Clinical Study On The Application Of Ultrasound-guided Dexmedetomidine Combined With Ropivacaine In Fascia Iliaca Compartment Block In Femoral Surgery

Objective: To investigate the analgesic effect and the adverse reactions of ultrasound-guided dexmedetomidine combined with ropivacaine in fascia iliaca compartment block during and after femoral surgery so as to provide reference for clinical application.Methods: Forty ASA I ~ III physical status patients,aged 60-80 yr,scheduled for femoral surgery,were randomly divided into 2 groups(n = 20 each)using a random number table: ropivacaine group(Group R)and ropivacaine combined with dexmedetomidine group(Group RD).All patients received ultrasound-guided fascia iliaca compartment block before general anesthesia induction.30 ml of 0.30 %ropivacaine was injected in group R,and 30 ml 0.30 % ropivacaine combined with 1?g/kg dexmedetomidine was injected in group RD.After operation,two groups both received patient-controlled intravenous analgesia(PCIA).In this study,mean arterial pressure(MAP)and heart rate(HR)of all the patients were recorded at the moment of pre-operation(T0),pre-induction(T1),tracheal intubation(T2),skin incision(T3)and immediately after surgery(T4).Intraoperative blood loss,duration of operation,awake time and extubation time of all patients were observed.Consumption of remifentanil and frequency of use of ephedrine and atropine during operation were recorded.Rest visual analogue scale(RVAS),passive visual analogue scale(PVAS)and observer's assessment of alertness/sedation scale(OAA/S)at the moment of T0,T1,immediately after tracheal extubation(T5),postoperative 4 h(T6),8 h(T7),18 h(T8),42 h(T9)were recorded.Sufentanil consumption at T5,T6,T7 and T8 were recorded.,cortisol and blood sugar levels at T0,T7,T8 were recorded.Side effects were also observed.Results: There was significant difference in MAP and HR between the two groups at the moment of T1,T2,T3 and T4(P < 0.05).The consumption of remifentanil during operation in Group RD was lesser than in Group R(P < 0.05).There was no significant difference in duration of operation,awake time and extubation time between the two groups(P > 0.05).RVAS and PVAS scores were found lower in the group RD than in the Group R at the moment of T6 and T7(P < 0.05).RVAS and PVAS scores at the moment of T1,T5,T6,T7 and T8 were lower than T0(P < 0.05).The consumption of sufentanil was lesser in Group RD than Group R at the moment of T6,T7 and T8(P < 0.05).Cortisol and blood sugar levels were lower in Group RD comparing to Group R at the moment of T7 and T8(P < 0.05).There were 19 patients with dry mouth in Group RD and 8 in Group R(P < 0.05).Conclusion: It is concluded that ultrasound-guided 1 ?g/kg dexmedetomidine combined with 0.30 % ropivacaine 30 ml in FICB could enhance the postoperative analgesic effect in femoral surgery,could decrease the consumption of analgesic during and after operation,could effectively reduce post-operation stress response,but dexmedetomidine can lead to the adverse reactions of dry mouth.