Utilization of dexmedetomidine and sufentanil in a co-administration with ropivacaine during TAP block anaesthesia for patients scheduled for keyhole colorectal cancer resection

Guo Peng-fei; Yao Ling-ling; Sheng Jian-yun

doi:10.3969/j.issn.1672-8157.2024.06.020

Abstract：Objective To explore the efficacy of application of dexmedetomidine and sufentanil combined with ropivacaine respectively in transversus abdominis plane block (TAPB) anesthesia for patients undergoing laparoscopic radical resection of col-orectal cancer. Methods A total of 82 patients undergoing minimally invasive surgery for colorectal cancer in Pingdingshan First People's Hospital from August 2021 to August 2023 were selected as the research subjects. These subjects were randomly divided into the dexmedetomidine group (n=41,indicated by a red ball) and sufentanil group (n=41,indicated by a blue ball) using a lottery method. In the sufentanil group,TAPB was performed with sufentanil administered in combination with ropivacaine,whereas the dexmedetomidine group received dexmedetomidine in combination with ropivacaine for TAPB. The operation time was compared between the two groups. The parameters of heart rate (HR) and mean arterial pressure (MAP) were assessed in both groups pre-an-esthetically,after skin incision,5 minutes after pneumoperitoneum,and upon awakening. Furthermore,the postoperative analgesia effects (time to first patient-controlled analgesia (PCA) demand,number of PCA demands within 24 hours postoperatively,analgesic consumption within 24 hours postoperatively,duration of postoperative sensory blockade,and proportion requiring rescue analgesia within 48 hours),were determined. We also evaluated pain levels at 6,12,24,and 48 hours post-surgery using the VAS,monitored postoperative recovery milestones such as the time to initial food consumption and first passage of gas,measured the duration of hos-pitalization and tracked the rate of side effects. Results There was no statistically significant difference in operation time between the two groups (t=0.171,P>0.05). For the dexmedetomidine group,HR and MAP after skin incision ((67.45±8.33) times·min-1,(69.77±3.11) mm Hg),5 minutes after abdominal insufflation ((64.34±4.55) times·min-1,(74.33±3.09) mm Hg),and at awakening ((70.11±7.88) times·min-1,(80.23±3.44) mm Hg) as well as the proportion of remedial analgesia within 48 hours after surgery (7.50％) and the VAS score at 12 hours after surgery (2.05±0.77) were all lower than those in the sufentanil group ((72.77±8.09) times·min-1,(75.44±4.01) mm Hg,(74.55±6.77) times·min-1,(79.34±3.02) mm Hg,(76.44±6.68) times·min-1,(83.33±3.56) mm Hg,25.00％,(2.83±1.11) points,respectively) (t=2.934,t=8.015,t=3.924,t=7.154,t=7.425,x2=4.010,t=4.479,all P<0.05). The first compression time of analgesia pump and the duration of postoperative sensory block ((9.56±2.55) h,(9.33±2.11) h) in the dexmedetomidine group were longer than those in the sufentanil group ((5.78±1.99) h,(5.77±1.33) h) (t=7.483,9.139,both P<0.05). The number of compres-sions within 24 hours after surgery and the dosage of analgesics within 24 hours after surgery ((6.33±2.33) times,(8.56±2.45) mL) were significantly less than those in the sufentanil group ((9.22±2.14) times,(11.34±3.11) mL) (t=5.849,4.496,both P<0.05). There was no significant difference in VAS score and incidence of adverse reactions at 24 and 48 hours after surgery (P>0.05). The first eating time,the first anal exhaust time and hospitalization time ((1.88±0.77) d,(1.45±0.89) d,(9.55±3.11) d) in the dexmedetomidine group were shorter than those in the sufentanil group ((2.89±0.34) d,(2.77±0.67) d,(11.56±2.13) d) (t=7.683,7.587,3.414,all P<0.05). Conclusion In laparoscopic colorectal cancer surgery,the application of dexmedetomidine combined with ropivacaine in TAPB shows excellent curative effect. Therefore,it is helpful to reduce postoperative pain and accelerate the rehabilitation process of patients.