| Preface:With the increasing aging of the population,the incidence of knee joint diseases has gradually increased,and knee replacement surgery has been developing more and more widely.In order to better restore the function of the knee,it is necessary to increase the pain caused by early activity after operation.In order to relieve pain,more reasonable postoperative analgesia is imminent.Intraoperative comfort anesthesia has become increasingly mature,but postoperative analgesia still has many challenges.Traditionally,postoperative analgesia is done by opioids.Sufentanil is the most commonly used opioid.Opioid medicine is ideal for analgesic effect,but it has many adverse reactions,such as pruritus,nausea,vomiting,constipation,retention of urine,and respiratory depression,which greatly reduce the comfort of the patients.Studies have shown that the side effects of opioids are related to the effects of mu receptors.Can analgesic drugs with low affinity for mu receptors achieve the desired analgesic effect? As a mixed agonist antagonist of opioid receptor,nappine exerts an analgesic and sedative effect,but the antagonistic nature of its micron receptor can produce less side effects mediated by micron receptors.Therefore,this study will explore whether the combined medication can achieve a better analgesic effect,and find a more optimized postoperative analgesia plan for the clinic.Objective: To compare the efficacy and adverse reactions of nalbuphine and sufentanil in Patient-Controlled Intravenous Analgesia(PCIA)after total knee arthroplasty,and to find a more optimized solution for PCIA after total knee arthroplasty.Methods:With the approval of Zhengzhou Orthopaedic Hospital Ethics Committee,66 patients with unilateral total knee arthroplasty completed from August 2017 to January 2018 were selected as the study subjects.According to the hospital admission sequence,patients who met the study conditions were randomly divided into experimental group(A),control group(B),and combination group(C),22 cases in each group.The inclusion criteria and exclusion criteria were consistent among the three groups.Before the study was conducted,each patient and their families were introduced to the contents of the experiment and the purpose of the experiment.The patient and his family members were informed and recognized,and informed consent was signed.All patients underwent surgery by the same anesthesiologist and the same group of surgeons.All subjects underwent total knee arthroplasty under total spinal-epidural combined anesthesia.Immediately after PCIA,the three groups of patients in the PCIA were dioxin(15 mg),dexamethasone(5 mg)and basal medication.Nosetron(10 mg),but nalbuphine(2 mg/kg)was added in group A;sufentanil(2 μg/kg)was added in group B;nalbuphine(1 mg/kg)+ sufentanil was added in group C(1 μg/kg).Double-blind observations recorded the postoperative recovery of the three groups of patients and assessed the patient’s analgesic score,Ramsay sedation score,and comfort at 1h(T1),6h(T2),12h(T3),and 24h(T4)postoperatively.Ratings and related adverse reactions.Inclusion criteria: 1.Patients undergoing total knee arthroplasty(including unilateral or bilateral)due to osteoarthritis or rheumatoid arthritis;2.No opioid dependence,no mental illness;3.Surgery Pre-assessment of ASA grades I-III;4.No serious history Iof IIIallergies;5.Major organs(such as heart,liver,spleen,lung,kidney,etc.)without serious disease;6.Age 50-70 years old;7.Ethical Students,the patient himself and his family agree to accept this experiment.Exclusion criteria: 1.Does not meet the above inclusion criteria;2.Long-term use of non-steroidal anti-inflammatory drugs;3.Scar physique;4.Active or past history of gastrointestinal ulcers or bleeding;5.With other serious diseases,such as cardiovascular,respiratory,and digestive diseases;6.Other treatments are performed at the same time and the treatment may affect the experimental observer;7.The patient or family disagrees with this experiment.Results:1.Pain score: Visual analog scale(VAS)was used to assess the pain of the three groups.There was no significant difference between the three groups at T1(P > 0.05).There was a statistically significant difference between group A and group C at time T2(P < 0.05).Compared with group C,scores in group A increased(P < 0.05).There was no significant difference between group B and group C;T3 and T4 time points in group A(3.56±0.86;3.78±1.65),group B(2.45±0.6;2.68±0.68),group C(2.15±0.58;2.26±0.56)The difference between the two groups was statistically significant(P < 0.05).Compared with group A and group B,the scores of group C decreased(P < 0.05)2.Ramsay sedation score: There was no significant difference between the three groups at T1 time point(P > 0.05).At the time of T2,the score of group A was lower than that of group C and the difference was statistically significant(P < 0.05).At the T3 time point,the A group(2.14±0.42)was smaller than the C group(3.10±0.42)(P < 0.05).The C group score was smaller than the B group score(P <0.05).There was no significant difference between group A and group C at T4(P > 0.05).The score in group C was less than group B(P < 0.05)3.Comfort rating: There was no significant difference between the three groups at T1(P > 0.05),and there was a statistically significant difference between the T2,T3,and T4 time points(P < 0.05).Compared with group A and B,scores in group C increased(P < 0.05).4.The incidence of adverse reactions in the three groups was A(4.5%),B(37.9%),and C(15.2%).Compared with group C,the incidence of adverse reactions in group A was the lowest(P < 0.05).Compared with group B,the incidence of adverse reactions in group C was low(P < 0.05).Conclusion:Patient-controlled analgesia after total knee arthroplasty combined with nalbuphine and sufentanil has the advantages of good analgesic effect,high comfort and less adverse reactions,and can well meet the needs of clinical postoperative analgesia. |
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