| Objective: To observe the effect of Dexmedetomidine combined with local anesthetics for brachial plexus block combined with general anesthesia in arthroscopic rotator cuff repair.Methods: From August 2020 to March 2021,60 patients who underwent arthroscopic rotator cuff repair at Yanbian Hospital were selected with the American Society of Anesthesiologists(ASA)grade I-II and were divided into three groups according to the random number table method,20 cases in each group.Group A treated with ultrasound-guided brachial plexus block(0.5μg/kg Dexmetomidine + 0.5%Ropivacaine,15 ml totally)combined with general anesthesia(n = 20),group B treated with ultrasound-guided brachial plexus block(0.5% Ropivacaine,15ml)combined with general anesthesia(n = 20),group C only treated with general anesthesia(n = 20).After the patient enters the room,venous channel was opened,monitoring equipment and bispectral index(BIS)were connected to monitor various vital signs.Radial artery puncture and catheterization were performed,and sensors were connected to monitor the invasive arterial blood pressure.Groups A and B treated with ultrasound-guide brachial plexus block.All patients used the same standard anesthesia induction and intraoperative management plan.During the operation,the parameters of anesthesia drugs were adjusted according to the change of blood pressure.All the postoperative patients were given patient-controlled intravenous analgesia(PCIA),and the drugs and parameters in PCIA set are the same.Heart rate,systolic pressure and diastolic pressure were recorded,before anesthesia(T0),before skin incision(T1),1min after skin incision(T2),5min(T3),10min(T4),20min(T5)and 60min(T6).Record the dosage of drugs during operation and the number of vasoactive drugs used.Evaluate and record the visual analogue scale(VAS)at 1h,2h,6h,12 h,24h,and 48 h after operation.Record the first PCIA compression time and the number of pressing after the operation.The changes of fasting blood glucose and hypersensitive c-reactive protein(hs CRP)were detected before and after surgery.Record the incidence of adverse reactions(including hypotension,nausea and vomiting,drowsiness,etc.).Results:(1)There was no difference in systolic blood pressure,diastolic blood pressure,and heart rate between the three groups at T0 and T1(P> 0.05).From T2 to T6,the systolic blood pressure,diastolic blood pressure,and heart rate of group C were higher than those of other two groups,the increase of each index of group C at T2 was significantly higher than that of other two groups,which was statistically significant(P<0.05).The change trends of systolic blood pressure,diastolic blood pressure and heart rate in group A and group B were similar in each period.(2)The dosage of general anesthetics and the number of applications of vasoactive drugs in group C were significantly higher than those of other two groups(P<0.05).The drug dosage was similar between group A and group B.(3)The VAS scores of group C was greater than that of other two groups at each time point,which showed statistically significant differences(P < 0.05).The VAS scores showed no difference at 1h and 2h between group A and group B,but lower at6 h,12h and 24 h in group A than those in group B,the differences were statistically significant(P < 0.05),but there was similar score at 48 h.(4)The preoperative fasting blood glucose was similar among the three groups.The postoperative fasting blood glucose in group C was obviously greater than that in the other two groups,showing statistically significant differences(P < 0.05),and it was higher in group B than that in group A(P < 0.05).(5)There was no difference in preoperative hs CRP among the three groups.The postoperative 24 h hs CRP in group C was significantly higher than that of the other two groups,with statistically significant differences(P < 0.05),and that in group B was significantly higher than that in group A(P < 0.05).(6)The first PCIA active compression time in group A was significantly later than that in group B,which was statistically significant(P <0.05).The pressing times of PCIA in group C was higher than that in other two groups,and that in group B was greater than that in group A(P < 0.05).(7)The incidence of intraoperative hypotension and postoperative nausea and vomiting were not statistically significant in the three groups(P> 0.05).Conclusion:(1)Brachial plexus block combined with general anesthesia not only can provide a good analgesic effect for arthroscopic rotator cuff repair,but also reduce the amount of anesthetics and postoperative pain.(2)Dexmedetomidine combined with anesthetics can prolong the analgesic time of brachial plexus block,reduce the dosage of postoperative analgesic drugs and stress response indicators,which is conducive to the rapid recovery of patients. |
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