Postoperative Multimodal Analgesia And Its Effects On Stress Reaction With Elderly Patients After Lower Limb Joint Replacement

Objective:To observe the effects and explore the clinical results of Postope rative Multimodal analgesia on the elderly patient who have suffered from Lower Limb Joint Replacement and its influence on stress reaction.Methods:Sixty patients with ASAⅡ～Ⅲ, aged65-92years and weight65-92kg who were scheduled for hip and knee replacement operation under CSEA a nd treated with Multimodal analgesia after the operation were randomly selected and divided into two groups:group D (Multimodal analgesia, n=30),15min bef ore the end of surgery, morphine of2mg were injected epidural and PCIA(sufent anil2.5ug/kg+droperido12.5mg)/100ml were connected. Group P (pure PCIA, n=30):PCIA were connected15min before the end of surgery, the ingredient is t he same to group D. VSA, Ramsay scores, side effect, vital signs as well as the quantity of additional analgesic requirement were recorded at2h(T1),6h(T2),12h(T3),24h(T4) after the surgery, CRP, IL-6were also recorded pre-operation and at6h(T1),24h(T2) after the surgery.Results:1Haemodynamics(1) SBP, DBP, MBP, HR:SBP, DBP, MAP, HR at T2in Group P were hi gher than Group D (P<0.05); There was no significant difference between Grou p D and Group P at To, T1and T3-T4(P>0.05).(2) SPO2:There were no significant difference between group D and group P (P>0.05).2. Analgesic sedation score(1) VAS scores:Group D showed better outcomes regarding to the VSA th an Group P at T1-T3(P<0.05); There was no significant difference between Gro up D and Group P at T4(P>0.05).(2) Ramsay scores:There was no significant difference between group D an d Group P at postoperative every time (P>0.05), but both groups showed higher Ramsay scores at T1than T2, T3, T4.(3) The requirement for additional analgesic:There were three patients in Gr oup D and thirteen patients in Group P who require additional analgesic.3. Stress response(1) CRP:There was no significant difference between group D and group P at To (P>0.05); CRP in Group P at T1and T2were significantly higher than Gr oup D (P<0.05); CRP at T2in both groups were significantly higher than T0, T1(P<0.05).(2) IL-6:There was no significant difference between group D and group P at To(P>0.05); IL-6at T1,T2in Group P were significantly higher than Group D(P <0.05); IL-6at T1in both groups were significantly higher than To,T2(P<0.05).4. Side effectsThere were three patients suffered from nausea, two vomiting and one suffer ed from pruritus in Group D, and two patients suffered from nausea and vomitin g in Group P. None of them showed respiratory depression and other side effect s.Conclusion:Multimodal analgesia can provide favorable postoperative analge sia for old people who suffered from lower joint replacement surgery, alleviate i nflammatory response and reduced additional analgesic and raised analgesic effect...