Effect of intraoperative application of dexmedetomidine on acute post-traumatic stress disorder in female patients

Abstract

Objective To evaluate the effect of intraoperative application of dexmedetomidine on acute post-traumatic stress disorder (PTSD) in female patients with lower limb fracture. Methods Ninety female patients with lower limb fractures caused by traffic accident, of American Society of Anesthesiologists physical status ⅠorⅡ, aged 20-35 yr, weighing 40-72 kg, scheduled for elective internal fixation, were divided into 3 groups (n=30 each) using a random number table: control group (group C), low-dose dexmedetomidine group (group Dl) and high-dose dexmedetomidine group (group D2). Ropivacaine (0.75%) 10-15 ml was injected into the epidural space, and operation was started after pain disappeared at the plane T8-10.Two percent lidocaine 5-10 ml was intermittently injected to maintain the anesthetic plane at T10.After successful epidural anesthesia, dexmedetomidine 0.5 and 1.0 μg/kg were intravenously infused over 30 min in Dl and D2 groups, respectively, while the equal volume of normal saline was given in group C. Patient-controlled epidural analgesia was performed with 0.15% ropivacaine after operation and lasted until 48 h postoperatively, maintaining visual analogue scale score ≤3 (baseline). Morphine 3 mg was intravenously injected for rescue analgesia when visual analogue scale score>3.The requirement for rescue analgesia within 48 h after operation was recorded.Acute Stress Disorder Scale (ASDS), Self-Rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) scores were assessed at 1 h before operation and on 1, 3 and 7 days after operation.The patients were followed up for 3 months by telephone, and the PTSD Checklist-Civilian Version score was evaluated.The occurrence of acute PTSD (PTSD Checklist-Civilian Version score > 38) was recorded. Results Compared with group C, the ASDS, SAS and SDS scores were significantly decreased on 1, 3 and 7 days after operation, and the incidence of acute PTSD was decreased in D1 and D2 groups (P 0.05). There was no significant difference in the requirement for rescue analgesia between the three groups (P>0.05). Conclusion Intraoperative application of dexmedetomidine can reduce the occurrence of acute PTSD and it is dose-related in female patients. Key words: Dexmedetomidine; Stress disorders, traumatic, acute; Female