Clinical Observation Of Butorphanol In Elderly Patients With Unilateral Knee Arthroplasty Under Lumbar Plexus Sciatic Nerve Block

Objective:To investigate the clinical effect of Butorphanol in elderly patients with unilateral knee arthroplasty under lumbar plexus sciatic nerve block.Methods:50 elderly patients(BMI 18-28kg/cm~2,ASA Ⅰ-Ⅲ) scheduled for unilateral knee arthroplasty were divided into two groups:butorphanol group and sufentanil group,25cases in each group.Before nerve block anesthesia,20μg/kg butorphanol and 0.1μg/kg sufentanil were given intravenously.MAP and HR were observed at the time of entering the room (T0),intravenous administration(T1),nerve block operation (T2),skin incision (T3),60 min after tourniquet(T4),tourniquet release(T5) and the end of operation(T6).4ml radial artery blood was drawn at T0 and T6 to determine the content of cortisol and norepinephrine.The incidence of intraoperative adverse reactions,such as nausea,retching/vomiting,hypotension,respiratory depression and somnolence,was recorded.Analgesia(VAS score) and sedative effect(Ramsay score) were observed at each time point.Results:There was interaction between MAP and HR at different time points and between groups(P<0.05).The changes of MAP and HR in butorphanol group and sufentanil group were different at different time points.The change range of butorphanol group was smaller and the hemodynamics was more stable.There was interaction effect between the two groups(P<0.05).The changes of cortisol and norepinephrine in the two groups at T0 and T6 were different.The increase of butorphanol group was significantly less than that of sufentanil group,indicating that butorphanol can strongly inhibit stress response.There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).There was interaction between groups and time points of VAS score in the two groups(P<0.05).The VAS score in T2-T6 showed a downward trend,and that in butorphanol group was slightly lower than that in sufentanil group at each time point.Ramsay scores of the two groups had interaction between groups and time points(P<0.05).Ramsay scores of the two groups showed an increasing trend at T2-T5,butorphanol group was higher than sufentanil group at all time points.Conclusion:Butorphanol can reduce tourniquet reaction,inhibit stress reaction,stabilizehemodynamics,has good sedative and analgesic effect,and has high comfort in elderly patients undergoing knee arthroplasty.