Clinical Study Of Analgesic Application Of Nalbuphine Combined With Supra-inguinal Fascia Iliaca Compartment Block In Patients Undergoing Total Hip Arthroplasty

Objective : To investigate the safety and efficacy of nalbuphine combined with supra-inguinal fascia iliaca compartment block(S-FICB)in inraoperative and postoperative analgesia in patients undergoing total hip arthroplasty(THA),so as to provide more clinical ideas for patients undergoing THA in the application of analgesia in enhanced recovery after surgery(ERAS).Methods:90 patients scheduled for unilateral THA under general anesthesia,and the American society of anesthesiologists(ASA)grade II-III,aged 65-85 years old,were randomly divided into three groups(30 cases in each group):Nalbuphine group(group N),S-FICB group(group S)and Nalbuphine combined with S-FICB group(group NS).All three groups of patients received general anesthesia with rapid induction of tracheal intubation,group N was given nalbuphine hydrochloride injection 0.2mg/kg intravenously 10 minutes before anesthesia induction;group S was intravenously injectied with normal saline of the same volume in group N and group NS 10 minutes before anesthesia induction,and ultrasound-guided S-FICB was performed after anesthesia induction,and 40 ml of 0.3% ropivacaine was given;group NS was intravenously injected 0.2mg/kg of nalbuphine hydrochloride 10 minutes before anesthesia induction,followed by ultrasound-guided S-FICB,and 40 ml of 0.3%ropivacaine was given after anesthesia induction.All three groups of patients were given the same patient controlled intravenous analgesia(PCIA)after surgery.The changes of mean arterial pressure(MAP)and heart rate(HR)before anesthesia(T0,10 minutes after entering the room),5 minutes after anesthesia induction(T1),5minutes after skin incision(T2),and at the end of operation(T3)were observed and compared among the three group,as well as the total dosage of propofol and sufentanil during operation;Visual analogue scale(VAS)scores and Ramsay sedation scale(RSS)scores were recorded at 1h,4h,6h,12 h and 24 h after operation;The effective pressing times of PCIA within 24 hours,the cumulative dosage of PCIA sufentanil and the occurrence of postoperative adverse reactions were recorded in the three groups,and the time of first landing and the overall satisfaction evaluation of patients within 24 hours after operation were recorded.Results:(1)Hemodynamic change:There was no significant differences in MAP and HR at T0 among the three groups(P>0.05);MAP and HR at T1 and T3 were significantly lower than those at T0 in the three groups(P<0.05);MAP and HR at T1 and T3 in the group S and the group NS were significantly higher than those in the group N(P<0.05);MAP and HR at T1 and T3 in the group NS were significantly higher than those in the group S(P<0.05);MAP and HR at T2 in the group NS were significantly lower than those in the group S(P<0.05).(2)Dosage for general anesthesia:Compared with the group N,the total dosage of propofol and sufentanil in the group S and the group NS was significantly reduced,and the difference was statistically significant(P<0.05);The total dosage of propofol and sufentannil in the group NS was less than that in the group S(P<0.05).(3)Postoperative analgesia,sedation and adverse reactions:The Resting VAS scores at 1h,4h and 6h after operation in the group S were significantly lower than those in the group N(P<0.05);and there was no significant difference at 12 h and 24 h after operation between the group S and the group N(P>0.05);the Resting VAS scores at1 h,4h,6h,12 h and 24 h after operation in the group NS were significantly lower than those in the group N(P<0.05);the Resting VAS scores and Passive VAS scores at 1h,4h,6h,12 h and 24 h after operation in the group NS were significantly lower than those in the group S(P<0.05);RSS scores at 1h,4h,6h,12 h and 24 h in the group S were significantly higher than those in the group N(P<0.05);and RSS scores at 1h,4h,6h,12 h and 24 h in the group NS were significantly higher than those in the group N and the group S(P<0.05);There were no significant differences in urinary retention,nausea and vomiting among the three groups(P>0.05),but there were significant differences in dizziness and adverse reaction rate among the three groups(P<0.05).(4)The effective pressing times of PCIA and the cumulative dosage of sufentanil in24 h after operation:The group S and the group NS were significantly lower than the group N,and the group NS was lower than the group S.(5)The time of first landing and the overall satisfaction scores of 24 hours after operation : The group S and the group NS were significantly lower than the group N,and the group NS was lower than the group S.Conclusions:The application of multimodal analgesia of nalbuphine combined with supra-inguinal fascia iliaca compartment block during the perioperative period can maintain a stable hemodynamics,reduce the dosage of general anesthetics during the operation,improve the postoperative analgesia and sedation effect,and without obvious adverse reactions,which is beneficial to the early activity and functional exercise of patients,and the patients have highly satisfaction,which has good clinical application value.