Application Effect Of Flurbiprofen Axetil Combined With "Cocktail" Therapy In Elderly Patients Undergoing Total Knee Arthroplasty

Objective:To explore the analgesic effect of flurbiprofen axetil combined with"cocktail"therapy in elderly patients undergoing total knee arthroplasty and its effect on sleep quality after operation.Methods:Eighty patients undergoing elective unilateral total knee arthroplasty were randomly divided into two groups:simple cocktail group(group C,n=40)and flurbiprofen axetil combined with cocktail group(group FA,n=40).The age was 65 to 88 years old,the BMI index was19?28kg/m~2,and the American association of anesthesiologists was II or III.The patients were randomly divided into two groups:simple cocktail group(group C)and flurbiprofen axetil combined with cocktail group(group FA).After entering the room,the patients were routinely monitored by HR,BP,Sp O2,ECG and body temperature.The invasive arterial blood pressure(Invasive arterial blood pressure,IBP)was monitored by radial artery catheterization on the opposite side of the affected limb under local anesthesia,and the depth of anesthesia was monitored by Narcotrend monitor(MT,Germany).Patients in both groups were treated with"cocktail"therapy(Local infiltration analgesia,LIA)before knee prosthesis was implanted.FA group was slowly injected with flurbiprofen axetil 2mg/kg by intravenous injection before skin incision,and group C was injected with the same amount of fat emulsion at the same time point.Intravenous inhalation combined anesthesia was used,followed by intravenous injection of midazolam,etomidate,sufentanil and rocuronium,laryngeal mask(Laryngeal Mask Airway,LMA),target-controlled infusion of propofol and remifentanil,and intermittent inhalation of sevoflurane to maintain the depth of anesthesia.After the operation,the PCIA electronic analgesia pump(sufentanil 0.2ug/kg diluted to 100ml)was connected.The PCA dose was 1ml,no background dose.The dosage of remifentanil,the time of the first rescue analgesia and the times of postoperative rescue analgesia were recorded,and the visual analogue scores(Visual Analogue Scale,VAS)of the two groups were evaluated and recorded at rest and activity at 1 day before operation(T0),6 hours after operation(T1),24hours(T2),48 hours(T3)and 72 hours(T4)after operation.Pittsburgh sleep quality assessment(Pittsburgh sleep quality index,PSQI)and insomnia severity index(Insomnia Severity Index,ISI)scores were performed at T0,T2 and T4,respectively.Postoperative sleep quality was evaluated and recorded.Postoperative recovery time,intestinal peristalsis recovery time,hospital stay and adverse reactions such as nausea and vomiting,dizziness and headache,somnolence and respiratory depression were recorded in the two groups.Results:Compared with group C,the dosage of remifentanil during operation and the times of postoperative rescue analgesia in FA group were less,and the time of first rescue analgesia was shorter than that in group C(P<0.05).The VAS scores of T1?T4 at rest and after exercise decreased at each time point(P<0.05).The scores of PSQI and ISI decreased at T2 and T4(P<0.05).The recovery time of postoperative intestinal peristalsis and hospital stay were shortened in FA group(P<0.05),but there was no significant difference in the incidence of postoperative adverse reactions between the two groups(P>0.05).Conclusion:Flurbiprofen axetil combined with"cocktail"therapy in elderly patients undergoing total knee arthroplasty can effectively reduce the dosage of opioids and improve early postoperative acute pain.It has certain clinical value to improve the early sleep quality of elderly patients after operation.