The Effect Of Local Anesthetics Infiltration At Incision Sites Combined With PCIA As Multimodal Analgesia In Advanced Aged Patients After Total Hip Arthroplasty

Objective: To evaluate the safety and effect of local anesthetics injection at incision sites combined with intravenous tramadol as multimodal analgesia in elderly patients after total hip arthroplasty through the vital sign, VAS and Ramsay score, adverse effects and the postoperative stress reaction. Methods: Sixty patients aged over 80 and ASA classified 2-3 who received elective total hip arthroplasty under general anesthesia were included in this study. Patients were divided into 2 groups: multimodal group(Group M) and the control group(Group C). Each group contains 30 patients. Intravenous access was established after patients entering the operation room and connecting to the monitor. Induction and maintain of anesthesia were same in 2 groups. Before the end of the surgery, Group M were injected with the local anesthetics(compound of 0.25% ropivacaine mesylate, 0.5% lidovacaine and saline at a total volume of 20 m L) to block the incision site in layers, and Group C were injected with the same volume of saline. Patient-control analgesia(PCA) pump was connected to the intravenous access after extubation. The formulation of PCA contains tramadol 0.3mg/(kg.h) and granisetron 9mg. Parameters of PCA were set as follows: infusion speed 2.5 ml/h, bolus 1.5ml and time locked 20 minutes. VAS and Ramsay scores, times of PCA pressed and adverse effect were recorded at 4h(T1), 8h(T2), 12h(T3), 24h(T4) and 48h(T5) after post-operative analgesia. Fasting venous blood sample was collected at the morning before the surgery(D0), and the first(D1) and third(D3) morning postoperatively. Concentration of serum catecholamines were tested by high-performance liquid chromatography. Results:1.Comparing with Group M, the VAS score at each time point was significantly higher in Group C(P<0.05). 2.The Ramsay score had no statistically difference between the 2 groups(P>0.05). 3. Compared with M group, PCA pump was effective pressed more times in Group C than that in Group M with statistically significance(P>0.05). 4.The incidence of postoperative nausea and vomiting was significantly higher in Group C(P<0.05). 5.Within-group comparison showed that the concentration of 3 tested catecholamines were higher at D1 than D0 and D3 in both groups(P<0.05) while the concentration of dopamine at D3 was higher than D0 in Group C(P<0.05). When comparing between groups, the concentration of 3 tested catecholamines at D1 in Group C was higher than Group M(P<0.05), but there was no statistically difference at D0 between 2 groups(P>0.05). Conclusion:1. Multimodal analgesia which combined of local anesthetic infiltration and PICA with tramadol can be applied easily and safely in elderly patients under orthopaedic surgery, and the analgesia effect is superior compared with using tramadol alone. 2.Using multimodal analgesia in elderly patients is superior in relieving stress reaction postoperatively and with lower incidence of adverse effect.