Fascia Iliac Nerve Block With Different Local Anesthetic Adjuvants Was Used To Observe The Clinical Effect Of Artificial Femoral Head Replacement In Elderly Patients

Objective:To investigate the clinical effects of dexmedetomidine or betamethasone combined ropivacaine for artificial femoral head replacement for fascial iliac nerve block.Method:From November 2021 to June 2022,60 elderly patients who underwent artificial femoral head replacement under subarachnoid anesthesia combined with fascia iliac nerve block in our hospital,aged>65 years old,American Society of Anesthesiologists（ASA）grade Ⅰ～Ⅲ,body mass index（BMI）19.1-28Kg/m²,divided into three groups:L,B and Y,with 20 cases in each group.All three groups underwent fascia iliac nerve block on the surgical side,and 30 mL of 0.4%ropivacaine was injected in the L group.Group B injected mixed drug:0.4%ropivacaine+betamethasone 7mg for a total of30ml;Group Y injected mixed drug:0.4%ropivacaine+dexmedetomidine0.5μg/kg for a total of 30ml.The duration of analgesia in three groups:L,B and Y was recorded;levels of interleukin-6（IL-6）and tumor necrosis factor-α（TNF-α）in plasma before,after and 24 hours after surgery;Ramsay sedation scores before the start of block（T₁）,30 minutes after block（T₂）,1 h after block（T₃）,end of surgery（T₄）,6 h postoperative（T₅）,12 h postoperative（T₆）,24 h postoperative（T₇）,48 h postoperative（T₈）;VAS pain scores at rest and exercise at 6 h,12 h,24 h,48 h postoperatively;Additional analgesia and postoperative adverse effects within 48 hours after surgery.Outcome:1、General situationThere were no significant differences in gender,age,BMI value,ASA grade and operation duration between the three groups（P>0.05）.2、Duration of analgesiaThe duration of analgesia was 8.41±1.35 hours in the L group,10.23±1.47 hours in the B group,and 9.34±1.27 hours in the Y group.Compared with group L,the duration of analgesia was significantly prolonged（P<0.05）,compared with group L,the duration of analgesia was significantly prolonged（P<0.05）,and group B compared with group Y,the duration of analgesia was significantly longer and the difference was statistically significant（P<0.05）.3、Comparison of IL-6 and TNF-αlevels in bloodBefore the start of surgery,there was no significant difference in plasma levels of IL-6 and TNF-αin the three groups（P>0.05）,and at the end of surgery and 24 hours after surgery,the plasma levels of IL-6 and TNF-αin group B and Y were significantly lower than those in group L（P<0.05）,and the levels of IL-6 and TNF-αin plasma in group B were significantly lower than those in group Y,with a significant difference（P<0.05）.4、Ramsay sedation score comparisonThere was no significant difference in Ramsay sedation scores between the T₁,T₆,T₇and T₈groups（P>0.05）,and the Ramsay sedation scores in the Y group were significantly higher than those in the L and B groups at the time points of T₂,T₃,T₄and T₅（P<0.05）,and there was no significant difference between the L group and the B group（P>0.05）.5、VAS score at rest and during exerciseThere were no significant differences in resting VAS score and exercise VAS score between the three groups 6 hours after surgery,24 hours after surgery and 48 hours after surgery（P>0.05）,and the resting VAS score and exercise VAS score 12 hours after surgery in group B and Y were significantly lower than those in group L（P<0.05）,and there was no significant difference between group B and Y（P>0.05）.6、Additional analgesia within 48 hours after surgerySixteen cases in group L underwent additional analgesia;Seven cases in group B underwent additional analgesia;There were 9 cases in the Y group who underwent additional analgesia,and the difference of the postoperative additional analgesia between the three groups was statistically significant（P<0.05）.7、Adverse reactionsThere were 2 cases in the group L with nausea and vomiting,1 case in group B with nausea and vomiting,1 case in group Y with drowsiness,and 1case with bradycardia.No other adverse reactions were observed.There was no significant difference in the occurrence of adverse reactions between the three groups（P>0.05）.Conclusion:Both local anesthetic adjuvants combined with ropivacaine can effectively improve the analgesic effect of fascia iliac nerve block during artificial femoral head replacement in elderly patients,and betamethasone is better.