Retrospective analysis of remifentanil combined with dexmedetomidine intravenous anesthesia combined with brachial plexus block on shoulder arthroscopic surgery in elderly patients

Objectives: To analyze the effect of remifentanil combined with dexmedetomidine intravenous anesthesia combined with brachial plexus block on shoulder arthroscopic surgery in elderly patients.

Methods: This retrospective study conducted at Jiading Branch of Shanghai General Hospital, investigated clinical data from elderly patients receiving shoulder arthroscopy between January 2020 and June 2021. Based on the treatment, patients were retrospectively divided into Group-I (remifentanil combined with dexmedetomidine) and Group-II (remifentanil continuous pump injection). Hemodynamic indices, such as mean arterial pressure (MAP) and heart rate (HR), degree of pain (VAS score), and stress response marker levels were examined prior to the operation and at various time points post-operation. Operation time and adverse reaction incidences were also evaluated.

Results: There was no significant differences in MAP and HR between the two groups prior to the operation. However, MAP and HR levels were lower in Group-I patients at three time points post-operation. Similarly, VAS scores were not different between the two groups prior to the operation but were much lower in Group-I at multiple time points post-operation. The same trend was observed for the stress-induced angiotensin-II, cortisol, and aldosterone. Additionally, patients in Group-I had lower incidence of adverse reactions and shorter operation time.

Conclusion: Remifentanil combined with dexmedetomidine intravenous anesthesia for shoulder arthroscopic surgery under general anesthesia combined with brachial plexus block in elderly patients can maintain hemodynamic stability, shorten operation time, reduce the degree of stress reaction, pain caused by invasive operation, and reduce the incidence of adverse reactions.