Application Of Ropivacaine Combined With Dexmedetomidinein In Fascia Illiaca Compartment Block In Total Hip Arthroplasty

Objective:With the development of medicine,Total hip arthroplasty(THA)has been widely used in patients with femoral neck fracture,femoral head ischemic necrosis,osteoarthropathy and deformity of hip joint.Iliac fascia space block(fascia illiaca compartment block FICB)technology is used safely in anesthesia and postoperative analgesia for total hip arthroplasty because it can effectively blocked femoral nerve,the lateral cutaneous nerve and sciatic nerve,and the punctureing position which is far from nerves and blood vessels.Which is used safely in anesthesia and postoperative analgesia for total hip arthroplasty.However,because of the limit of blocking time of local anesthetics,this technology is not commonly used in clinical practice.Studies have shown that the dexmedetomidine combined with local anesthetics can shorten the onset time of local anesthetics and prolong the action time at the same time,which provided new ideas for postoperative analgesia of total hip arthroplasty.The aim of this study is to observe the effects of different doses of dexmedetomidine combined with ropivacaine for ultrasound-guided fascia iliaca compartment block on postoperative analgesia and rehabilitation in patients undergoing total hip arthroplasty.Methods:80 patients with ASA I-II undergoing total hip arthroplasty were ramdonly divided into 4 groups.20 in each group.Group R :0.3%ropivacaine 30ml;Group RE1 :0.3%ropivacaine and dexmedetomidine 0.5 ? g/kg 30 m L;Group RE2:0.3%ropivacaine and dexmedetomidine 1.0 ? g/kg 30 m L;Group RE3:0.3%ropivacaine and dexmedetomidine 1.5 ? g/kg 30 m L.Recordings of patients with ultrasound guided fascia iliaca compartment block onset time,block fading time,VAS at 4 h,8 h,12 h,24 h,48 h statically and dynamically;duration of operation,intraoperative remifentanil and propofol requirement;recording the heart rate(HR),mean arterial pressure(MAP)at begining of anesthesia;the moment of skin's cutting and the moment of removing the throat mask,the total of sufentanil requirement at Postoperative 24 h and 48h;after the operation were recorded for the first time,ambulation time,hospitalization time and observe whether bradycardia,intraoperative awareness and other adverse reactions were recorded.Results:Compared with group Rand RE1,the onset time of RE2 were shorter(P<0.05);the VAS was less(P<0.05);the remifentanil equirement was significantly was reduced(P<0.05);the amount of sufentanil after operation 24 h and 48 h was reduced(P<0.05);the first time out of bed time and total hospitalization time was shorter(P<0.05);Reduce the incidence of nausea and vomiting after surgery(P<0.05): patient satisfaction increased(P<0.05);The extubation time was significantly longer and the occurrences of tachycardia were significantly increased in group RE3 compared to other groups respectively.Conclusion: 0.3% ropivacaine combined with 1.0?g/kg dexmedetomidine ultrasound-guided fascia iliaca compartment block can shorten the onset time of local anesthetics and prolong the action time at the same time,provide better postoperative analgesic and recover rapidly with fewer side effects in total hip arthroplasty,clinical popularization and application value.