Clinical Study Of Nalbuphine Combined With Iliac Fascia Block For Operative Analgesia Of Hip Fracture

Objective:To prolong the time of postoperative analgesia and restore the exercise in the early stage are the difficulties in the early rehabilitation of patients with hip fracture.The purpose of this study was to investigate the analgesic effect of nalbuphine combined with ropivacaine used for iliac fascial nerve block after hip fracture surgery.Methods:90 elderly patients undergoing hip fracture surgery under general anesthesia combined with nerve block anesthesia were randomly divided into three groups,(n=30): 0.33% ropivacaine 30 ml(group A),0.1 mg/kg nalbuphine combined with 0.33% ropivacaine 30 ml(group B),and 0.1mg/kg intravenous nalbuphine + 0.33% ropivacaine 30 ml(group C).Ultrasound-guided iliac fascial nerve block was performed in all patients before operation.The resting and dynamic pain score(VAS score),Ramsay sedation score and quadriceps muscle strength rating were recorded before surgery(T0)and after surgery at 4 h(T1),8 h(T2),24 h(T0),48 h(T0),72h(T5).The duration of nerve block,the first time of landing,analgesia satisfaction score,the occurrence adverse reactions and length of hospital stay were recorded.Results:1.VAS pain scoreCompared with the resting VAS score of group A,the scores of T1,T2,T3 and T5 in group B were lower(P<0.05).Compared with group A,the dynamic scores of T1,T2,T3,T4 and T5 in group B were lower(P<0.05).Compared with the resting VAS scores of group C,the scores of group B in T3 and T4 were lower(P<0.05).Compared with group C,the dynamic scores of T1,T3,T4 and T5 in group B were lower(P<0.05).Compared with the dynamic VAS score of group A,the T1 score of group C was lower(P<0.05).2.Sedation scoreThere was no significant difference in preoperative and postoperative sedation scores among the three groups(P>0.05).3.The effect of nerve blockCompared with groups A and C,patients in group B had longer duration of nerve block,higher analgesic satisfaction score,and earlier time of first landing;Compared with group A,patients in group C had longer duration of nerve block and earlier time of first landing,(P<0.05).4.Quadriceps muscle strength ratingCompared with groups A and C,quadriceps muscle strength rating of group B was higher at T1,T2 and T3(P<0.05).But there was no statistical significance between group A and group C(P>0.05).5.Adverse reactions and postoperative hospital stayThere was no significant difference in the occurrence adverse reactions and postoperative hospital stay among the three groups(P>0.05).Conclusion:Nalbuphine combined with ropivacaine used for iliac fascial nerve block after hip fracture surgery has a good analgesic effect,which not only extend the block time,but also reduces the postoperative VAS score and improves the postoperative analgesic satisfaction.In addition,compared with advanced analgesia,nalbuphine as an adjuvant of ropivacaine has signification effects on dynamic VAS score,analgesic satisfaction,and postoperative muscle strength recovery,It can be safely applied to postoperative analgesia of hip fracture in elderly patients,and has certain clinical application value.