Effect of postoperative analgesia with dexmedetomidine on the survival rate of amputated finger replantation

Abstract

To observe the effect of postoperative analgesia with dexmedetomidine on the survival rate of amputated finger replantation. 91 cases, who was going to receive amputated finger replantation, were randomly divided into group A (n = 48) and B (n = 43). PCIA (patient-controlled intravenous analgesia) was set immediately after operation in group A (fentanyl 1.0 mg + tropisetron 4.0 mg + 10 mg + dexmedetomidine 200 microg + saline 100 ml) and group B (same as group A except dexmedetomidine). Background infusion is 2 ml/h with a bolous of 0.5 ml and lockout time is 15 min. postoperative VAS score, Ramsay score, condition of replanted fingers and other adverse events at the 0-6 h, 6-12 h, 12-24 h and 24-48 h were recorded and analyzed. The age, sex, height, weight, amputated time (Ts), revascularized time (Tt) in the two groups were not statistically different (P > 0.05). Postoperative VAS score in the two groups was significantly different at the 0-6 h, 6-12 h, 12-24 h and 24-48 h (P < 0.05), but Ramsay score was not (P > 0.05). The highest and lowest postoperative VAS score and Ramsay score were markedly different between two groups (P < 0.05). 3 of the 60 fingers in group A experienced vascular crisis and 2 underwent vascular explore surgery. 13 of 56 fingers in group B occurred vascular crisis, and 10 underwent vascular explore surgery, showing significant difference between the two groups (P < 0.05). PCIA adverse reactions showed no difference between the two groups (P > 0.05). Bradycardia and hypotension didn't happen in any patients in the two groups. 4 weeks after surgery, the survival rate was 96.7% (58/60) in group A, and 83.9% (47/56) in group B (P < 0.05). Postoperative analgesia with dexmedetomidine as an adjuvant can increase the survival rate of replantation fingers with high safety.