patients in group C and group D received the same volume of normal saline. Group D and group M received dezocine(0.1mg/kg)15min before the end of surgery, group C received the same volume of normal saline. Vital signs were compared among the three groups at10time points:patient entering the operation room (T1),5minutes after intravenous infusion (T2), intubation (T3), extubation (T4),5minutes after extubation (T5),1hours(T6)、2hours(T7)、4hours(T8)、6hours(T9)、24hours(T10) after surgery. The duration of anesthesia and surgery, duration for anesthesia recovery and extubation, evaluation of postoperative agitation (EA), postoperative pain, sedation score and adverse reactions at time points T6-T10were compared. Serum concentrations of substance P(SP), β-endorphin(β-EP), Orphanin FQ(OFQ) of children at T1、T6、T10were measured as well.Results:The general information and the duration of anesthesia, operation, anesthesia recovery period and extubation were not statistically different among the three groups (P>0.05) Compared with group C (65%,3.2±1.0), the incidence and the grading of EA were lower in group group D (30%,2.4±0.8) and M (10%,2.0±0.7) in anesthesia recovery period (P<0.05) Compared with group C(8.8±2.5,ml), the dosage of sevoflurane was significantly less in the group M (5.8±2.0,ml) during the surgery (P<0.05). Compared with group C during T2-T9and group D during T2-T8, the heart rate was significantly lower in group M(P<0.05). Compared with group C and group D、T1of group M, the SBP was significantly higher at T2of group M (P<0.05).Compared with group C, the VAS score during T6-T8, the FLACC score during T6-T9 were significantly lower in group D and group M (P<0.05).Compared with group C, the Ramsay score of group D and group M were significantly higher at T6(P<0.05). The incidence of postoperative tachycardia was35%in group C, compared with group C, none of the patients in group M had tachycardia after surgery (P<0.05).Compared with group C, the serum concentrations of Substance P and β-endorphin were significantly lower at T6and T10in group D and group M (P<0.05); at T6, the serum concentrations of SP and β-EP were even significantly lower in group M than group D at T6(P<0.05). The serum concentrations of Orphanin FQ were significantly lower at T6and T10in group D and group M compared with group C (P<0.05),and those in group M were even significantly lower than those in group D at T10(P<0.05)Conclusion:Injection of dezocine (0.1mg/kg) at15minutes before the end of operation is safe for the pediatric patients and can effectively inhibit the postoperative agitation, provide satisfactory postoperative Analgesia. The mechanism may be associated with decreased serum SP, P-EP, OFQ levels. There are more advantages to use this dose of dezocine with dexmedetomidine in the form of multimodal analgesia. It can reduce the usage of sevoflurane, and makes the vital signs of the pediatric patients more stable.