| Objective:To explore the effect of dexmedetomidine as a quadratus lumborum block adjuvant on perioperative analgesia and inflammatory indexes in patients with gynecological malignant tumor undergoing transabdominal staging surgery and in order to provide theoretical basis for rapid rehabilitation in transabdominal staging surgery for gynecological malignant tumor.Methods:A total of 93 patients with gynecological malignant tumor scheduled for transabdominal staging surgery in the Second Norman Bethune Hospital of Jilin University from July 2022to December 2022 were randomly divided into control group（group C,n=31）,ropivacaine group（group R,n=31）and ropivacaine+dexmetomidine group（group RD,n=31）.All the patients in the three groups underwent bilateral quadratus lumbar block under ultrasound guidance after tracheal intubation induced by general anesthesia and before the beginning of the operation.0.9%saline 0.4 ml/kg was injected into each side in group C,0.33%ropivacaine 0.4 ml/kg was injected into group R,0.5μg/kg dexmetomidine+0.33%ropivacaine 0.4ml/kg was injected into each side of group RD,and all the patients were connected with patient-controlled intravenous analgesia pump（PCIA）after operation.Age,BMI index,length of operation and clinical diagnosis were recorded.The observation indexes were as follows:VAS score of resting and active and Ramsay score at extubation（T2）,1 hour（T3）,6 hours（T4）,12 hours（T5）,24 hours（T6）,36 hours（T7）and 48 hours（T8）after operation.The first compression time of analgesia pump,effective compression times,rescue times and analgesia satisfaction score within 48 hours after operation and venous blood TNF-αand IL-6 concentrations at T0,T2 and T6.Mean arterial pressure（MAP）and Heart rate（HR）at admission（T0）,skin incision（T1）and extubation（T2）;dosage of propofol（ml）and remifentanil（mg）;recovery time of awakening,extubation and recovery of orientation.Postoperative nausea and vomiting,restlessness,respiratory depression,lower limb movement disturbance,numbness,bradycardia,hypotension and so on.Time of underground activity,exhaust time,length of hospital stay.Results:1.There was no significant difference in age,BMI index,operation time and clinical diagnosis among the groups（P>0.05）.2.Comparison of resting VAS scores between groups:At T2-T6,the scores of group R and RD were lower than those of group C,and at T7,the score of group RD was lower than that of group C（P<0.05）.Comparison of active VAS scores between groups:at T2-T5,the scores of group R and RD were lower than those of group C,at T6,the score of group RD was lower than that of group C,and at T7,the score of group RD was lower than that of group C and R（P<0.05）.At T8,there was no significant difference in resting and active VAS scores among the three groups（P>0.05）.3.The first pressing time of analgesia pump in group C<group R<group RD（P<0.05）,the number of effective pressing in group C was higher than that in group R and RD（P<0.05）,the number of times of rescue analgesia in group C>group R>group RD（P<0.05）,and the score of analgesia satisfaction in group C was lower than that in group R and RD（P<0.05）.4.At T0,there was no significant difference in blood TNF-αand IL-6 among the three groups（P>0.05）,but at T2 and T6,the order of TNF-αand IL-6 in the three groups was group C>group R>group RD（P<0.05）,and TNF-αand IL-6 at T2 and T6 were higher than those at T0 in each group（P<0.05）.5.There was no significant difference in MAP at T0,T1 and HR at T0 among the groups,but HR in group RD was lower than that in group C at T1,MAP in group RD was lower than that in group C at T2,and HR in group R and RD was lower than that in group C（P<0.05）.6.The intraoperative dosage of propofol and remifentanil in group C was higher than that in group R and group RD（P<0.05）.7.There was no significant difference in awakening quality among the three groups（P>0.05）.8.Comparison of Ramsay sedation scores among groups:At T2-T4,the scores of group RD and group R were higher than those of group C,while at T5,the score of group RD was higher than that of group C,but there was no significant difference among the three groups at T6-T8（P>0.05）.9.The incidence of nausea and vomiting in group C>group R>group RD（P<0.05）,bradycardia occurred in 1 case in group RD and limb movement disorder numbness in 1 case in group R（P>0.05）.10.The time of underground activity and exhaust in group RD and group R were earlier than that in group C（P<0.05）,but there was no significant difference in hospital stay among the three groups（P>0.05）.Conclusions:1.Compared with total intravenous anesthesia combined with PCIA,lumbar quadratus block can relieve acute pain and inflammatory reaction after transabdominal surgery in patients with gynecological malignant tumors.2.Dexmetomidine as an adjuvant in quadratus lumbar block can amplify the analgesic effect and significantly inhibit the levels of inflammatory factors TNF-αand IL-6.It can be used as an effective scheme for multi-mode analgesia in patients with gynecological malignant tumors and promote their postoperative recovery. |
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