| Objective The purpose of this study was to observe the effects of opioid analgesics(OA)and non-opioid analgesics(N-OA)on early postoperative sleep quality and mental state in elderly patients undergoing total knee arthroplasty.Methods According to the inclusion and exclusion criteria,110 elderly patients with TKA under spinal anesthesia during elective surgery in our hospital from February 1,2021 to August 1,2021 were selected,aged between 65-80 years old,and ASA grade Ⅱ or Ⅲ,the patients were divided into 2 groups(n=55)according to the random number scale method:Opioid analgesia group(group A)and non-opioid analgesia group(group N).After the patient enters the room,connect the ECG monitoring,Then,a single femoral nerve block was performed on the surgical side under ultrasound guidance(blocking formula: 0.5% ropivacaine hydrochloride 10 ml + sterile water for injection 10 ml mixed to 20ml),after the above operations were completed,unilateral total knee arthroplasty was performed under spinal anesthesia.After prosthesis implantation,peri-knee injection was performed by the same surgeon before skin suture(injection formula: 1% ropivacaine hydrochloride 100 mg + dexamethasone injection 5 mg + epinephrine hydrochloride injection 0.5 mg + sterilization mixed with water for injection to 50 ml),afterwards,the two groups of patients were given different patient-controlled intravenous analgesia(PCIA)regimens according to different groups.Group A: The pureμreceptor agonist sufentanil citrate was used as the drug in the PCIA(sufentanil citrate injection 2.5ug/kg plu normal saline mix to200ml),set the loading volume to 4.0ml,the continuous volume to 4.0ml/h,the self-control volume to 1ml,and the locking time to 20 minutes.Group N: The non-steroidal anti-inflammatory drug ketorolac tromethamine was used as the drug in the PCIA(ketorolac tromethamine was 3 mg/kg plus normal saline mix to 200 ml),set the loading volume to 4.0ml,the continuous volume to 4.0ml/h,the self-control volume to 1ml,and the locking time to 20 minutes.The Bispectral Index(BIS)was used to evaluate the objective sleep quality,monitor and record the BIS value from18 h on the 1st night to 6h on the next morning after the operation,and observe the sleep time and sleep efficiency of the patients throughout the night;The Pittsburgh Sleep Quality Index(PSQI)was used to evaluate subjective sleep quality 1d before surgery,1d and 3d after surgery,Calculating the number of patients with sleep disorders in the two groups and comparing the incidence of sleep disorders in the two groups;The Generalizad Anxiety Scale-7(GAD-7)and The Patient Health Questionnaire-9(PHQ-9)were used to assess the occurrence of anxiety and depression in patients on the 1st day before surgery,the 1st day after surgery,and the3 rd day after surgery;The Visual Analogue Scale(VAS)was used to evaluate the pain level of patients at rest/exercise on the 1st day before surgery,the 1st day after surgery,and the 3rd day after surgery;The incidence of adverse reactions such as respiratory depression,nausea and vomiting,and gastrointestinal bleeding in the two groups were observed on the 1st day after operation.Results Sleep condition:BIS monitoring results showed that compared with group A,the sleep time and sleep efficiency of patients in group N were significantly reduced(P<0.05).PSQI evaluation results: The PSQI scores and total scores of the two groups on the 1st and 3rd days after surgery were significantly higher than those on the 1st day before surgery(P<0.05).on the 3rd day after surgery,the PSQI scores and total scores of the two groups were significantly lower than those on the 1st day after surgery(P<0.05);The PSQI scores and total scores of the patients in group N were significantly higher than those of group A on the first day after operation(P<0.05);The PSQI scores and total scores of patients in the two groups on the third day after operation There was no statistically significant difference in scores(P>0.05).GAD-7 and PHQ-9: Compared with the 1st day before operation,the CAD-7 and PHQ-9 scores of the two groups were significantly increased on the 1st day and the 3rd day after operation(P<0.05).Compared on the 1st day,the CAD-7 and PHQ-9 scores of the two groups on the 3rd day after the operation were significantly decreased(P<0.05).The incidence of anxiety and depression in group N was also significantly lower than that in group A(P<0.05).There was no significant difference in the degree and incidence of anxiety and depression between the two groups on the 3rd day after surgery(P>0.05).General information: gender,age,height,weight,BMI,co-existing diseases,ASA classification,operation time,anesthesia time,intraoperative ropivacaine and lidocaine dosage,there was no significant difference in the above indicators(P>0.05).VAS score and adverse reactions: There was no significant difference in the pain score and the incidence of adverse reactions measured in different time periods(P>0.05).Conclusion The opioid analgesic regimen in elderly patients undergoing TKA has little effect on early sleep quality and sleep efficiency,and the incidence of postoperative sleep disturbance is low;the non-opioid analgesic regimen has a lower incidence of early postoperative anxiety and depression. |
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