| BackgroundTotal knee arthroplasty(TKA)is a common procedure to improve mobility and quality of life in patients with osteoarthritis or rheumatoid arthritis.However,the severe pain caused by the operation often brings great psychological pressure to the patients,especially if the elderly do not relieve the pain in time,on the one hand,it will increase the surgical stress response.On the other hand,it causes different degrees of damage to the circulatory,respiratory and other systems,which affects the prognosis of patients and increases the length of hospital stay.A series of stress reactions caused by perioperative pain in TKA surgery can be alleviated by reasonable and effective analgesic methods.Therefore,choosing an appropriate analgesic method to reduce the degree of pain in the perioperative period of TKA and accelerate the recovery of patients is the focus of current research.Compared with general anesthesia,spinal anesthesia can reduce the adverse reactions of TKA patients,shorten the length of hospital stay,benefit the prognosis of patients and optimize the allocation of medical resources.Hydromorphone is a μ receptor agonist,which has partial activating activity on δ and κopioid receptors,and is a highly effective,safe,highly selective and potent opioid analgesic.Compared with morphine,hydromorphone has a lower risk of adverse reactions such as nausea and vomiting,respiratory depression and pruritus,and can significantly improve the patient’s mood.Compared with other routes of administration such as oral administration and intravenous administration,intrathecal injection of hydromorphone can directly act on the central nervous system,and can exert an analgesic effect stably and rapidly.At the same time,the intrathecal injection of hydromorphone requires a smaller drug dose,and the incidence of adverse reactions is lower and the degree is milder.At present,there are few clinical studies on intrathecal injection of hydromorphone for perioperative analgesia,and only in the clinical observation of individual operations such as orthopedics and obstetrics.However,whether it has advantages in TKA anesthesia and analgesia,its optimal dose is not yet clear.ObjectiveTo investigate the effects of intrathecal injection of different doses of hydromorphone on hemodynamics,postoperative analgesia and rehabilitation quality of patients during total knee arthroplasty.Finding the optimal dose of intrathecal hydromorphone provides a new idea for perioperative analgesia.MethodSelect 120 patients who planned to undergo total knee arthroplasty in our hospital from June2021 to October 2022 as the research objects.The patients were divided into four groups(n = 30)by random number table method: ropivacaine group(R group),ropivacaine+0.1mg hydromorphone group(RH1 group),ropivacaine+0.2mg Hydromorphone(RH2 group)and ropivacaine+0.3mg hydromorphone(RH3 group).Corresponding doses of drugs were injected after spinal canal puncture.Observe the records and study the following indicators:(1)General information such as patient grouping,gender,age,body mass index,ASA classification,operation duration and anesthesia plane;(2)Resting and exercise VAS scores at2 h,6h,12 h,24h,and 48 h after operation;(3)The time of the first PCIA use,the number of analgesic pump presses and the rate of rescue analgesia;(4)The active maximum range of motion of the knee joint at 12 h,24h,and 48 h after operation,and the time to get out of bed for the first time;(5)The MAP and HR of the patient entering the room(T0),when the anesthesia took effect(T1),30 minutes after the tourniquet was applied(T2),after the tourniquet was loosened(T3),and at the end of the operation(T4);(6)The incidence of adverse reactions such as itching,nausea,vomiting,and respiratory depression in patients 24 hours after operation;(7)Qo R-40 scale scores on the 1st day before operation,the 1st day after operation,and the 2nd day after operation.ResultsAfter 6h,12 h,and 24 h,the resting and exercise VAS scores of RH2 and RH3 groups were significantly lower than those of R and RH1 groups(P<0.05),and 6h and 12 h after operation of RH1 group were lower than those of R group(P<0.05).The time of the first use of PCIA in the RH2 and RH3 groups was significantly later than that of the R and RH1 groups(P<0.05),and the RH1 group was lower than that of the R group(P<0.05),but there was no significant difference in the time of the first use of PCIA between the RH2 and RH3 groups(P>0.05);The number of analgesic pump presses in RH1,RH2,and RH3 groups was less than that in R group(P<0.05).At 12 h,24h,and 48 h after operation,the active maximum range of motion of the knee joint in the RH2 and RH3 groups was significantly higher than that in the R and RH1 groups(P<0.05),and the RH1 group was higher than that in the R group(P<0.05),while the RH2 and RH3 groups were significantly different No statistical significance(P>0.05);The time to get out of bed for the first time after operation in the RH2 and RH3 groups was significantly earlier than that in the R and RH1 groups(P<0.05),but there was no significant difference between the RH2 and RH3groups(P>0.05).There was no significant difference in HR and MAP between the four groups at the rest of the time(P>0.05);At T1,the HR of the RH3 group was faster than that of the R group,and the MAP was decreased(P<0.05).The incidence of postoperative itching in R,RH1,and RH2 groups was lower than that in RH3 group,and the incidence of postoperative nausea in R,RH1 group was lower than that in RH3 group(P<0.05).The Qo R-40 scores on the 1st and 2nd day after operation were higher in the RH2 group than in the other three groups,R group was lower than the other three groups,the difference was statistically significant(P<0.05).There was no statistically significant difference between RH1 and RH3groups(P>0.05).Conclusions(1)Intrathecal injection of hydromorphone in TKA surgery has good postoperative analgesic effect and long-lasting effect,which is beneficial to exercise,can effectively improve the overall recovery quality of patients,and promote early recovery.(2)Intrathecal injection of 0.2 mg hydromorphone has better analgesia and exercise rehabilitation results after operation,and at the same time has fewer adverse reactions,and the overall postoperative recovery quality is better. |
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