Effect of dexmedetomidine on perioperative stress and postoperative pain in patients with radical resection of esophageal cancer under combined thoracoscope and laparoscope

Abstract

Objective: To investigate the effects of dexmedetomidine on perioperative stress and postoperative pain in patients with radical resection of esophageal cancer under combined thoracoscope and laparoscope. Methods: In this prospective study, one hundred patients undergoing radical resection of esophageal cancer in Affiliated Cancer Hospital of Zhengzhou University from January 2016 to October 2017, were randomly divided into control group (group C) and dexmedetomidine group (group D), n=50. All patients were anaesthetized (induced and maintained) with intravenous target-controlled infusion(TCl) of propofol and remifentanil, and intermittent intravenous injection of cisatracuriumbesylate. Bispectral index(BIS) was used to monitor the depth of anesthesia and maintained between 45-60 during operation.All patients received sufentanil (0.3 μg/kg) 30 min before the end of the operation and then received intravenous analgesia pump for postoperative patient controlled analgesia(PCA). Patients in group D received intravenous infusion of dexmedetomidine(1 μg/kg) 20 min before anesthesia induction, followed by intravenous pumping of dexmedetomidine(0.2 μg·kg(-1)·h(-1)) intraoperatively.Postoperative intravenous patient-controlled analgesia(PCA) was performed in all patients, with background doses of sufentanil 0.04 μg· kg(-1)·h(-1) for patients in group C, and sufentanil 0.025 μg·kg(-1)·h(-1) plus dexmedetomidine 0.1 μg· kg(-1)·h(-1) for patients in group D. The operation time, liquid input and output during operation, the number of PCA pressings after operation were recorded. At these time points: T(0)(the day before operation), T(1)(immediate before anesthesia induction), T(2)(1 h after emergence), T(3)(24 h after operation), T(4)(3 d after operation), T(5)(7 d after operation), T(6)(one month after operation), T(7)(3 months after operation) and T(8)(6 month after operation) , venous blood samples of patients were collected for detection of epinephrine, norepinephrine and corticosterone. The pain visual analogue scale(VSA) was used to assess pain levels in patients at T(2), T(3), T(4), T(5), T(6), T(7), T(8). Results: The age, sex ratio, body mass index (BMI) and ASA grading ratio in two groups were not significantly different(all P>0.05). There were no Significant differences in operation time, liquid input and blood output between group C and group D(all P>0.05). Within 24 h after operation, the sufentanil consumption in group D[(35.86±8.65)μg]was significantly less than that in group C[(59.53±15.26) μg, t=7.061, P<0.05], and the number of PCA pressing in group D(2.15±1.38) was obviously less than that in group C(5.85±2.16, t=4.971, P<0.05). Compared with group C, serum norepinephrines in group D was significantly less (t=13.276, 16.027, 14.319, 12.771, 12.296, respectively; all P<0.05) at T(1), T(2), T(3), T(4), T(5).And there were no difference between these two groups at T(0), T(6), T(7), T(8)(all P>0.05). Serum epinephrine in group D were significantly lower than them in group C at T(2), T(3), T(4), T(5) (t=6.153, 8.774, 9.127, 8.409, respectively; all P<0.05), but there were no difference between these two groups at T(0), T(1), T(6), T(7), T(8)(all P>0.05). Serum corticosterone in group D were sharply less than them in group C at T(2), T(3), T(4), T(5) (t=16.364, 15.306, 12.153, 12.592, respectively; all P<0.05), but at T(0), T(1), T(6), T(7), T(8), there were no difference between these two groups (all P>0.05). Compared with group C, the number of patients with postoperative pain(VAS score≥4) in group D was obviously less at T(6), T(7), T(8)(10 vs 20, 4 vs 12, 3 vs 10; χ(2)=4.762, 4.762, 4.332, respectively; all P<0.05). Conclusion: Perioperative application of dexmedetomidine can effectively decrease the perioperative stress response, obviously cut down the perioperative opioid consumption, and prevent the transition from postoperative acute pain to chronic pain in patients with radical resection of esophageal cancer under combined thoracoscope and laparoscope.