The Inflewnce Of Dexmedetomidine Combined With Ropivacaine In The Ultrasound-Guided Llionguinal/Llionhypogastric Nerve Blocks

Objective:To observe the effect of dexmedetomidine combined with ropivacaine in ultrasound-guided llionguinal/llionhypogastric nerve blocks; to evaluate its effectiveness and safety of used in intraoperative, postoperative sedation and analgesia in children undergoing inguinal surgery.Methods:Sixty patients scheduled for inguinal surgery in our hospital, aged 3～7 years, weighted 10～27kg, ASA physical status I, all patients were randomly assigned into three groups with 20 cases in each group, control group(C group),0.25% ropivacaine for ultrasound-guided llionguinal/llionhypogastric nerve block(R group),0.25ug/kg dexmedetomidine combined with ropivacaine for ultrasound-guided llionguinal/llionhypogastric nerve block(D group).Intravenous general anesthesia induction, after induction, group D and group R recive the ultrasound-guided llionguinal/llionhypogastric nerve block. Each group of nerve block anesthesia drug does of 0.4ml/kg.Total intravenous anesthesia is use for maintain of anesthesia, according to the mean arterial pressure and heart rate changes more than ±20% of the basic value, adjust the injection speed, stop it when surgeons began to subcutaneous suture, after the operation, children restore spontaneous breathing, we pull out the laryngeal mask. And then children were send to Postanesthesia Care Unit(PACU), with nasal catheter 31/min to oxygen. The mean arterial pressure(MAP) and heart rate were recorded at the time of preanesthesia(TO), the end of laryngeal mask insertion(T1), the skin incision(T2), pulling hernia sac (T3), seaming the skin(T4) and recovery time(T5). Face legs activity cry consolability (FLACC) score was used to assess the postoperative pain score at recovery time(T5)、2h(T6)、4h(T7)、6h(T8)、12h(T9)and 24h(T10) after operation. The consumption of Propofol and remifentanil, operative time, postoperative recovery time, residence time in PACU, agitation incidence and postoperative adverse reactions were also recorded. The degree of parental satisfaction were investigated at 24h(T10) after operation.Results:(1) Three groups of patients gender, age, weight, operation time have no significant difference(P>0.05).(2) Three groups of residence time in PACU have no significant(P>0.05).The postoperative recovery time of group C and group R is shorter than group D (P<0.05). The consumption of Propofol and remifentail of group C was larger than group R and group D, but group R was larger than group D (P< 0.05).(3) The comparison of hemodynamic data:the comparison among groups:T2～5,the HR、MAP in group D and group R were significantly lower than those in group C(P<0.05), MAP at T3 and HR at T5 in group D was also lower than group R(P<0.05). The comparison within groups:Compared with T0, MAP at T2, T3 and T5, the HR at T4, T5 in group D were decreased; HR at T4 and T5 in group R were decreased(P<0.05). (4) The FLACCA score at T5, T6, T7 in group R and the score at T8, T9, T10 in group D were significantly lower than those in group C(P< 0.05);the postoperative adverse reactions, including nausea, vomiting, the agitationof awaking period and the use of sedative and analgesic drug,group D were less than those in group C and group R(P<0.05).Conclusion:1 llionguinal/llionhypogastric nerve block can provide satisfactory analgesic effect for inguinal region surgery.2 The analgesic effect of 0.25ug/kg dexmedetomidine combine with 0.25% ropivacaine for ultrasound-guided llionguinal/llionhypogastric nerve blocks is better than 0.25% ropivacaine.3 The incident of the postoperative adverse reactions, including nausea, vomiting, the agitation of awaking period and the use of sedative and analgesic drug,0.25ug/kg dexmedetomidine combine with 0.25% ropivacaine for ultrasound-guided llionguinal/llionhypogastric nerve blocks is less than 0.25% ropivacaine.