The Effects Of Preemptive Analgesia On Postoperative Pain In The Elderly Patients Undergoing Hip Surgery

objectives: to study the effects of preemptive analgesia on post-operative pain and sleep quality in the elderly patients undergoing hip surgery.Methods: Ninety elderly patients undergoing scheduled hip surgery were randomly selected in Chengdu First People's Hospital from 09/2016 to09/2017.All patients are more than 65-year-old and graded as ASA I-III.Each patient was randomly assigned to either patient-controlled epidural analgesia(PCEA)group(group A,n=45)or preemptive analgesia group(group B,n=45).All patients were given routine nasal canula O2 and were monitor for BP,Tele and O2 saturation at the OR(operative room).Succinylated Gelatin 5-8ml/kg was given via IV during peri-operative period.Granisetron hydrochloride was used routinely to avoid nausea and vomiting.Patients from both groups received combined spinal and epidural analgesia(CSEA).Patient lay on the either side and L2-3 or L3-4 were used for puncture site.2ml 0.5% ropivacaine were initially injected into subarachnoid spaced and then epidural catheter were placed into the epidural space.The level of anesthesia usually approached to the T10 level before the surgery.Group A received PCEA which consist of300 mg Ropivacaine,0.3mg Fentanyl and 150 ml 0.9% saline.The flow rate is4 ml/h with each bolus of 1 ml with locked interval of 15 mins.Group Breceived both preemptive analgesia and PCEA.Patients were given oral Celecoxib Capsules 400 mg 2 hours before surgery,local infiltration block during operation and Iliac fascia block after surgery.We check pain degree in both resting state(sitting or lying)and active state(bending hips or walking)at12h,24 h,48h,72 h post surgery and at discharge.We also evaluated the frequency of PCA using in the 2 days after surgery and sleep quality at the night before surgery and in the 2 days after surgery.A variety of post-operation inflammatory factors and adverse outcomes were also evaluated.Results:(1)The pain score of group B in resting state 12 h,24h,48 h and 72 h after the surgery is significantly lower than that of group A(P < 0.01).There is no difference regarding to pain score between two groups at the resting status on discharge(P > 0.05).(2)The pain score in group B in active state at 12 h,24h,48 h and 72 h after the surgery was obviously lower than group A(P < 0.01).There is no difference between both groups in active state On discharged(P >0.05).(3)The frequency of PCA bolus using in group B is significantly lower in the 2 days post surgery(P < 0.01).(4)There is no significant difference regarding to the sleep quality at the night before the surgery P > 0.05)between2 groups.However,group B slept better in the 2 days after the surgery than group A(P < 0.01).(5)There is no difference between two groups in the levels of inflammatory factors IL-6,CRP and Cor(P > 0.05)before the surgery.However,the levels of IL – 6 and CRP was significantly lower in Group B when compared with group A(P < 0.01)at 1h,1d and 2d after the surgery.Moreover,the level of Cor in group B was lower(P < 0.01)at 1d and 2d after the surgery.(6)There was no difference in two groups regarding to postoperative outcomes(P > 0.05).Conclusions:(1)Preemptive analgesia can effectively reduce pain in the elderly patients undergoing hip surgery in both resting and active state,and reduce the use of PCA.(2)Preemptive analgesia could effectively improve the sleep quality in elderly patients with hip surgery.(3)Preemptive analgesia could effectively help to reduce inflammation related to hip surgery in the elderly patients.