| Objective:To observe the analgesic effect of hydromorphone combined with ropivacaine for femoral nerve block in patients undergoing knee replacement.Methods:60 patients（55-75 years old,ASA I-IIIgrade）with total knee arthroplasty were selected for anesthesia.Randomly divided into control group and experimental group,30cases in each group.After the patient entered the room,the blood oxygen saturation,noninvasive blood pressure,heart rate and electrocardiogram were monitored.Before the induction of general anesthesia,the femoral nerve block was guided by ultrasound and nerve stimulator.The control group was treated with 0.375%ropivacaine 20ml,the test group with 0.375%ropivacaine 20ml+hydromorphone 0.3mg.General anesthesia was performed for the patients with skin retardation and joint retardation.Induction drugs of general anesthesia:midazolam 3mg,etomidate 0.2mg/kg,cisatracurium 0.2mg/kg,sufentanil 0.2-0.4ug/kg.After induction,laryngeal mask was implanted successfully.The maintenance drugs were sufentanil and propofol.During the operation,PetCO2 was maintained at 35-50mmhg,BIS value was maintained between 40-65.After the operation,no analgesia pump was used.After the operation,the remedy drug for analgesia was flurbiprofen ester.The changes of mean arterial pressure,heart rate and BIS were recorded at the time of operation（T0）,the onset time（T1）and duration（T2）of sensory nerve block,the time of resting in the room（T3）,the time of inserting laryngeal mask（T4）,the time of upper tourniquet（T5）,the time of skin cutting（T6）and the time of releasing tourniquet（T7）.At 2,6,12 and 24 hours after operation,the visual analogue score（VAS）under resting state and functional exercise at different time points,as well as the time（T8）of the first use of the remedy drug flurbiprofen axetil within 24 hours after operation,the dosage and times of the remedy.Results:1.There was no significant difference in the time of sensory block（T1）between the two groups（P>0.05）;the time of sensory duration（T2）in the experimental group was longer than that in the control group（P<0.05）.2.There was no significant difference in mean arterial pressure,heart rate and BIS between the two groups（P>0.05）.3.The scores of the experimental group were lower than those of the control group in the resting state and functional exercise at 2h,6h and 12h（P<0.05）;there was no statistical significance in the VAS scores of the two groups in the resting state and functional exercise at 24h（P>0.05）.4.The time of the first supplement in the experimental group was later than that in the control group,and the dosage and times of the supplement in the experimental group were less than those in the control group,with statistical significance（P<0.05）.5.Three patients in the experimental group had related adverse reactions,the incidence was 10%（3/30）;two patients in the control group had related adverse reactions,the incidence was 6.67%（2/30）,the difference was not statistically significant（P>0.05）.Conclusion:1.The application of hydromorphone combined with ropivacaine in femoral nerve block in total knee arthroplasty is stable.2.The application of hydromorphone combined with ropivacaine for femoral nerve block in total knee arthroplasty can reduce the VAS score of patients in resting and functional state,reduce the use of analgesics,and the analgesic effect is satisfactory.3.The application of hydromorphone combined with ropivacaine for femoral nerve block in total knee arthroplasty does not increase the incidence of related adverse reactions,and the operation is simple and the curative effect is reliable,which is worth popularizing. |
