Combined use of dexmedetomidine and nalbuphine in laparoscopic radical gastrectomy for gastric cancer

Guo-Guang Zhao; Chao Lou; Rong-Lei Gao; Fu-Xing Lei; Jing Zhao

doi:10.4251/wjgo.v16.i7.2952

Combined use of dexmedetomidine and nalbuphine in laparoscopic radical gastrectomy for gastric cancer

World J Gastrointest Oncol. 2024 Jul 15;16(7):2952-2959. doi: 10.4251/wjgo.v16.i7.2952.

Authors

Guo-Guang Zhao¹, Chao Lou¹, Rong-Lei Gao¹, Fu-Xing Lei¹, Jing Zhao²

Affiliations

¹ Department of Anesthesiology, The Second Affiliated Hospital of Shandong First Medical University, Tai'an 271000, Shandong Province, China.
² Department of Dermatology, The Second Affiliated Hospital of Shandong First Medical University, Tai'an 271000, Shandong Province, China. 15662019899@163.com.

Abstract

Background: Radical laparoscopic gastrectomy is an important treatment modality for gastric cancer. Surgery requires general anesthesia, and patients are susceptible to the effects of anesthetic drugs and carbon dioxide insufflation during the procedure, leading to inflammation or severe pain, which can affect patient outcome.

Aim: To explore the efficacy of combining dexmedetomidine (DEX) with nalbuphine in patients underwent laparoscopic radical gastrectomy for gastric cancer.

Methods: Patients scheduled to undergo laparoscopic radical gastrectomy were selected and randomly assigned to A or B group. In A group, patients received an intravenous injection of nalbuphine 0.2 mg/kg + DEX 0.4 μg/kg 10 min before the end of surgery; in B group, patients received only an intravenous injection of nalbuphine. The trends in hemodynamic parameter fluctuations, awakening quality during the recovery period, serum inflammatory markers, agitation scores, cough severity, incidence, and duration of postoperative delirium (POD) were compared.

Results: The mean arterial pressure and heart rate in the A group were more stable (P < 0.05). The A group had a lower average awakening time, extubation time, and agitation scores during recovery than the B group. Agitation control in the A group was more effective at different time points (P < 0.05). Patients in the A group had lower serum interleukin (IL)-6, tumour necrosis factor alpha, and IL-10 levels at 1 h after surgery than the B group. The incidence of coughing and duration of POD were lower and shorter in the A group than in the B group. Adverse reactions caused by the two anesthesia methods were less frequent in the A group than in the B group (P < 0.05).

Conclusion: The use of DEX and nalbuphine in patients undergoing laparoscopic radical gastrectomy for gastric cancer help reducing the inflammatory response, cough severity, and agitation and helps maintain hemodynamic stability.

Keywords: Anesthetic effect; Anesthetic quality; Delirium; Dexmedetomidine; Gastric cancer; Laparoscopic radical gastrectomy; Nalbuphine; Restlessness.