Effect of dexmedetomidine combined with sufentanil on postoperative analgesia and stress response in laparoscopic gastrectomy

Abstract

Objective To study the effect of dexmedetomidine combined with sufentanil on postoperative analgesia and stress response in laparoscopic gastrectomy. Methods 80 patients with gastric cancer who underwent laparoscopic resection from March 2014 to March 2015 in Yiwu Central Hospital were selected as the subjects.According to draw method, the patients were divided into the observation group and the control group, with 40 patients in each group.All patients were treated with laparoscopic resection, midazolam, atropine sulfate, propofol, sufentanil citrate and rocuronium were used for anesthesia.The control group was given sufentanil analgesia after operation, while the observation group was given dexmedetomidine combined with sufentanil.The awake time, extubation time, agitation rate, incidence of postoperative cognitive dysfunction (POCD), epinephrine(E), norepinephrine(NE), cortisol(Cor), oxygen saturation(SpO2), mean arterial pressure(MAP), heart rate(HR), visual analogue scale(VAS) and changes of inflammatory factors in T0(before operation), T1(at the end of surgery), T2(extubation), T3(10 min after extubation), T4(20 min after extubation) of the two groups were compared. Results There was no statistically significant differences between the two groups in awake time and extubation time(all P>0.05). The incidence rates of restlessness and POCD in the observation group were significantly lower than those in the control group(5.0% vs.25.0%, 7.5% vs.30.0%)(χ2=6.275, 6.646, all P<0.05). At T1, T2, T3 and T4, the E, NE and Cor levels in the two groups were significantly higher than those in T0(all P<0.05), the levels at T2 were the highest, then gradually declined, the rising degree and maximum values of the observation group were significantly lower than those of the control group(all P<0.05). The elevated degree of MAP in the observation group was significantly lower than that in the control group(P<0.05). At T1, T2, T3, HR in the control group significantly increased(all P<0.05), HR at T2 was the highest, at T4 droped.At T1, T2, T3 and T4, HR in the observation group all decreased, which were lower than those in the control group(all P<0.05). Postoperative 4h, 8h, 24h, the VAS scores of the observation group were significantly lower than those of the control group[(4.30±0.50)points vs.(7.07±0.98) points, (4.01±0.46) points vs.(6.28±0.90) points, (2.79±0.31) points vs.(4.27±0.60) points](t=15.924, 14.204, 13.860, all P<0.05). The levels of TNF-α, IL-6 and IL-10 in the observation group were significantly lower than those in the control group(all P<0.05). Conclusion Dexmedetomidine combined with sufentanil has significant analgesic effect in laparoscopic gastrectomy for gastric cancer.It can stabilize the hemodynamics, relieve stress reaction and regulate inflammatory factors, and is beneficial to the recovery of the patients. Key words: Dexmedetomidine; Sufentanil; Stomach neoplasms; Laparoscopes; Gastrectomy; Anesthesia and analgesia; Stress disorders, traumatic