| Background and purpose:Perianal disease is a common clinical disease,and most patients with perianal disease need to be cured by surgery.Due to local anal nerve endings are particularly rich,feel more sensitive,especially most patients have experienced difficult defecation pain,bleeding,postoperative pain of torture,fear will be greatly enhanced,so good postoperative analgesia can reduce perioperative stress response,accelerate the rehabilitation of patients,reduce the patients with adverse reactions,therefore,appear on patients with perianal disease after surgery analgesia is necessary and important.Epidural anesthesia is widely used at present,because of its exact analgesic effect,the patient acceptance is relatively high.However,traditional epidural analgesia is a common local anesthetic and opioid drug,which has some side effects,so we consider with some analgesic sedative drugs to enhance the analgesic effect,reduce adverse reactions.Dexmedetomidine(Dexmedetomidine,Dex)as a new type of highly selective alpha 2 adrenergic receptor agonist,with sedative,analgesic,hypnotic,and anti anxiety and inhibition of sympathetic activity,can effectively reduce the perioperative stress response and other advantages,has been widely applied in clinic.But the study of dexmedetomidine on postoperative epidural analgesia for relatively little literature.Therefore,the purpose of this study is to observe the effects of dexmedetomidine on epidural surgical perianal disease after surgery and analgesic effects and adverse reactions,whether it can provide satisfactory analgesic effect for patients with perianal disease,as well as the medicinal provide some reference for the clinical use.Object and method:Approved by the ethics committee of the Second Affiliated Hospital of Zhengzhou University,the Second Affiliated Hospital of Zhengzhou University from March 2016 to September 2016 160 cases of patients with perianal common diseases,screening conditions: ASA grade I-II,ECG showed no bradycardia,no history of hypertension,age 18 to 55 years old,weighting 50 ～ 80 kg,no epidural puncture contraindications,no special family history.Using random number table method was divided into four groups(n=40),A group as the control group,B,C,D as the experimental group.Patients were treated with L3 ～ 4 lumbar epidural anesthesia catheter,Inject anesthetic drug when we find Cerebrospinal fluid outflow,epidural to the end of 3 ～ 4cm,anesthetic efficacy included observation,postoperative PCEA.Postoperative epidural analgesia group A ropivacaine 150 mg + sufentanil 2.0ug/kg;group B ropivacaine 150 mg + sufentanil 1.5ug/kg + dexmedetomidine 0.5ug/kg;group C ropivacaine 150 mg + sufentanil 1.0 ug/kg + dexmedetomidine 1.0ug/kg;group D ropivacaine 150mg+ sufentanil 0.5ug/kg + dexmedetomidine 1.5ug/kg.All groups of drugs were add 100 ml saline with electronic analgesia pump in,with a loading dose(LD)2ml,continuous infusion rate(CR)of 2ml/h pump,an additional dose of(PCA)1ml,and lock time 30 minutes.Patients were observed after 4h,12 h,24h,48 h,60h 5 time node resting pain score(VAS score),sedation(Ramsay score),blood pressure(SBP/DBP),heart rate(HR),the dosage(compressions)and adverse effects(nausea and vomiting,respiratory depression,skin itching,the incidence of urinary retention).Using SPSS 16 statistical software for processing,measurement data to mean + standard deviation(s),said the group between the single factor analysis of variance,within group comparisons used repeated measurement data analysis of variance,count data expressed in percentage or number of cases,2 test was used in processing,if P<0.05 said the difference was statistically significant.Result:Resting pain VAS scores :Compared with the control group:A group,the score of B、C and D group were lower than those in group A at 12 h,24h,48 h,60h time point,the difference was statistically significant(P < 0.05),C、D group and B group,there was statistical significance at 12 h,24h,48h(P < 0.05),there was no significant difference between group C and D(P > 0.05).The Ramsay score of sedation level: Compared with the control group A: the Ramsay sedation score of B、C and D group is higher than those in group A at 4h,12 h,24h and 48 h time point,the difference was statistically significant(P < 0.05);the C、D group compared with B group,the D group at 4h,12 h,24h,48 h each time point Ramsay score is higher,the difference was statistically significant(P < 0.05),C group and B group had no statistical significance(P > 0.05);D group compared with C group,D group at 4h,12 h,24h time point of sedation Ramsay score is higher,the difference was statistically significant(P < 0.05).But the D group had 5 cases of sleepiness,call to wake up,but the SpO2 observation period is greater than or equal to 95%.The PCA comparison:Compared with A group,the B,C,D group was significantly less than the A group,the difference was statistically significant(P < 0.05);B,C,D group also had a different number of times,but no statistical significance(P >0.05).The blood pressure and heart rate comparison: compared with A group,the B group in blood pressure at 12 h,24h,the C group at 12 h,24h,48 h,the D group at 4h,12 h,24h,48 h,the SBP were decreased,the difference was statistically significant(P < 0.05);c with group B,each time point in group C decreased not obviously;in group D,at 4h,12 h,24h,48 h were decreased obviously,the difference was statistically significant(P < 0.05);compared with C group,the SBP of D group decreased at 4h,24 h and 48 h,the difference was statistically significant(P < 0.05).Obviously,compared with the A,D group,the blood pressure fluctuations of B and C group are more stable.Compared with group A,the HR of B,C,D group at 4h,12 h,24h,48 h time point were decreased,the difference was statistically significant(P < 0.05);compared with group B,each time point in group C decreased not obviously;in group D,at 4h,12 h,24h,were decreased obviously,the difference was statistically significant(P < 0.05);compared with C group,the D group decreased at 4h and 12 h,the difference was statistically significant(P < 0.05).the D group bradycardia were treated without adverse consequences.The incidence of adverse reactions: there was no significant respiratory depression in the 4 groups.Group A had 5 cases of nausea and vomiting,and 3 cases of pruritus;B group had one case of nausea and vomiting,In group D,5 patients suffered from sleepiness and bradycardia in 3 cases.there was 1 case of hypotension.The adverse reaction of C group was the least.Conclusion:1.Dexmedetomidine combined with ropivacaine and sufentanil is safe and effective for perianal postoperative epidural analgesia,it significantly reduced the incidence of nausea and vomiting of adverse reaction after operation,at the same time can reduce the amount of opioid drugs.2.In the use of the dexmedetomidine the best dose is 1.0ug/kg. |
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