Application Of Dexmedetomidine For Multimodal Analgesia In Patients With Obesity Undergoing Laparoscopic Sleeve Gastrectomy

Objective:To evaluate the application of dexmedetomidine for multimodal analgesia in patients with obesity undergoing laparoscopic sleeve gastrectomy.Methods:A total of 38 patients undergoing LSG,aged 16～65 years,ASAⅡ～Ⅲ,were randomly divided into 3 groups,group A,B and C,all patients were received bilateral Ultrasound-guided Subcostal Transversus Abdominis Plane Block（USG-TAPB）with 0.375%ropivacaine and with saline 12ml with or without dexmedetomidine 48μg（40ml in total for bilateral）,and i.v.injection of saline 12ml with or without dexmedetomidine 48μg intraoperative.The combinations of saline and dexmedetomidine were as follows:Group A,perineural and i.v.saline.Group B,perineural dexmedetomidine and i.v.saline.Group C,perineural saline and i.v.dexmedetomidine.The speed of injection was 6.5ml/h.The sensory block time onset t₀,mean arterial pressure（MAP）and heart rate（HR）at 1 min before induction T1,1 min before cutting the skin T2,first Trocar placement T3,pneumoperitoneum starting T4,epiploon exploration T5,pneumoperitoneum closing T6,sewing T7,extubation T8,the total of propofol and remifentanil,the time of postoperative autonomous respiration recovery,regain consciousness,extubation were recorded.The steward recovery score after extubation 5 minutes,the rest and dynamic pain scores at 0.5,1,3,6,24 and 48h postoperative demand of analgesic and the incidences of adverse reactions were recorded.Results:Compared to group A and group C,the t₀ and steward recovery score after extubation 5 minutes of group B were markedly decreased（p<0.05）.Compared to group A,the MAP,HR,rest and dynamic pain scores at every time point were evidently decreased（p<0.05）.Compared to group A,the consumption of propofol and remifentanil,the time of post operative autonomous respiration recovery,regain consciousness,extubation and additional postoperative demand of analgesic of group B and group C were observably decreased（p<0.05）.The MAP,HR in T1--T5,consumption of remifentanil,time of postoperative autonomous respiration recovery,the rest pain scores at3,6h and dynamic pain scores at 6h after operation of group C were higher than group B（p<0.05）.The incidences of dysphoria,nausea and vomitting of group A were highest and hypopiesis were lowest（p<0.05）.Conclusions:Dexmedetomidine combined with ropivacaine for USG-TAPB can shorten the onset time of block,enhance the effect of block analgesia,prolong the duration of block analgesia,and effectively reduce the amount of intraoperative sedation and analgesic drugs,maintain the stability of perioperative hemodynamics,advance quality of recovery period,moreover,availably reduce the additional postoperative demand of analgesic and the incidences of adverse reactions.Utilizing dexmedetomidine as an adjuvant to ropivacaine for TAPB effects more availably than intravenous dexmedetomidine in patients with obesity undergoing laparoscopic sleeve gastrectomy.