RESUMEN

Objective To explore the efficacy of ropivacaine combined with dexmedetomidine for ultrasound-guided erector spinae plane block(ESPB)in elderly patients undergoing thoracoscopic radical surgery for lung cancer.Methods A total of 119 lung cancer patients who underwent thoracoscopic radical resection of pulmonary carcinoma at the First Affiliated Hospital of Henan Polytechnic University from October 2020 to October 2022 were selected and randomly divided into the observation group(n=59)and the control group(n=60),with 3 patients excluded from the observation group and 4 patients excluded from the control group.Finally,56 patients were included in each group.Patients in the control group received ultrasound-guided ESPB with ropivacaine,while patients in the observation group received ultrasound-guided ESPB with both ropivacaine and dexmedetomidine.The pre-anesthesia preparation,anesthesia induction,and anesthesia maintenance were the same for patients in both groups,and patients in both groups used patient-controlled intravenous analgesia to relieve pain after surgery.The heart rate(HR)and mean arterial pressure(MAP)of patients in the two groups after entry(T1),successful block(T2),skin incision(T3),and end of surgery(T4),as well as the visual analogue scale(VAS)scores at rest and activity 6,12,24,and 48 hours after surgery were recorded.The amount of analgesic medication used,the number of analgesia pump presses,and the incidence of delirium and adverse reactions were compared between the two groups 48 hours after surgery.Results The MAP and HR of patients in the two groups at T2 and T3 were significantly higher than those at T1 and T4(P＜0.05).However,there was no significant difference in MAP and HR between the two groups at T4 and T1(P＞0.05),and there was also no significant difference in MAP and HR between the two groups at T2 and T3(P＞0.05).The patients in both groups showed no significant difference in MAP and HR at T1(P＞0.05),while at T2,T3,and T4,the MAP and HR in the observation group were significantly lower than those in the control group(P＜0.05).The patients in both groups had lower VAS scores at rest and activity 12,24,and 48 hours postope-ratively compared to 6 hours postoperatively(P＜0.05).The patients in both groups had lower VAS scores at rest and activity 24 and 48 hours postoperatively compared to 12 hours postoperatively(P＜0.05).The patients in both groups had lower VAS scores in both resting and active states 48 hours after surgery compared to 24 hours after surgery(P＜0.05).There was no significant difference in VAS scores at both rest and activity 6 hours after surgery between the two groups(P＞0.05).At 12,24,and 48 hours after surgery,the patients in the observation group had lower VAS scores in both resting and active states compared to the control group(P＜0.05).Compared with the control group,the observation group used fewer analgesic drugs and pressed analgesia pumps less 48 hours after surgery(P＜0.05).The incidence of overall adverse reactions within 48 hours after surgery was 5.36％(3/56)and 8.93％(5/56),respectively;there was no significant difference in the incidence of overall adverse reactions between the two groups(x2=0.135,P＞0.05).The incidence of delirium within 48 hours after surgery in the control and observation groups was 14.29％(8/56)and 3.57％(2/56),respectively.The incidence of delirium in the observation group was significantly lower than that in the control group(x2=3.953,P＜0.05).Conclusion The use of ropivacaine combined with dexmedetomidine for ultrasound-guided ESPB in elderly patients undergoing thoracoscopic radical surgery for lung cancer can maintain perioperative hemodynamic sta-bility,improve analgesic effect,and reduce the dosage of analgesic drugs,the number of analgesia pump presses,and the inci-dence of postoperative delirium.