Effect of dexmedetomidine combined with oxycodone on postoperative cognitive function and analgesic effect in elderly patients undergoing percutaneous endoscopic lumbar discectomy

doi:10.3877/cma.j.issn.2096-0263.2024.04.003

Abstract

Abstract:

Objective

To investigate the effect of dexmedetomidine combined with oxycodone on postoperative cognitive function and analgesic effect in elderly patients undergoing percutaneous endoscopic lumbar discectomy (PELD).

Methods

A prospective controlled study was conducted. 95 elderly patients with lumbar disc herniation (LDH) who underwent PELD at the hospital from January 2022 to December 2023 were selected as the study subjects. They were divided into the treatment group (48 cases) and the control group (47 cases) using a random number table. The control group was treated with oxycodone plus 0.9% sodium chloride injection before anesthesia induction, while the treatment group was treated with dexmedetomidine combined with oxycodone before anesthesia induction. The two groups were compared on perioperative indicators (dosage of sufentanil, surgery time, awakening time and extubation time), postoperative Mini Mental State Examination (MMSE) score, Pain Visual Analogue Scale (VAS) score, the levels of pain mediators [substance P (SP) and prostaglandin E₂ (PGE₂)], and adverse reactions.

Results

Repeated measures analysis of variance found that there were statistically significant differences between the treatment group and the control group in terms of MMSE score, VAS score, SP, and PGE₂ level at each time point after surgery (P<0.05). There was interaction between the groups and time points. Postoperative MMSE scores of the two groups showed a decreasing trend at first and then an increasing trend (P<0.05). Postoperative VAS scores, SP, and PGE₂ levels showed an increasing trend at first and then a decreasing trend (P<0.05).

Conclusion

Applying dexmedetomidine combined with oxycodone in PELD for elderly patients can effectively improve their postoperative cognitive function, reduce postoperative pain, and lower the levels of pain mediators. Besides, it is safe and reliable.

Key words: Dexmedetomidine, Oxycodone, Percutaneous transforaminal endoscopic surgery, Aged, Cognitive function

Qian Zhang, Wei Tang, Lili Liu. Effect of dexmedetomidine combined with oxycodone on postoperative cognitive function and analgesic effect in elderly patients undergoing percutaneous endoscopic lumbar discectomy[J]. Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition), 2024, 10(04): 209-214.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhlngkykfdzzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2096-0263.2024.04.003

https://zhlngkykfdzzz.cma-cmc.com.cn/EN/Y2024/V10/I04/209

Figures/Tables 6

References 25

1	Zhang AS, Xu A, Ansari K, et al. Lumbar disc herniation: diagnosis and management [J]. Am J Med, 2023, 136(7): 645-651.
2	Sousa O, Dos Santos Coelho F, Pereira P. Postoperative recommendations for single-level lumbar disc herniation: a cross-section survey [J]. Arch Orthop Trauma Surg, 2023, 143(9): 5467-5473.
3	Laasik R, Lankinen P, Kivimäki M, et al. Return to work after lumbar disc herniation surgery: an occupational cohort study [J]. Acta Orthop, 2021, 92(6): 638-643.
4	张莹,姬月娇,朱琳.康复运动操联合牵引在老年腰椎间盘突出症患者中的应用效果研究[J].中华老年骨科与康复电子杂志, 2020, 6(5): 285-290.
5	Gadjradj PS, Harhangi BS, Amelink J, et al. Percutaneous transforaminal endoscopic discectomy versus open microdiscectomy for lumbar disc herniation: a systematic review and meta-analysis [J]. Spine (Phila Pa 1976), 2021, 46(8): 538-549.
6	马丽,王媚.右美托咪定联合尼卡地平对老年脊柱手术患者控制性降压及炎症因子的影响[J].中华老年骨科与康复电子杂志, 2021, 07(1): 15-21.
7	Aruldhas BW, Quinney SK, Packiasabapathy S, et al. Effects of oxycodone pharmacogenetics on postoperative analgesia and related clinical outcomes in children: a pilot prospective study[J]. Pharmacogenomics, 2023, 24(4):187-197.
8	中华医学会骨科学分会脊柱外科学组.中华医学会骨科学分会骨科康复学组.腰椎间盘突出症诊疗指南[J].中华骨科杂志, 2020, 40(8): 477-487.
9	赵以林,罗爱林. 2018版美国麻醉医师协会适度镇静和镇痛指南解读[J].临床外科杂志, 2019, 27(1): 24-28.
10	周小炫,谢敏,陶静,等.简易智能精神状态检查量表的研究和应用[J].中国康复医学杂志, 2016, 31(6): 694-696, 706.
11	孙兵,车晓明.视觉模拟评分法(VAS) [J].中华神经外科杂志, 2012, 28(6): 645.
12	Salhotra R, Kamal V, Tyagi A, et al. Suppression of perioperative stress response in elective abdominal surgery: A randomized comparison between dexmedetomidine and epidural block[J]. J Anaesthesiol Clin Pharmacol, 2023, 39(3):397-403.
13	Waelkens P, Alsabbagh E, Sauter A, et al. Pain management after complex spine surgery: A systematic review and procedure-specific postoperative pain management recommendations[J]. Eur J Anaesthesiol, 2021, 38(9):985-994.
14	Bain CR, Myles PS, Martin C, et al. Postoperative systemic inflammation after major abdominal surgery: patient-centred outcomes[J]. Anaesthesia, 2023, 78(11):1365-1375.
15	Raak CK, Scharbrodt W, Berger B, et al. Hypericum perforatum to Improve Postoperative Pain Outcome After Monosegmental Spinal Sequestrectomy (HYPOS): Results of a Randomized, Double-Blind, Placebo-Controlled Trial[J]. J Integr Complement Med, 2022, 28(5):407-417.
16	Esses G, Deiner S, Ko F, et al. Chronic Post-Surgical Pain in the Frail Older Adult[J]. Drugs Aging, 2020, 37(5):321-329.
17	Farrar JT, Bilker WB, Cochetti PT, et al. Evaluating the stability of opioid efficacy over 12 months in patients with chronic noncancer pain who initially demonstrate benefit from extended release oxycodone or hydrocodone: harmonization of Food and Drug Administration patient-level drug safety study data[J]. Pain, 2022, 163(1):47-57.
18	黄晓玲,易珍,唐轶珣,等.羟考酮注射液在老年患者全麻诱导中的安全与疗效研究[J].中华实验外科杂志, 2023, 40(8): 1606-1610.
19	Modir H, Jafarirismani R, Almasi-Hashiani A, et al. Efficacy appraisal of four regimens (granisetron, ketamine, dexmedetomidine, and lidocaine combined with fentanyl) for cystoscopy-associated sedation and analgesia and catheter-related bladder tolerance: a randomized clinical trial[J]. Med Gas Res, 2023, 13(4):181-186.
20	Yang S, Guo L, Wang D, et al. Research on Mechanism of miR-106a Nanoparticles Carrying Dexmedetomidine in Regulating Recovery and Metabolism of Nerve Cells in Hypoxia-Reoxygenation Injury[J]. J Biomed Nanotechnol, 2022, 18(2):343-351.
21	关明函,薛志强.右美托咪定改善大鼠脑缺血再灌注后脑损伤的研究[J].中华神经创伤外科电子杂志, 2023, 9(5): 270-276.
22	徐娟,孙汝贤,赵东亚,等.右美托咪定序贯镇静模式对中深度镇静的机械通气患者预后和谵妄的影响[J].中华危重症医学杂志:电子版, 2023, 16(5): 363-369.
23	移小峰,巫绍汝,彭艳.右美托咪定对老年胃癌根治术患者围术期血流动力学及术后镇静镇痛的影响[J].中华老年医学杂志, 2021, 40(5): 637-640.
24	夏黎,林欣,孙岩,等.右美托咪定对甲醛致疼痛小鼠炎症介质释放的干预研究[J].中华危重症医学杂志:电子版, 2020, 13(2): 118-123.
25	王丽蓉,朱进飘,方媛媛,等.大鼠炎性痛形成时脊髓神经元P2X7受体与NLRP3/IL-1β信号通路的关系[J].中华麻醉学杂志, 2020, 40(4): 437-441.

组别	例数	性别[n（%）]		年龄（岁， ±s）	BMI（kg/m²， ±s）	ASA分级[n（%）]		疾病类型[n（%）]
组别	例数	男	女	年龄（岁， ±s）	BMI（kg/m²， ±s）	Ⅰ级	Ⅱ级	中央型突出	旁中央型突出	极外侧型突出
试验组	48	33（68.75）	15（31.25）	68.03±5.29	23.86±3.09	31（64.58）	17（35.42）	27（56.25）	19（39.58）	2（4.17）
对照组	47	29（61.70）	18（38.30）	66.95±4.71	24.15±3.26	34（72.34）	13（27.66）	26（55.32）	20（42.55）	1（2.13）
统计值		χ²=0.52		t=1.05	t=0.445	χ²=0.661		χ²=0.367
P值		0.471		0.296	0.657	0.416		0.832

组别	例数	性别[n（%）]		年龄（岁， ±s）	BMI（kg/m²， ±s）	ASA分级[n（%）]		疾病类型[n（%）]
组别	例数	男	女	年龄（岁， ±s）	BMI（kg/m²， ±s）	Ⅰ级	Ⅱ级	中央型突出	旁中央型突出	极外侧型突出
试验组	48	33（68.75）	15（31.25）	68.03±5.29	23.86±3.09	31（64.58）	17（35.42）	27（56.25）	19（39.58）	2（4.17）
对照组	47	29（61.70）	18（38.30）	66.95±4.71	24.15±3.26	34（72.34）	13（27.66）	26（55.32）	20（42.55）	1（2.13）
统计值		χ²=0.52		t=1.05	t=0.445	χ²=0.661		χ²=0.367
P值		0.471		0.296	0.657	0.416		0.832

组别	例数	舒芬太尼用量（ μg）	手术时间（min）	苏醒时间（min）	拔管时间（min）
试验组	48	65.73±9.82	75.96±14.28	13.28±4.36	16.87±4.95
对照组	47	70.24±13.19	82.35±19.47	15.17±5.04	19.02±6.13
t值		1.893	1.827	1.956	1.883
P值		0.062	0.071	0.054	0.063

组别	例数	舒芬太尼用量（ μg）	手术时间（min）	苏醒时间（min）	拔管时间（min）
试验组	48	65.73±9.82	75.96±14.28	13.28±4.36	16.87±4.95
对照组	47	70.24±13.19	82.35±19.47	15.17±5.04	19.02±6.13
t值		1.893	1.827	1.956	1.883
P值		0.062	0.071	0.054	0.063

组别	例数	MMSE评分
组别	例数	术前	术后12 h	术后24 h
试验组	48	29.34±0.17	26.38±1.02^*	28.46±0.52^*＃
对照组	47	29.28±0.15	25.74±0.93^*	27.95±0.48^*＃
F值		1.823	3.194	4.964
P值		0.072	0.002	<0.001

Please choose a citation manager

Content to export