Application of local block anesthesia with ropivacaine and dexmedetomidine in elderly patients undergoing laparoscopic tension-free inguinal hernia repair

doi:10.3877/cma.j.issn.1674-392X.2024.05.016

Abstract

Abstract:

Objective

To investigate the application effect of local block anesthesia with ropivacaine and dexmedetomidine in elderly patients undergoing laparoscopic tension-free inguinal hernia repair.

Methods

A total of 80 elderly patients who underwent laparoscopic tension-free inguinal hernia repair in People's Hospital of Ningguo City from February 2022 to September 2023 were selected. Patients were divided into control group (ropivacaine 42 cases) and experimental group (ropivacaine and dexmedetomidine 38 cases) using the random number table method. All patients received local block anesthesia, the control group received ropivacaine, while the experimental group received ropivacaine combined with dexmedetomidine. Clinical indicators, analgesic effects, stress reactions, and anesthesia adverse reactions were compared between the two groups. Hemodynamic changes before block anesthesia(T₀), at 10 minutes after block anesthesia (T₁), at skin incision (T₂), at 30 minutes after surgery (T₃) and at the end of surgery (T₄) were analyzed.

Results

The block onset time and removal time of laryngeal mask in the experimental group were significantly shorter as compared with the control group (P＜0.05). There was no significant difference in anesthesia recovery time between the two groups (P＞0.05). From T₀ to T₁,heart rate (HR) and mean arterial pressure (MAP) of both groups decreased, but the experimental group had higher HR and MAP than the control group, and the difference was statistically significant (P＜0.05).From T₂ to T₄, the experimental group had higher HR, blood oxygen saturation and MAP than the control group, but the differences were not statistically significant (P＞0.05). On the 3rd and 5th day after surgery,the levels of norepinephrine and cortisol in the experimental group were significantly lower than those in the control group (P＜0.05). There was no significant difference in the incidence rates of perioperative adverse reactions between the two groups (P＞0.05).

Conclusion

Applying local block with ropivacaine and dexmedetomidine in elderly patients undergoing laparoscopic tension-free inguinal hernia repair can maintain hemodynamic stability and reduce stress response with good safety.

Key words: Ropivacaine, Dexmetomidine, Local block, Tension-free inguinal hernia repair;Laparoscopes, Aged

Zhijing Yuan, Jie Huang, Guoan He, Huiqiang Fang. Application of local block anesthesia with ropivacaine and dexmedetomidine in elderly patients undergoing laparoscopic tension-free inguinal hernia repair[J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2024, 18(05): 557-561.

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URL: https://zhshfbwkzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-392X.2024.05.016

https://zhshfbwkzz.cma-cmc.com.cn/EN/Y2024/V18/I05/557

Figures/Tables 5

组别	例数	年龄(岁, $\overset{ˉ}{x}$ ±s)	手术时间(h, $\overset{ˉ}{x}$ ±s)	体重(kg, $\overset{ˉ}{x}$ ±s)	性别[例(%)]		ASA分级[例(%)]
组别	例数	年龄(岁, $\overset{ˉ}{x}$ ±s)	手术时间(h, $\overset{ˉ}{x}$ ±s)	体重(kg, $\overset{ˉ}{x}$ ±s)	男性	女性	Ⅰ级	Ⅱ级
对照组	42	68.19±3.62	1.24±0.26	65.72±10.33	40(95.24)	2(4.76)	25(59.52)	17(40.48)
观察组	38	68.35±3.88	1.29±0.33	66.19±10.52	37(97.37)	1(2.63)	23(60.53)	15(39.47)
χ ² /t值		0.191	0.756	0.201	0.201		0.008
P值		0.849	0.452	0.841	0.654		0.927

组别	例数	年龄(岁, $\overset{ˉ}{x}$ ±s)	手术时间(h, $\overset{ˉ}{x}$ ±s)	体重(kg, $\overset{ˉ}{x}$ ±s)	性别[例(%)]		ASA分级[例(%)]
组别	例数	年龄(岁, $\overset{ˉ}{x}$ ±s)	手术时间(h, $\overset{ˉ}{x}$ ±s)	体重(kg, $\overset{ˉ}{x}$ ±s)	男性	女性	Ⅰ级	Ⅱ级
对照组	42	68.19±3.62	1.24±0.26	65.72±10.33	40(95.24)	2(4.76)	25(59.52)	17(40.48)
观察组	38	68.35±3.88	1.29±0.33	66.19±10.52	37(97.37)	1(2.63)	23(60.53)	15(39.47)
χ ² /t值		0.191	0.756	0.201	0.201		0.008
P值		0.849	0.452	0.841	0.654		0.927

组别	例数	麻醉苏醒时间	阻滞起效时间	摘除喉罩时间
对照组	42	7.64±1.13	11.34±2.05	9.24±1.36
观察组	38	7.96±1.04	9.52±1.67	7.62±1.11
t值		1.313	4.325	5.799
P值		0.193	＜0.001	＜0.001

组别	例数	心率(次/min)
组别	例数	T0	T1	T2	T3	T4
对照组	42	74.78±5.19	70.03±4.28^b	76.11±3.45	72.31±3.92	71.08±3.04
观察组	38	74.67±5.25	72.25±3.19^ab	75.08±3.65	73.17±3.02	72.33±2.55
F _组间/P_组间				2.718/0.100
F _时间/P_时间				19.703/＜0.001
F _交互/P_交互				2.093/0.081
组别	例数	血氧饱和度(%)
组别	例数	T0	T1	T2	T3	T4
对照组	42	99.26±0.31	99.12±0.27	99.23±0.29	99.10±0.28	99.05±0.33
观察组	38	99.21±0.33	99.13±0.25	99.24±0.21	99.17±0.23	99.15±0.26
F _组间/P_组间				1.000/0.318
F _时间/P_时间				4.216/0.002
F _交互/P_交互				0.873/0.480
组别	例数	平均动脉压(mmHg)
组别	例数	T0	T1	T2	T3	T4
对照组	42	85.05±6.28	76.37±5.19b	80.19±5.83	75.31±4.72	73.16±4.98
观察组	38	84.89±6.33	80.19±5.54ab	81.19±4.69	77.13±5.21	75.94±4.41
F _组间/P_组间				11.912/0.001
F _时间/P_时间				46.213/＜0.001
F _交互/P_交互				1.651/0.161

组别	例数	去甲肾上腺素			皮质醇
组别	例数	术前	术后3d	术后5d	术前	术后3d	术后5d
对照组	42	240.36±20.19	379.67±25.32^a	332.46±21.68^ab	275.46±33.59	395.67±25.21^a	336.19±22.18^ab
观察组	38	241.18±20.64	331.16±23.08^a	285.76±22.19^ab	277.15±35.62	351.42±23.59^a	301.25±20.16^ab
t值		0.179	8.923	9.514	0.218	8.082	7.346
P值		0.858	＜0.001	＜0.001	0.828	＜0.001	＜0.001

组别	例数	恶心呕吐	躁动	心率减慢	总发生率
对照组	42	2(4.76)	1(2.38)	1(2.38)	4(9.52)
观察组	38	1(2.63)	1(2.63)	0(0.00)	2(5.26)
χ ²值					0.522
P值					0.470

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