Effects Of Intraarticular Hydromorphone And Dexamethasone On Inflammatory Factors And Pain Mediators In Elderly Patients With Total Hip Replacement

Objective:To investigate the effect of intraarticular injection of hydromorphone and dexamethasone on inflammatory factors and pain mediators in elderly patients with total hip arthroplasty.Methods:Eighty elderly patients undergoing total hip arthroplasty under light gravity subarachnoid anesthesia were selected and randomly divided into four groups（20cases in each group）:hydromorphone combined with dexamethasone group（group A）,hydromorphone group（group B）,dexamethasone group（group C）,and normal saline group（group D）.At the end of surgery,group A was injected with 10μg/kg hydromorphone combined with 0.1mg/kg dexamethasone,group B was injected with10μg/kg hydromorphone,group C was injected with 0.1mg/kg dexamethasone,and group D was injected with the same amount of normal saline.Records of the patient’s general condition and the operation time,intraoperative heart rate and blood pressure of each point in time after each each time point（after 12 h,24 h and 48 h）VAS pain score and postoperative analgesia pump pressure within 48 h,and record the postoperative recovery（bed activity time and the length of time for the first time）and lethargy,nausea,vomiting,adverse reactions such as respiratory depression.Finally,the concentrations of IL-1?,IL-6 and IL-8 inflammatory cytokines and SP,5-HT and PGE₂pain mediators were determined at the end of surgery and 12h,24h and 48h after surgery.Results:There were no significant differences in general condition and operation duration among the four groups（P>0.05）.Hemodynamic comparison:intra-group comparison:compared with T0,HR and MAP in the four groups were lower at T1（P<0.05）;Comparison between groups:at T1,the blood pressure of groups B,C and D was significantly higher than that of group A;at T4,the heart rate of groups C and D was significantly higher than that of group A（P<0.05）.Comparison of pain indicators:12h and 24h after surgery,VAS score of group B,C and D was significantly higher than that of group A（P<0.05）;At 48h after operation,VAS score of group C and D was significantly higher than that of group A（P<0.05）,but there was no significant difference between group B and group A（P>0.05）.The number of analgesia pump pressing in groups B、C and D was significantly higher than that in group A（P<0.05）.Comparison of postoperative recovery and adverse reactions:the first time of getting out of bed and the length of hospital stay in group C and D were significantly longer than group A（P<0.05）.Comparison of inflammatory cytokines and pain mediators concentration:intra-group comparison:compared with T0,the concentrations of inflammatory cytokines IL-1?,IL-6 and IL-8,SP,5-HT and PGE₂in B,C and D groups were significantly increased at T1（P<0.05）.Comparison between groups:At T1,T2 and T3,the concentrations of IL-1?,IL-6 and IL-8 inflammatory cytokines and SP,5-HT and PGE₂pain mediators in groups B,C and D were significantly higher than those in group A（P<0.05）,and the concentrations of>in group C and>in group B and>in group D were significantly higher than those in group A（P<0.05）.Conclusion:Intraarticulation of hydromorphone or dexamethasone can have a definite analgesic effect,and single injection of hydromorphone is stronger than single injection of dexamethasone.Intraarticular injection of hydromorphone and dexamethasone can provide a stronger postoperative analgesic effect than hydromorphone or dexamethasone alone,and is more beneficial to reduce the release of inflammatory factors IL-1?,IL-6,IL-8 and pain mediators SP,5-HT,and PGE₂,which is more conducive to the recovery of patients.