Efficiency Of Different Dose Of Dexmedetomide Combined With Butorphano In Patient-controlled Intravenous Analgesia After Total Hip Replacement In The Elderly

The trauma of total hip replacement is relatively large,and the postoperative patients are often accompanied by severe pain,which affects the early functional exercise of patients.At the same time,elderly patients generally have decreased physiological reserve capacity and more complications,severe or uncontrolled postoperative pain may lead to an increase in postoperative complications and affect the recovery of elderly patients.The study was designed to explore the efficiency of different dose of dexmedetomide combined with butorphano in Patient-controlled intravenous analgesia after total hip replacement in the elderly,and to determine the effective and safe analgesic dose of dexmedetomidine.the study involved 60 cases scheduled for total hip replacement in our hospital from August 2018 to August 2019,sixty patients of ASA Ⅰ or Ⅱ aged from 60-75 were randomly devided into three groups（Group C、Group B1 and Group B2）,20 cases in each group.All of them proformded Patient-controlled intravenous analgesia after operation.In group C,PCIA solution contained butorphano 0.15mg·kg^-1;In group B1,PCIA solution contained butorphano 0.15mg·kg^-1+dexmedetomide 1.5ug·kg^-1;In group B2,PCIA solution contained butorphano 0.15mg·kg^-1+dexmedetomide2.0ug·kg^-1,which in all groups were diluted with normal saline to 100 ml and connected with patients after operation.The VAS pain score,Ramsay sedation score at 4,12,24,36,48 hours after operation;systolic pressure,diastolic pressure,heart rate,adverse reactions and the PCIA pressing times at 4,24,36,and 48 hours after operation were evaluated.Results show that:（1）There was no significant difference in gender,age,BMI,operation time and other general data among the three groups;（2）There was no difference in blood pressure,heart rate and VAS score among the three groups before operation;（3）The VAS score of the three groups was no more than 4,and the analgesic effect was satisfactory;The VAS pain score of B1 and B2 at all time points were lower than those of group C（P<0.05）,and the analgesic effect was better than group C,the difference of VAS pain score between group B1 and B2 were not statistically significant（P>0.05）;（4）The Ramsay sedation scores of the three groups were not oversedated;Compared with group C,the Ramsay sedation score of B1 and B2 were higher than those of group C（P<0.05）,and the effect of sedation of B1 and B2 is better than group C,the difference of Ramsay sedation score between group B1 and B2 were not statistically significant（P>0.05）;（5）Compare with B1 and B2,the hemodynamic indexes of systolic blood pressure,diastolic blood pressure,heart rate of C fluctuated greatly（P<0.05）;（6）The incidence of nausea,vommiting and dizziness was significantly higher in group C（P<0.05）,the incidence of hypotension and bradycardia was significantly higher in group B2（P<0.05）;（7）The PCIA pressing times of group C was significiently higher than group B1 and B2（P<0.05）.The conclusion can be gotten through the above experimental results as follows:1The analgesic effect of dexmedetomidine combined with butorphanol in elderly patients after hip replacement is effective.2 Dexmedetomide 1.5ug·kg^-1 and Butorphano 0.15mg·kg^-1 used for PCIA after total hip replacement in elderly is significant and have fewer side effects,it is more suitable for analgesia after total hip replacement in the elderly compared with the other two groups.