Abstract:Objective To analyze the analgesic effect of dexmedetomidine combined with dexamethasone for intercostal nerve block in elderly patients with lung cancer after thoracoscopic radical surgery.Methods Eighty-two elderly patients with lung cancer who underwent thoracoscopic radical surgery in our hospital from December 2020 to June 2023 were selected and divided into the control group and the study group by random number table method, with 41 cases in each group. The control group was given dexamethasone combined with ropivacaine, and the study group was given dexmedetomidine combined with dexamethasone and ropivacaine for intercostal nerve block after the operation. The effect of intercostal nerve block and use of patient-controlled intravenous analgesia (PCIA) were compared between the two groups. Besides, perioperative pain, cognitive function, stress response, inflammatory response and anesthesia-related adverse drug reactions were also compared between the two groups.Results The effective duration of analgesia via intercostal nerve block in the study group was longer than that in the control group, and the total consumption of sufentanil within 48 hours after the operation in the study group was lower than that in the control group (P < 0.05). Comparison of Visual Analogue Scale (VAS) scores 4 h, 12 h, 24 h and 48 h after the surgery in the two groups showed that VAS scores were different among time points (F = 9.156, P = 0.000) and between the study group and the control group (F = 7.851, P = 0.000), where VAS scores 12 h and 24 h after the surgery in the study group were lower than those in the control group. The change trends of VAS scores were also different between the study group and the control group (F = 7.061, P = 0.000). Comparison of Mini-Mental State Examination (MMSE) scores before and 24 h and 48 h after the surgery in the two groups showed no difference in MMSE scores among time points (F = 0.179, P = 0.834) or between the two groups (F = 0.151, P = 0.859), and no difference in the change trends of MMSE scores between the two groups (F = 0.309, P = 0.724). Comparison of levels of adrenaline (Adr) and cortisol (Cor) before and 24 h and 48 h after the surgery in the two groups showed that levels of Adr and Cor were different among time points (F = 7.967 and 8.043, both P = 0.000) and between the two groups (F = 7.123 and 7.691, both P = 0.000), where levels of Adr and Cor 24 h and 48 h after the surgery in the study group were lower than those in the control group. Besides, the change trends of levels of Adr and Cor were different between the study group and the control group (F = 8.003 and 7.961, both P = 0.000). The levels of tumor necrosis factor-α (TNF-α) and high mobility group box 1 (HMGB1) at the time of anesthesia and 24 h and 48 h after the surgery were compared between the two groups, which exhibited that they were different among time points (F = 8.236 and 8.417, both P = 0.000) and between the two groups (F = 6.298 and 7.215, both P = 0.000), where levels of TNF-α and HMGB1 24 h and 48 h after the surgery in the study group were lower than those in the control group. The change trends of levels of TNF-α and HMGB1 were different between the two groups (F = 7.035 and 7.152, both P = 0.000). There was no significant difference in the overall incidence of adverse reactions between the two groups (P > 0.05).Conclusions Dexmedetomidine combined with dexamethasone for intercostal nerve block can be applied for analgesia in elderly patients with lung cancer after thoracoscopic radical surgery. It prolongs the effective duration of analgesia via intercostal nerve block, reduces postoperative consumption of sufentanil, and alleviates the postoperative pain, stress response and inflammation with few safety concerns.
