The Effects Of Multimodal Analgesia And The Effects Of Multimodal Analgesia On Immune Function And Cytokine In Patients With Lower Limb Fracture

Objective Patients with lower limb fracture not only suffered pain caused by fractures and surgical incision, but alse suffered postoperative limb swelling and restricted activity and other problems.Surgical stimulation and pain caused massive release of inflammatory cytokines, while inflammatory cytokines also induced central and peripheral sensitization of pain,increased pain, and pain also inhibited the body’s immune function, althoμgh analgesic could relieve suppression of immune function, but analgesic drμg itself could inhibit immune function. This study investigated the effects of multimodal analgesia and the effects of multimodal analgesia on immune function and cytokines in patients with lower limb fracture. Method 100 cases of patients with lower limb fracture, ASAI~II level,undergoing lumbar-epidural anesthesia for open reduction and internal fixation,were randomly divided into the control group(group C, preoperative intravenous saline 10 ml,epidural saline 6ml,postoperative intravenous injection of saline 10 ml,epidural saline 6ml.), multimodal analgesia I group(group MMA I, preoperative intravenous flurbiprofen 100 mg,epidural sufentanil 0.3μg/kg(diluted to 6ml with saline), when surgery finished,intravenous saline 10 ml,epidural saline 6ml.), multimodal analgesia II group(group MMA II, preoperative intravenous saline 10 ml, epidural saline 6ml, when surgery finished,intravenous flurbiprofen100 mg, epidural sufentanil 0.3μg/kg(diluted to 6ml with saline)), multimodal analgesia III group(group MMA III, preoperative intravenous flurbiprofen 50 mg,epidural sufentanil 0.15μg/kg(diluted to 6ml with saline),when surgery finished, intravenous flurbiprofen 50 mg, epidural sufentanil 0.15μg/kg(diluted to 6ml with saline)), 25 cases in each group, four groups were performed by intravenous fentanyl analgesia. VAS scores at postoperative 6h, 8h, 12 h, 24 h, 48 h and 24 h fentanyl requirements,meperidine requirements as well as adverse reactions were recorded.CD4+, CD8+ and CD4+/CD8+ were observed at preoperation and postoperative 24 h, 48 h.The concentrations of interleukin-6(IL-6) and tumor necrosis factor-a(TNF-α) were recorede before surgery and at postoperative 24 h, 48 h. Results At postoperative 12 h, 24 h, 48 h, VAS scores in group MMA I,group MMA II, group MMA III were significantly lower than those in group C(P<0.05); at postoperative 24 h, 48 h, VAS scores in group MMA III were significantly lower than those in group MMA I and group MMA II(P<0.05). Fentanyl requirements in postoperative 24 h in group MMA I, group MMA II and group MMA III were significantly less than those in group C(P<0.05), and fentanyl requirement in group MMA III was significantly less than that in group MMA I and group MMA II(P<0.05). There were no significant difference in pethidine requirement and adverse reactions in four groups(P>0.05). At postoperative 24 h, 48 h, CD4+ and CD4+/CD8+ in group MMA I, group MMA II and group MMA III were significantly higher than those in group C(P<0.05), but those in group MMA III were significantly higher than those in group MMA I and group MMA II(P<0.05).At postoperative 24 h, 48 h, the concentrations of IL-6 and TNF-α in group MMA I, group MMA II and group MMA III were significantly lower than those in group C(P<0.05), while those in group MMA I,group MMA II were significantly higher than those in group MMA III(P<0.05). Conclusion Multimodal analgesia(preoperative intravenous flurbiprofen 50 mg,epidural sufentanil 0.15μg/kg, when surgery finished, intravenous flurbiprofen 50 mg,epidural sufentanil 0.15μg/kg, and postoperative fentanyl controlled intravenous analgesia) effectively improved postoperative pain, protected the immune function and reduced inflammation in patients with lower limb fracture.