Effect of transversus abdominis plane block using dexmedetomidine combined with ropivacaine on the awakening quality and postoperative recovery of elderly patients undergoing radical resection for hilar cholangiocarcinomas

HAN Shuai; LI Fulong; CUI Dapeng

doi:10.3969/j.issn.1002-7386.2023.24.019

Abstract：Objective To investigate the effect of transversus abdominis plane(TAP)block using dexmedetomidine combined with ropivacaine on the awakening quality and postoperative recovery of elderly patients undergoing radical resection for hilar cholangiocarcinomas.Methods Sixty male or female patients for radical resection for hilar cholangiocarcinomas,with the American Society of Anesthesiologists physical(ASA)Physical Status Classification System of grade Ⅱ～Ⅲ,body mass index(BMI)of 18～25kg/m2,and 65～89 years of age from May 2019 to May 2022 were recruited.They were randomly divided into ropivacaine group(group C)and dexmedetomidine combined with ropivacaine group(group D),with 30 cases per group.All the patients received bilateral ultrasound-guided TAP block before the induction of general anesthesia.Patients in group C were administrated with 20ml of ropivacaine 0.375%on each side,and those in group D were administrated with 20ml of dexmedetomidine 0.5 μg/kg combined with ropivacaine 0.375%on each side.Patient-controlled intravenous analgesia(PCIA)pump containing fentanyl 0.02mg/kg and naborphine 20 mg diluted to 100 ml of normal saline was used for remedial analgesia.The time of extubation,the Visual Analogue Scale(VAS)pain sore at 2h postoperatively,time of first remedial analgesia,first time of exhaust,time of first eating,length of stay postoperatively and postoperative adverse reactions were recorded.Patients were surveyed using the Quality of Recovery-40(QoR-40)at 24h preoperatively and 24h postoperatively.Results Compared with those of group C,patients in group D had significantly shorter time of extubation,first time of exhaust,first eating,length of stay postoperatively,lower VAS pain scores at 2h postoperatively,and longer time of first remedial analgesia(P<0.05).Compared with that of group C,the QoR-40 score at 24h postoperatively was significantly higher in group D(P<0.05).There was no significant difference in the incidence of postoperative adverse reactions between groups(P>0.05).Conclusion Dexmedetomidine combined with ropivacaine for ultrasound-guided TAP block can improve the awakening quality and accelerate the postoperative recovery of elderly patients undergoing radical resection for hilar cholangiocarcinomas.