Clinical Effects Of Preventive Use Of Different Doses Of Diphenhydramine In Elderly Patients Undergoing The Hip Arthroplasty

Objective:To discuss the clinical effects of preventive use of different doses of diphenhydramine injection undergoing the hip arthroplasty surgery in elderly patients,including the influence of anesthesia quality,and postop-erative influence of sedative and analgesic action.Methods:Ninety patients in ASA gradesⅠ～Ⅲ,aged over 75 years,undergoing selective hip arthroplasty surgery under epidural nerve block were selected.All patients were divided into three groups randomly（Group C:Control Group,Group D1:injection with diphenhydramine of 20mg,Group D2:injection with diphenhydramine of 40mg,each group n=30）.All patients selected L2-3 epidural puncture in vertebral space.A catheter of 3 cm was placed at the caudal side,and 3ml lidocaine of 1.33%was injected.After it was confirmed that there was no whole spinal anesthesia,5 ml more was injected.The third-time dose of lidocaine was selected individually according to the blocking range,and the blocking range was controlled from T₁₀ to S₁.Use of diphenhydramine during anesthesia:Group C:No diphenhydramine injection;Group D1:20 mg Diphenhydramine deep intramuscular injection intravenously 30min before skin incision;Group D2:40 mg Diphenhydramine deep intramuscular injection intravenously 30 min before skin incision.All patients were injected with dexamethasone of 10 mg intravenously 5 min before skin incision.When the BIS value was higher than 85,midazolam was injected intravenously to maintain the BIS value between 70 and 80;The target sedation depth during surgery was maintained.Changes of MAP,HR and SPO2 were recorded before anesthesia（T1）,during skin incision（T2）,within 30 min after application of bone cement（T3）and after surgery（T4）.When blood pressure decreased by more than 20%,norepinephrine was injected intravenously（to increase blood pressure）,and the dosage of norepinephrine was recorded.The occurrence of bone cement reaction was recorded by grading method.The amount of inflow and outflow of fluid during surgery and the abnormal situation such as nausea and vomiting during surgery were recorded.Postoperative patient-controlled intravenous analgesia with sufentanil of 1.5ug/kg and tropisetron of 20mg was used and visual analogue of pain（VAS）score and sedation degree（Ramsay）score at rest were observed.When VAS≥4,dezocine of 5mg was injected intravenously.MAP,HR,SPO₂,the occurrence of nausea,vomiting,dizziness,delirium,etc.12h,24h and 48h after surgery in each group were observed and recorded,and patients’postoperative delirium and mental state were evaluated quantitatively by Nu-DESC standard.Results:Patients’bone cement reaction during bone cement implantation was significantly lower in Group D1 and Group D2 than in Group C,with statistically significant difference（P<0.05）,and it was significantly lower in Group D2 than in Group D1,without statistically significant difference（P>0.05）.The average dosage of norepinephrine during surgery was significantly lower in Group D1 and Group D2 than in Group C,with statistically significant difference（P<0.05）.The average additional dose of midazolam during surgery was significantly lower in Group D1 and Group D2than in Group C（P<0.05）,with statistically significant difference,and it was significantly lower in Group D2 than that in Group D1.The fluid infusion volume during surgery was significantly lower in Group D1 and Group D2than in Group C,with statistically significant difference（P<0.05）.The incidence of intraoperative nausea and vomiting was significantly lower in in Group D1 and Group D2 than in Group C,with statistically significant difference（P<0.05）.MAP value at 12 hours after surgery was significantly lower in Group C than in Group D1 and Group D2,with statistically significant difference（P<0.05）.Comparison of postoperative adverse reactions:the incidence of postoperative nausea and delirium was higher in Group C than in Group D1 and Group D2,with statistically significant difference（P<0.05）.Conclusion:Preventive use of Diphenhydramine undergoing hip arthro-plasty surgery in elderly patients can efficiently decrease the occurrence of bone cement reaction syndromes,maintain the cyclic stability of patients,increase the operation safety,strengthen perioperative sedation,reduce the dosage of anesthetics,it also reduces the incidence of nausea,vomiting,postoperative delirium,other adverse reactions,and improves anesthesia quality undergoing hip arthroplasty surgery in elderly patients.Diphenhy-dramine doses of 20 mg and 40 mg make no significant difference in clinical practices,only in strengthening sedation,the 40 mg dose is better than its counterpart.