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Intravenous Dexmedetomidine Combined with Ultrasound-Guided Rectus Sheath Block for Open Gastrectomy: a Prospective Randomized Trial

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Purpose

To compare the incidences of positive hemodynamic response (HR > 100 beats min−1 or SBP > 160 mmHg) during abdominal exploration and moderate pain after surgery, when using dexmedetomidine infusion and rectus sheath block.

Methods

One hundred patients undergoing open gastrectomy were randomized to receive rectus sheath block with ropivacaine (Group B, n = 25), initial loading dose of 0.6 μg kg−1 dexmedetomidine, followed by a continuous infusion of 0.2 μg kg−1 h−1 throughout surgery (Group D, n = 25), both rectus sheath block and dexmedetomidine (Group BD, n = 25), or neither rectus sheath block nor dexmedetomidine (Group C, n = 25). General anesthesia techniques were standardized. HR, SBP, and positive hemodynamic response at peritoneum incision (TPI), 5 min (TAE-5), 10 min (TAE-10), and 15 min (TAE-15) after the start of abdominal exploration, and incidences of moderate postoperative pain were recorded.

Results

Positive hemodynamic responses during abdominal exploration were more common in Groups B (82%) and C (74%) than in Groups D (14%) and BD (9%) (all P = 0.000). HR and SBP were lower in Groups D and BD, compared with those in Groups C and B (all P < 0.05). Compared with TPI, HR and SBP increased significantly in Groups B and C during abdominal exploration (all P < 0.05), but not in Group BD (except HR at TAE-15). The incidences of moderate pain in Groups B and BD were noticeably lower than in Groups C and D at 1 h, 2 h, and 6 h after surgery (all P < 0.0083).

Conclusion

Dexmedetomidine infusion combined with rectus sheath block provided more hemodynamic stability during abdominal exploration and better analgesia after surgery.

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Acknowledgements

We are thankful to Dr.Fengfeng Mo and Dr. Xiaofei Ye for their help in statistical work.

Funding

The authors received financial support from the National Science Foundation of China (81671304, 81873945, 81870864, 81571935), the Pujiang Talent Program of Shanghai (16PJD002), and the Outstanding Technical Leader Project of Shanghai Science and Technology Commission (17XD1424300).

Author information

Author notes

  1. Yonghua Li, Xin Jiang and Jiafeng Wang contributed equally to this work.

Authors and Affiliations

  1. Department of Anesthesiology, Changzheng Hospital, Second Military Medical University, No. 415 Fengyang Road, Shanghai, 200003, China

    Yonghua Li, Xin Jiang, Liye Yang, Wei Chen & Hongbin Yuan

  2. Department of Anesthesiology, Changhai Hospital, Second Military Medical University, No. 168 Changhai Road, Shanghai, 200433, China

    Jiafeng Wang

  3. Department of Anesthesiology, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, No.225 Changhai Road, Shanghai, 200433, China

    Xuerong Miao

Authors
  1. Yonghua Li
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  2. Xin Jiang
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  3. Jiafeng Wang
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  4. Liye Yang
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  5. Wei Chen
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  6. Xuerong Miao
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  7. Hongbin Yuan
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Contributions

All authors contributed to the concept and design of the trial, reviewed the analyses, and participated in the preparation of the submitted manuscript. Yonghua Li, Xin Jiang, and Jiafeng Wang conducted or supervised patient recruitment and data collection. Liye Yang performed nerve block and anesthesia. Wei Chen conducted the statistical analysis with the collaboration of Xuerong Miao and Hongbin Yuan. Dr. Xuerong Miao and Hongbin Yuan had full access to the study data and take responsibility for the integrity of the data and the accuracy of the data analysis.

Corresponding authors

Correspondence to Xuerong Miao or Hongbin Yuan.

Ethics declarations

This study was approved by the Chinese Ethics Committee of Registering Clinical Trials (ethical number ChiECRCT-20170107) and was registered at http://www.chictr.org.cn (registration number ChiCTR1800014437). Written informed consents were obtained from all patients.

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Li, Y., Jiang, X., Wang, J. et al. Intravenous Dexmedetomidine Combined with Ultrasound-Guided Rectus Sheath Block for Open Gastrectomy: a Prospective Randomized Trial. J Gastrointest Surg 24, 1290–1297 (2020). https://doi.org/10.1007/s11605-019-04249-2

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  • DOI: https://doi.org/10.1007/s11605-019-04249-2

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