The Analgesic Effect Of Dexmedetomidine Combined With 0.375% Ropivacaine In Femoral Nerve Block To Position In Patients With Hip Fracture

Objective:To study and compare the analgesic effect of dexmedetomidine combined with 0.375%ropivacaine in ultrasound-guided femoral nerve block to position before spinal anesthesia in patients with hip fracture,and Provide theoretical basis for analgesic measures in clinically placed hip fractures.Methods:One hundred and fifty patients with hip fractures who were treated surgically in our hospital from November 2016 to February 2019 were selected for this trial.The types of fractures included 88 intertrochanteric fractures and 62 femoral neck fractures.Patients were divided into 3 groups according to the random number table method,50 patients in each group:group A,0.375%ropivacaine for femoral nerve block;group B,intravenous injection of 0.2ug/kg dexmedetomidine;group C,intravenous injection of 0.2ug/kg dexmedetomidine plus 0.375%ropivacaine for femoral nerve block.Recording the changes of vital signs(mean arterial MAP,heart rate HR,SpO2)at several time points(T0,T1,T2,T3)from entering operating room to the end of spinal anesthesia;The analgesia(VAS score)and sedation score(OAA/S grade)of the three groups of patients were recorded.The adverse reactions(nausea and vomiting,respiratory depression,dizziness,etc.)of the three groups were recorded;The concentrations of plasma norepinephrine(NE),adrenaline(E)and cortisol(Cor)were measured in the three groups of patients;The incidence of delirium after the surgery was recorded.Results:1.The basic data of the three groups had no significant difference(P>0.05),2.Compared with To,the MAP and HR of group A and C decreased significantly at T1,T2 and T3(P<0.05),The MAP and and HR of group B decreased significantly at T1 and T3(P<0.05);Compared with group A and C,the MAP of group B at the time of T2 was significantly increased(P<0.05);Compared with group A,the HR of group B and C decreased significantly at T3(P<0.05).In addition,the HR of group C was significantly lower than that of group A and group B at T1 and T2.3.Compared with T0,the VAS scores of group A and C was significantly lower at T2(P<0.05);Compared with group A and C,the VAS scores of group B was significantly higher at T2(P<0.05).Compared with T0,the OAA/S scores of group B and C was significantly increased at T1(P<0.05);Compared with group A,the OAA/S scores of group B and C were significantly increased at T1(P<0.05).4.There was 1 case(2.00%)of nausea and vomiting in group A,and no adverse reaction occurred in test group B.One case(2.00%)of vertigo occurred in group C,and all of them resolved spontaneously after a few minutes.There was no significant difference in the incidence of complications between groups(P>0.05).5.Compared with T0,the concentrations of NE、E and Cor in the three groups all having a significant increased at T2(P<0.05);Compared with group B,group A and group C was significantly lower(P<0.05),and group A was significantly higher than group C(P<0.05).6.The incidence of delirium in group B and group C was 4.00%,which was significantly lower than that in group A(22%)(P<0.05).Conclusion:Dexmedetomidine combined with ultrasound-guided femoral nerve block for pre-anesthesia analgesia of hip fractures has a definite analgesic effects,less stress response,less adverse reactions,High security.It has a good clinical application value.