Fluctuation of visual analog scale pain scores and opioid consumption before and after total hip arthroplasty

Clinical effects of intravenous patient-controlled analgesia with dexmedetomidine plus inhalation-intravenous combined anesthesia in patients with gastric cancer undergoing laparoscopic radical gastrectomy

BACKGROUND

Laparoscopic radical gastrectomy is widely used in the treatment of gastric cancer, but patients often experience moderate to severe pain after surgery. In the past, postoperative analgesia mostly relied on opioids, which have significant adverse reactions and easily induce cognitive dysfunction during general anesthesia. When combined with dexmedetomidine, they can enhance analgesic effect, reduce cognitive impairment, and promote patient recovery.

AIM

To investigate the effects of dexmedetomidine patient-controlled intravenous analgesia (PCIA) with dexmedetomidine in combination with inhalation-intravenous combined anesthesia on early cognitive function in patients with gastric cancer undergoing laparoscopic radical gastrectomy.

METHODS

A total of 206 patients with gastric cancer who were scheduled to undergo laparoscopic radical gastrectomy in our hospital from May 2021 to March 2024 were selected. They were divided into a control group (n = 103) and a study group (n = 103) using the random number table method. Both groups underwent PCIA after surgery. The control group additionally received pump injections of sufentanil citrate and tropisetron hydrochloride, while the study group additionally received pump injections of sufentanil citrate, tropisetron hydrochloride, and dexmedetomidine. The mean arterial pressure (MAP), heart rate (HR), blood oxygen saturation (SpO₂), analgesia score [visual analog scale (VAS) score], sedation score [Ramsay sedation scale], early cognitive function [Montreal Cognitive Assessment Scale (MoCA) score and mini-mental state examination (MMSE) score], and serum factors [interleukin-6 (IL-6), high mobility group box 1 protein (HMGB1), and tumor necrosis factor-α (TNF-α)] at different time points after surgery, as well as anesthesia drug use within 48 hours after surgery and adverse reaction rate, were compared between the two groups.

RESULTS

The MAP and HR of the study group were significantly lower than those of the control group from 2 to 48 hours after surgery (P < 0.05). The VAS scores of the study group were significantly lower than those of the control group from 12 to 48 hours after surgery (P < 0.05), while the MMSE and MoCA scores were significantly higher than those of the control group (P < 0.05). The levels of IL-6, TNF-α, and HMGB1 in the study group were significantly lower than those in the control group at 24 and 48 hours after surgery (P < 0.05). The number of PCIA pump compressions in the study group was significantly lower than that of the control group within 48 hours after surgery (P < 0.05). There was no significant difference in SpO₂, Ramsay score, or the incidence of adverse reactions between the two groups from 2 to 48 hours after surgery (P > 0.05).

CONCLUSION

PCIA with dexmedetomidine in combination with inhalation-intravenous combined anesthesia can effectively relieve pain within 48 h after surgery in patients with gastric cancer, maintain circulation stability, reduce the degree of postoperative cognitive dysfunction, decrease inflammatory injury, and reduce the number of postoperative PCIA pump compressions, suggesting that this combined anesthesia regimen is safe and reliable.

Clinical effects of intravenous patient-controlled analgesia with dexmedetomidine plus inhalation-intravenous combined anesthesia in patients with gastric cancer undergoing laparoscopic radical gastrectomy

BACKGROUND

Laparoscopic radical gastrectomy is widely used in the treatment of gastric cancer, but patients often experience moderate to severe pain after surgery. In the past, postoperative analgesia mostly relied on opioids, which have significant adverse reactions and easily induce cognitive dysfunction during general anesthesia. When combined with dexmedetomidine, they can enhance analgesic effect, reduce cognitive impairment, and promote patient recovery.

AIM

To investigate the effects of dexmedetomidine patient-controlled intravenous analgesia (PCIA) with dexmedetomidine in combination with inhalation-intravenous combined anesthesia on early cognitive function in patients with gastric cancer undergoing laparoscopic radical gastrectomy.

METHODS

A total of 206 patients with gastric cancer who were scheduled to undergo laparoscopic radical gastrectomy in our hospital from May 2021 to March 2024 were selected. They were divided into a control group (n = 103) and a study group (n = 103) using the random number table method. Both groups underwent PCIA after surgery. The control group additionally received pump injections of sufentanil citrate and tropisetron hydrochloride, while the study group additionally received pump injections of sufentanil citrate, tropisetron hydrochloride, and dexmedetomidine. The mean arterial pressure (MAP), heart rate (HR), blood oxygen saturation (SpO₂), analgesia score [visual analog scale (VAS) score], sedation score [Ramsay sedation scale], early cognitive function [Montreal Cognitive Assessment Scale (MoCA) score and mini-mental state examination (MMSE) score], and serum factors [interleukin-6 (IL-6), high mobility group box 1 protein (HMGB1), and tumor necrosis factor-α (TNF-α)] at different time points after surgery, as well as anesthesia drug use within 48 hours after surgery and adverse reaction rate, were compared between the two groups.

RESULTS

The MAP and HR of the study group were significantly lower than those of the control group from 2 to 48 hours after surgery (P < 0.05). The VAS scores of the study group were significantly lower than those of the control group from 12 to 48 hours after surgery (P < 0.05), while the MMSE and MoCA scores were significantly higher than those of the control group (P < 0.05). The levels of IL-6, TNF-α, and HMGB1 in the study group were significantly lower than those in the control group at 24 and 48 hours after surgery (P < 0.05). The number of PCIA pump compressions in the study group was significantly lower than that of the control group within 48 hours after surgery (P < 0.05). There was no significant difference in SpO₂, Ramsay score, or the incidence of adverse reactions between the two groups from 2 to 48 hours after surgery (P > 0.05).

CONCLUSION

PCIA with dexmedetomidine in combination with inhalation-intravenous combined anesthesia can effectively relieve pain within 48 h after surgery in patients with gastric cancer, maintain circulation stability, reduce the degree of postoperative cognitive dysfunction, decrease inflammatory injury, and reduce the number of postoperative PCIA pump compressions, suggesting that this combined anesthesia regimen is safe and reliable.