Effects Of Dexmedetomidine And Sufentanil On Postoperative Analgesia And Stress Reaction In Patients Undergoing Total Knee Arthroplasty

ObjectiveTo evaluate the clinical effect and safety of different doses of dexmedetomi-dine（DEX）combined with sufentanil on postoperative analgesia in patients undergoing total knee arthroplasty（TKA）.MethodsSixty patients aged 49-74 years with ASA classⅠ-Ⅲ,undergoing primary unilateral TKA,were randomly divided into sufentanil group（C group）,sufentanil and DEX with 0.05ug·kg^﹣1·h^﹣1 group（DE1 group）,sufentanil and DEX with 0.08ug·kg^-1·h^-1 group（DE2 group）by patient-controlled intravenous analgesia.Local infiltration anesthesia was performed in all patients before and after the prosthesis placed.The postoperative static and movement VAS,Ramsay-score,SBP,DBP,HR,SpO2 and incidence of side effects after operation were aseesed at the time 6（T0）,12（T1）,24（T2）,48h（T3）following operation.The range of motion,cortisol and C reaction protein were detected at the time T1,T2 and T3.Recorded adverse reaction of patients after operationResults（1）VAS:The static and movement VAS score of group D1 and D2 were lower than those of group C at T0-T3.Compared with group D1,The static VAS at T0,T1 and movement VAS at T0-T3 of group D2 were lower（P<0.05）.（2）Ramsay evaluation of group C at T0-T3 were lower than group D1 and D2（P<0.05）,while the Ramsay in group D2 at T0,T1 were higher than group D1（P<0.05）.（3）Values of SBP,DBP and HR at T0-T3 decreased statistically in group D1 and D2 than group C.There was no significant difference in SpO2 of the three groups.（4）The C reaction protein and cortisol level in group D1 and D2 were lower than group C at T1-T3（P<0.05）,In group D2,it were lower than group D1 at T1-T2（P<0.05）.（5）The range of motion in group D1 and D2 were higher than group C at T1-T3（P<0.05）,while the group D2 were higher than group D1 at the same time（P<0.05）.（6）The rate of adverse reaction:the rate of nausea and vomiting in group D1（10%）and D2（10%）were obviously lower than group C（45%）.ConclusionThe dose of 0.08ug·kg^﹣1·h^﹣1of dexmedetomidine in patients with TKA can enhance the effect of sufentanil on analgesia,decrease stress reaction,maintain stable hemodynamic index and reduce the related adverse effects.This treatment will be advantageous to the recovery of the functioning of the knee joints.