Observation Of Analgesic Effect Of Intra-articular Injection Of Dexmedetomidine Combined With Ropivacaine After Hip Arthroplasty In The Elderly

Osteoarthropathy such as femoral head necrosis and end-stage osteoarthritis in the elderly is related to reduced mobility,loss of independence,and excessive morbidity and mortality.As the current commonly used method for the treatment of osteoarthritis,hip replacement has become one of the successful orthopedic surgeries,however,pain is a factor that seriously affects the rehabilitation training and quality of life of patients after hip replacement.Dexmedetomidine has been proven to shorten the onset time of local anesthetics and reduce the incidence of adverse reactions when used in combination with other local anesthetics.In our study,we planned to collect elderly patients undergoing unilateral hip arthroplasty and observed the sedative effects and the occurrence of adverse reactions through giving two dose of dexmedetomidine which combined with fixed concentration of ropivacaine into the articular cavity to the analgesic,In order to provide for reference for linical rational use of drugs.Objective:To observe the analgesic and sedative effects of intra-articular administration of two dose of dexmedetomidine which combined with fixed concentration of ropivacaine,and provide references for clinical rational drug use.Method:A total of 90 elderly patients who underwent unilateral hip arthroplasty aged 65 to 85 years were selected to turn on the intravenous analgesia pump at the end of the operation during October 2018 to March 2019,The patients were randomly divided into three groups with 30 patients in each group.The control group(Group C)was in jected with 20 mL 0.25%ropivacaine only,the experimental group 1(Group D1)was injected 0.5μg/kg dexmedetomidi ne plus 0.25%ropivacaine with 20 mL,and the experimental group 2(group D2)was injected 1.0μg/kg dexmedet omidine plus 0.25%ropivacaine with 20 mL.The pain grade was determined by visual analogue scale(VAS).The incidence of adverse reactions was calculated.The postoperative sedation effect was evaluated by ramsay sedation score(RSS),comfort score(BCS)and functional activity of joint after operation by Harris score.Result:1.Comparison of general information:there was no significant difference among the three groups.2.Comparison of arterial pressure and heart rate indicators:there was no significant difference between preoperative and postoperative 4h,12h,24h and 48h.3.Comparison of incidence of adverse reactions:there were no significant difference among the control group(3.33%),the D1 group(6.67%)and the D2 group(10.00%).4.Changes of VAS score(RVAS)in resting state after operation:compared with group C,the RVAS scores of D1 and D2 groups at 4h,8h,12h,24h and 48h were significantly lower,and compared with group D1,the RVAS scores of D2 groups at 24h and 48h were significantly lower.5.Changes of VAS score(PVAS)in active state after operation:Compared with group C,the PVAS scores at 12 h,24 h and 48 h in D1 and D2 groups were much lower,and the 48 h PVAS in D2 group was significantly lower than that in D1 group.(P<0.05).6.Changes of RSS sedation score after operation:compared with group C,RSS score at 12 h,24 h and 48 h in D1 group increased significantly(P<0.05),RSS score in D2 group increased significantly at each time point(P<0.05),and RSS score at 24 h and 48 h in D2 group increased significantly compared with D1 group(P<0.05).7.Comparison of comfort:compared with group C,the BCS scores at 8h,12h,24h and 48h in D1 and D2 groups were significantly higher(P<0.05),and the BCS scores at 24h and 48h in D2 group were significantly higher than those in D1 group(P<0.05).8.Changes of functional activity of hip joint after operation:compared with group C,the Harris scores of hip joint function in D1 and D2 groups at 12h,24h and 48h were significantly higher,and the Harris scores at 24h and 48h in D2 group were significantly higher than those in D1 group.Conclusion:1.The analgesic effect of 0.5 μg/kg and 1.0 μg/kg dexmetomidine+0.25%ropivacaine is better than that of 0.25%ropivacaine alone.2.High concentration dexmedetomidine+ropivacaine:low concentration combined group,good analgesic effect,long duration,and less adverse reactions.