Postoperative analgesic effect of dexmedetomidine combined with TPVB applied to open gastrectomy for gastric cancer

Abstract

Purpose: This study is aimed to investigate the analgesic effect of combined dexmedetomidine and thoracic paravertebral nerve block (TPVB) on gastric cancer (GC) patients undergoing open gastrectomy. Methods: From May 2019 to Nov 2020, a total of 80 GC patients preparing for open gastrectomy were enrolled in our hospital and were divided into the ropivacaine (RO) group and the ropivacaine + dexmedetomidine (RD) group ad libitum. All of the patients underwent TPVB. The characteristics, usage of patient-controlled analgesia (PCA), adverse events, visual analogue scale (VAS) scores, inflammatory cytokines, and T cell subgroups between the two groups were compared. Patients in the RD group showed the decreased occurrence rate of postoperative adverse events and VAS scores and improved anti-inflammation and immune function.Results: These findings implied that the application of dexmedetomidine in combination with ropivacaine in TPVB has a good postoperative analgesic effect, as well as anti-inflammatory and immune-enhancing effects. Conclusion: Thus, dexmedetomidine as an adjunct analgesic may be potentially applied in clinical practice for GC patients undergoing open gastrectomy.

Dexmedetomidine as an Adjuvant to Nerve Block for Cancer Surgery: A Systematic Review and Meta-Analysis

“…This study selection process is summarized in the PRISMA flow chart ( Figure 1 ). According to Cochrane’s Risk of Bias 2 (RoB2) assessment, seventeen RCTs [ 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 ] were considered to be low-risk and three RCTs [ 30 , 31 , 32 ] had some concerns. Moreover, the quality of the included studies is summarized in Supplementary Materials (Table S2) .…”

“…Two out of three abdominal cancer surgery reported on 48 h postoperative sufentanil consumption [ 26 , 27 ]. The meta-analysis of those studies concluded that sufentanil consumption was significantly lower in the dexmedetomidine group (SMD = −1.34 [95% CI −2.29 to −0.40], p = 0.005, I2 = 84%, random effects) ( Figure 2 ).…”

“…There were seventeen studies that reported about the adverse events of dexmedetomidine adjuvant in peripheral nerve blocks [ 15 , 16 , 17 , 18 , 19 , 20 , 21 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 ]. Following cancer surgery, bradycardia, hypotension, nausea, and vomiting were the most frequently reported adverse effects.…”

“… Forest plot of meta-analysis for total opioid consumption. SD, standard deviation; IV, inverse variance; CI, confidence interval [ 13 , 16 , 17 , 18 , 20 , 21 , 22 , 23 , 26 , 31 ]. …”

“… Forest plot of meta-analysis for any adverse events: ( A ) PONV; ( B ) bradycardia and hypotension [ 15 , 16 , 17 , 18 , 19 , 20 , 21 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 ]. …”