The Effect Of Different Dosage Of Ketorolac Tromethamine Combined With Dexmedetomidine For Postoperative Intravenous Analgesia In Elderly Patients After Hip Replacement

Objectives By comparing different dosage of ketorolac tromethamine combined with dexmedetomidine for postoperative intravenous analgesia in elderly patients after hip replacement,to explore the appropriate dosage of intravenous self-controlled-analesia for the elderly patients after hip replacement surgery.Methods Patients who underwent selective hip replacement surgery were enrolled.ASA class1~2,aged 65~74years,BMI18.5~27.5kg/m2 Preoperative patients refused to sign informed consent,patients with ischemic heart disease and cerebrovascular,patients who are undergoing renal replacement therapy or have severe hepatic insufficiency,patients with sleep apnea syndrome or NASIDs allergies are excluded.Patients who underwent selective hip replacement surgery use general anesthesia,the same set of patient controlled intravenous analgesia,PCIA(background rate 2ml/h,reservoir bag volume 100 ml,block time 15 minutes,additional dose 0.5ml).Patients were randomly divided into three groups: Group A(ketorolac tromethamine1.5mg/kg+dexmedetomidine2.0ug/kg),B group(ketorolac tromethamine2.0mg/kg+dexmedetomidine2.0ug/kg)and C group(ketorolac tromethamine2.5mg/kg+dexmedetomidine 2.0ug/kg).record the sedation(Ramsay)score;at postoperative 2,6,24,48 and 72 hours,record the pain scoreinclude motion and resting pain score(VRS).Operation finished 48 hours,recorded numbe of the effective pressing PCIA;In the day before surgery application of MMSE on the cognitive impairment of the elderly,if who had,been exclude,the scores of cognitive function were received on the first day,the second day and the fifth day after surgery,the occurrence of nause and vomitting,bleeding,respiratory depression drowsiness,and other adverse reactions of the situation;At postoperative 72 hours,we evaluated the satisfaction of patients;To record the incidence of sinus,respiratory depression,sinus tachycardia,hypertension,deep sedation low blood pressure,after 72 h,those were recorded in each group of patients.respectively.Results 1.general conditions: body mass index(BMI),the distribution of ASA classification,operation time,.the age,height,total amount of drugs(eg propofol and remifentanil)there was no statistical difference(P>0.05).2.At T1,T2,T3,T4,there were no significant differences in mean arterial blood pressure and heart rate between each groups.3.At each time-point among three group there was no statistical significance in Ramsay score(P>0.05).4.Ramsay scores:there was no significant difference of the three groups at each time point after operation(P>0.05).5.Postoperative analgesia was performed : in group A,there was two patients,in group B,there was one patient and in group C,there was no patient.additional analgesics:compared with group C.there was no statistically significant,but through compared with the group A,the group B,group C was significantly reduced.Compared to the number of effective pressing:through compared with group C,there was no statistically significant(P>0.05).compared with group A,PCIA group was significantly increased,compared with group B and group C,there was statistical significance(P<0.05).6.Compared the detail of side effects:postoperative incidence of dizziness nausea.and headache,group C was higher than that in group B and in group A,has statistically significant(P<0.05).In group C,one case of patient has a fundas hemorrhage.there was no significant difference in the incidence of other side effects(P>0.05).7.At postoperative 2h,6h,in group A,the mean arterial pressure was higher than that in group B and in group C(P<0.05).At postoperative 2h,6h,compared with group A,the heart rate in group B and group C was lower(P<0.05).In all patients,only two patients in group A had postoperative hypertension.8.Between the three groups,there was no significant difference in MMSE score after operation(P>0.05).9.The patients in group B had the best satisfaction of analgesia Postoperative satisfaction compared with the other groups of patients(P<0.05).10.5-TH and substance P(SP):The values at postoperative 2,6,24,48 hours all higher than those before the operation,had statistical significance(P<0.05),the values at postoperative 72 hours are higher than those before the operation,but There was no significant difference(P>0.05).After operation,at 6 hours,the values is highest,the number of 24 hours,48 hours,72hours after the operation gradully decreased with the prolongation.Comparison between the three groups:through compared with group A,group B and group C was elevated(P<0.05),there was no statistically significant,compared with group C(P>0.05).Conclusions ketorolac tromethamine can be used safely for postoperative analgesia in elderly patients undergoing hip arhroplasty,ketorolac tromethamine 2.0mg/kg+dexmedetomidine 2.0ug/kg,it can improve analgesia and moderate sedative,low incidence of adverse reaction and high satisfaction of patients.