Study On Analgesia Effect Of Different Doses Dexmedetomidine On Epidural Space In Postoperative Patients With Transurethral Resection Of The Prostate (TURP)

Objective:Exploring the best way to sedation and analgesia is urgent need by surgery patients.This study focus on combined application of different doses of dexmedetomidine matching ropivacaine in epidural analgesia pump.and observes its analgesic effects and adverse reactions to patients after transurethral resection of prostate in order to get comfortable treatment effect.Methods:One hundred and twenty patients with transurethral resection of prostate in combined spinal and epidural anesthesia aged 30~80,rated I to II by ASA.They are randomly divided into four groups: control group with 0.1% ropivacaine,RD1 group with0.1% ropivacaine and 0.5?g/kg dexmedetomidine,RD2 group with 0.1% ropivacaine and1?g/kg dexmedetomidine,RD3 group with 0.1% ropivacaine and 2?g/kg dexmedetomidine.All patients take routine monitoring of basic vital signs before operation.The steps are as follows.Establish vein channels,take L3-4 gaps,perform with local infiltration anesthesia using 2% lidocaine,and give 0.67% ropivacaine of 2.5~3 ml to subarachnoid,indwelling epidural catheter to the head tube 4cm,record the anesthesia plane,and continue to monitor vital signs situation until the end of surgery.After operation,four groups of patients take PCEA.analgesia pump fluid and add saline of 150 ml are prepared,connect the analgesia pump with the epidural catheter in the end of surgery,give loading doses of 6ml with injection rate of 3ml/h,and closely monitor reactions of patients aftertreatment.After the surgery,the connection with medical adhesive are strengthened,meanwhile patients are guided the usage of PCEA.When the patients are not satisfied with analgesia,they can press PCA button.Pressing once can get dose of 3ml,locking time twenty minutes,continuing for forty-eight hours.the operation time,vital signs and other conditions during operation of patients should be observed and record.Follow up and record Ramsay score,VAS score,number of PCEA press of patients 8 hours,24 hours and 48 hours after operation.Record number of bladder spasm,number of using additional analgesic,and adverse reaction such as nausea,vomiting,vertigo and breathing discomfort during pump casting.After data collection,use SPSS19.0 software to do data analysis according to the grouping summary.Record:1.Compare VAS scores of four groups,the result is that comparing R group,RD1dosen't show the obvious difference,whileRD2 and RD3 groups can satisfy surgery needs.VAS score is low,the number of people applying pump is small,the number of patients using other analgesic drugs is significantly reduced.The difference is statistically significant,(p<0.05).And there is no significant difference between the two groups.2.Compare Ramsay score of four groups,the result is that comparing R group,RD1dosen't show the obvious difference,Sedation of RD2 group and RD3 group is more effective,with statistical significance,(p<0.05).There is no significant difference between RD1 group and R groups.,none of the four groups was overly sedated.3.Four groups of postoperative analgesia pump,the result is that there is no statistical difference between R group and RD1 group in 8hr and 24 hr according to the postoperative analgesia pump which is higher than RD2 group and RD3 group,with statistical significance,(p<0.005).For group control,there is no significant difference between RD2 group and RD3 group.Four groups in 48 hr according to the postoperative analgesia pump have no statistical significance.4.Compare the number of additional analgesic drugs used by four groups,and the result is as follow: there is no significant difference between R group and RD1 group.Thenumber of patients taking additional analgesic drugs of R group and RD1 group are more than that of RD2 group and RD3 group.There is obvious significant difference,(p<0.01).Comparison between RD2 group and RD3 group has no statistical significance.5.Compare bladder spasm of four groups,and the result is as follow: there is no significant difference between R group and RD1 group.The number of patients getting bladder spasm after operation are more than that of RD2 group and RD3 group.There is obvious significant difference,(p<0.005).Comparison between RD2 group and RD3 group have no statistical significance.6.The general condition,difference of operation time of patients in four groups are not statistically significant,(p>0.05).Compare adverse reactions of four groups,and we find the rate of dizziness,drowsiness,is low.Conclusion:Combination of Dexmedetomidine of 1 ~ 2?g/kg and ropivacaine of 0.1% can significantly improve epidural analgesia sedative effect after transurethral resection of prostate which meets the need of postoperative analgesia and reduces the occurrence of bladder spasm and adverse reactions.The usage of patient control epidural analgesia after transurethral resection of prostate is suggested.The suggested effective dose is 0.1%ropivacaine and1?g/kg dexmedetomidine.