Effects Of Butorphanol On Serum Inflammatory Factors IL-6,TNF-α And Early Cognitive Function In Elderly Patients After Unilateral Total Knee Arthroplasty

Objective:To investigate the effect of butorphanol on perioperative serum levels of inflammatory cytokines IL-6,TNF-α and early postoperative cognitive function in elderly patients undergoing order-side total knee arthroplasty(TKA)under combined spinal-femoral nerve block anesthesia.Methods:From November 2018 to January 2020,elderly patients(age 65 ～ 80,Grade ASAⅡ～Ⅲ)who came to our hospital were selected,who signed informed consent form with patients and their families,and divided them into butorphanol group and control group according to the grouping criteria of randomized digital method.All surgery,anesthesia operations,and collection and collation of experimental data were completed by the same doctor team.All patients were anesthetized with spinal anesthesia combined visual femoral nerve block.The butorphanol group administered the same volume of normal saline to the butorphanol 1 mg,control group in the same manner immediately before the implementation of regional block anesthesia.Excluding regional block and / or nerve block failure,and patient inability to cooperate with the study,80 patients were 40 included in each group.Thelevels of serum IL-6 and TNF-α in the two groups were collected and recorded before anesthesia,immediately after operation and 1 day after operation.Their MMSE scores at 1 day before operation,1 day after operation and 3 days after operation were evaluated to analyze their cognitive function.Record the occurrence of adverse reactions including postoperative nausea and vomiting,drowsiness,dizziness,and hypotension.Results:There was no significant difference in the general data,condition,operation time,anesthesia time,bleeding and infusion between the two groups(P > 0.05).There was no significant difference between the two groups in the levels of serum IL-6 and TNF-αmeasured before block anesthesia and the MMSE cognitive function score recorded and analyzed 1 day before operation and 3 days after operation.The serum levels of IL-6 and TNF-α in the butorphanol group were lower than those in the control group immediately after operation,and the MMSE score on the first day after operation was significantly higher than that in the control group(P < 0.05).The incidence of postoperative adverse reactions between the two groups was recorded and compared,and there was no significant difference between the two groups(P > 0.05).Conclusion:In elderly patients undergoing unilateral TKA surgery under combined spinal and femoral nerve block anesthesia,butorphanol preconditioning before anesthesia can reduce the levels of perioperative serum inflammatory factors IL-6 and TNF-α and the incidence of early cognitive impairment,with less adverse reactions,excellent effect,high reliability and safety,so it is worthy of more extensive implementation and application in clinical surgical anesthesia.