The Study Of Dexmedetomidine On The Effect Of Postoperative Pain In Spine Posterior Approach

Objective: Dexmedetomidine is highly selective2receptor agonist.To investigate the preemptive analgesic effect and safety ofdexmedetomidine (DEX) in different infusion approaches combined withropivacaine infiltration around the wound in posterior thoracolumbarsurgery.Methods:75patients undergoing posterior thoracolumbar surgerywere randomly divided into three groups: control group (group C), DEX0.5μ g/kg/h infusion until the end of surgery (group D1), DEX0.5μ g/kg/hinfusion continued until24h after operation (group D2), all the threegroups received local infiltration of ropivacaine around the wound afteroperation. Recorded MAP, HR, SpO2on before operation(T0), ropivacainelocal infiltration ti me (T1), extubation time (T2),5min after extubation(T3),30min (T4),60min (T5) each time. Record ed visual after extubation(VAS) score on the simulation of5min,30min,6h,12h,24h,48h and72h; recorded72h after extubation in the first analges ic need time,postoperative analgesic the total patient satisfaction; recordedDetermination of patients given DEX (T1), extubation time (T2),6h afterextubation (T3),12(T4) and24h (T5) level of serum cortisol (μ g/dl).The effects of DEX infusion combined with local infiltration of ropivacaineon hemodynamics and postoperative analgesia and level of serum cortisolwere observed.Results: Compared with group C, patients of group D1and group D2had lower mean arterial pressure (MAP) before extubation time; heart rate(HR) in group D1and D2was significantly decreased during after su rgeryor postoperative30min; visual analogue scale (VAS) in group D1and D2significantly reduced in6h~72h after extubation; the ti me of first need forpostopera tive analgesia was delayed and the tota l amount of tramadolreduced to (P<0.05) in group D1and D2. Group D2had higher PatientSatisfaction Scale and lower VAS30min,24h and48h after extubation thangroup D1(P<0.05). No significant difference of the time first requiring for analgesics and the amount of tramadol (P>0.05); Compared with group C,patients of group D1and group D2had lower level of serumcortisol(P<0.05); Compared with group D1,Group D2had1ower level ofserum cortisol during after extubation6h and12h(P<0.05).Conclusion: Dexmedetomidine infusion continued after operation or to24hafter surgery combined with wound infiltration of ropivacaine cansignificantly reduce postoperative pain, decreases the amount ofpostoperative pain medication, with benefits to hemodynamic stability. Itwill have a very good value in preventing postoperative acute pain. Butdexmedetomidine infusion continued to24h after surgery increased theecono mi c b u rd en of th e pati ents.