The Effect Of Hydromorphone Combined With Intra-articular Ropivcaine On Postoperative Analgesia After Knee Arthroscopic Surgery

Objective: The purpose of this study was to explore the effect of hydromorphone combined with intra-articular ropivcaine on postoperative analgesia and stress response after knee arthroscopic surgery.Methods: 90patients(ASA I-II,age 16-91 y,41-95Kg)were scheduled for knee arthroscopic surgery.According to the random digital table,the patients were randomly divided into 3 groups,30 patients each group.Patients in group Areceived intra-articular injection of 20 ml 0.25% ropivacaine mixed with solution containing0.6mghydromorphone for postoperative analgesia after intravenous 20 ml saline;Patients in group B received intra-articular injection of 20mlsolutionof0.25%ropivacaine for postoperative analgesia after intravenous injection of 20 ml solution containing 0.6mg hydromorphone;Patients in group C received intraarticular injection of 20 ml solution of 0.25% ropivacaine after intravenous injection 20 ml saline.Intravenous administration was at 5 minutes before the start of the surgery,intra-articular injection was performed by the surgeon at the end of the surgery.All patients received general anesthesia with LMA ventilation,the general anesthesia was inducted by sufentanil 0.2?g/kg,cisatracurium 0.15mg/kg and propofol1.0-2.0mg/kg,and was maintained by sevoflurane,remifentanil andpropofol.ECG,NIBP,SPO2,BIS,Pet CO2 were monitored,during perioperative period.When the patients insuffered pain during postoperative analgesia period,theremedial analgesia of parecoxib 40 mg each time was given.SBP,DBP,MAPand HR were recorded at the following time: before induction(T1),5min after induction(T2),immediately after extubation(T3),10 min after extubation(T4)and30 min after extubation(T5).Recovery time,surgery duration were recorded.The static and dynamic NRS scores,Ramsay scores and BCS scores on 1h,6h and 24 h after operations were recorded.The time at wich remedial analgesic drug was given to postoperative patients for the first time and the total dose of the analgesics in 24 hours after operation were recorded.Plasma catecholamine [epinephrine(E),norepinephrine(NE)and dopamine(DA)] levels were detected at the time before anesthesia,6h and 24 h after operation.All patients were scored according to the Qo R-40 scale and the quality of the patients' recovery was evaluated according to the sub record.The adverse reactions of postoperation,including bradycardia,hypotension,hypoxemia,respiratory depression,pruritus,nausea and vomiting,urinary retention,etc.were recorded.Results : 1.There was no significant difference in the gender ratio,age,BMI,recovery time,surgery duration,among the three groups(P>0.05).2.There was no significant difference in SBP,DBP,MAP,HR at T1-T5 time pointsamong the three groups(P>0.05).3.The static and dynamic NRS score of group C were obviously higher than those of group A and B at 1h,6h,24 h after operation(P<0.001).The dynamic NRS score of group B at 24 h after operation was obviously higher than group A(P<0.001),the static and dynamic NRS score at 6h after operation were obviously higher than at1 h and 24 h among the three groups(P<0.001).4.The time of patients receivingremedal analgesic drug for the first time after operation in group C was obviously lower than in the group A and group B(P<0.05),the total dose of the analgesics within 24 hours after operations in group C was obviously higher than the group A and group B(P<0.05).5.There was no significant difference in Ramsay scores and BCSscores between thethree groups(P>0.05).6.There was no significant difference in plasma catecholamine [epinephrine(E),norepinephrine(NE)and dopamine(DA)] levels at before anesthesia,6hand 24 h after operation in the three groups(P>0.05).7.There was no significant difference in the Qo R-40 total score,emotional state score,body comfort score,psychological support score,pain score before and 24 h after operation(P>0.05).The score of self-care ability after operation,was lower than before operation(P<0.05).8.There were 1 case of nausea in group A and group C,1 case of nausea and 1 case of nausea and vomiting in group B.There was no significant difference in adverse effects between the three groups(P>0.05).There were no other adverse reactions in the three groups.Conclusion:Both intra-articular and intravenous 0.6mg hydromorphone for preventive analgesia enhance the analgesic effect of intra-articular 0.25%ropivacaine after knee arthroscopic surgery,and the effect of preventive analgesia in intra-articular0.6mg hydromorphone is better than the intravenous 0.6mg hydromorphone.The side-effects are not increased with preventivehydromorphone0.6mg for analgesia after knee arthrocopysurgery.