Effect Of Different Administration Methods Of Dexmedetomidine On Analgesic Effect And Inflammatory Factors In Elderly Patients Undergoing Femoral Head Replacement

Objective:To investigate the effects of intravenous and perineural dexmedetomidine on postoperative analgesia and inflammatory factors in elderly patients undergoing femoral head replacement,and to explore a better route of dexmedetomidine administration.Methods:Sixty patients admitted to our hospital from November 2021 to September 2022 scheduled for unilateral femoral head replacement were randomly divided into three groups,20 patients in each group.All three groups were anesthetized with subarachnoid block combined with fascia iliaca nerve block.（1）ID group（Intravenous dexmedetomidine,ID）:nerve block was treated with 30 ml of 0.4%ropivacaine and intravenous dexmedetomidine was pumped at 0.1 ml/kg/h（0.4 ug/kg/h）for 75 min（total amount of0.5ug/kg）;（2）PD group（Perineural dexmedetomidine,PD）:nerve block was treated with 0.4%ropivacaine+dexmedetomidine 0.5ug/kg 30ml and intravenous saline was pumped at 0.1 ml/kg/h for 75 min;（3）C group:nerve block was treated with 30 ml of 0.4%ropivacaine and intravenous saline was pumped at 0.1 ml/kg/h for 75 min.VAS scores at rest and during exercise were recorded at 6h,12h,24h and48h after operation in all patients;venous blood samples were collected before nerve block（Ta）,at the end of operation（Tb）and 24h after operation（Tc）to detect the levels of interleukin-6 and tumor necrosis factor-α;hemodynamic parameters,oxygenation status and sedation scores were monitored at admission（T₀）,10 min after nerve block（T₁）,20 min after nerve block（T₂）,at the beginning of operation（T₃）,30 min after the start of operation（T₄）and at the end of operation（T₅）;adverse reactions such as nausea,vomiting,hypotension and bradycardia and postoperative rescue analgesia needs were recorded.Results:1 General data comparisonAge,sex,BMI,ASA grade,basic disease and operating time were not markedly different（P>0.05）.2 Comparison of postoperative VAS scoresThere was no discernible change in VAS scores among both rest and exercise in the three groups six hours after surgery（P>0.05）.After 12 and 24hours following surgery,group ID and group PD’s VAS scores at rest and during movement were considerably lower than those of group C（P<0.05）;however,the PD group had somewhat lower rest and movement VAS scores than the ID group,but the difference was not statically meaningful（P>0.05）;during 48 hours following surgery,there was no big variation between groups ID and C（P>0.05）,and the VAS scores at rest and movement were considerably higher in groups ID and C than in group PD.3 Comparison of inflammatory factor indicatorsComparison of the groups’IL-6 and TNF-αlevels at Ta and Tb:There was no major distinction among the three groups（P>0.05）;at Tc,the IL-6and TNF-αlevels in the ID group and PD group were significantly lower than those in the C group（P<0.05）;PD group was signally lower than ID group（P<0.05）.Intra-group comparison:At Tb,there was no noticeable difference in the levels of IL-6 and TNF-αbetween three groups and Ta（P>0.05）;TNF-αwas vastly better in the three groups at Tc than at Ta（P<0.05）,IL-6 was markedly larger in all three groups at Tc than at Ta and Tb（P<0.05）,group C and ID were considerably higher at Tc than at Tb（P<0.05）,and Tc and Tb did not vary noticeably（P>0.05）.4 Comparison of postoperative rescue analgesiaTwelve patients in group C required rescue analgesia after surgery,6 and4 patients in group ID and PD,respectively,and significantly fewer patients in group ID and PD required rescue analgesia after surgery than in group C（P<0.05）.5 Hemodynamic function comparisonHemodynamic measures included in this study were mean arterial pressure（MAP）,heart rate（HR）.When compared to the C group and the PD group,the MAP of the ID group at T₂and T₃was lower,and the distinction was significant（P<0.05）.And at the other time points,the MAP of the three groups was not significantly different（P>0.05）;the HR of the ID group at T₂,T₃,and T₄was lower than the C group（P<0.05）,and when compared to the PD group,there was no appreciable difference（P>0.05）,and at T₀,T₁,and T₅,there was no discernible difference between the three groups’HR（P>0.05）.6 Oxygenation Status Comparison The index for monitoring oxygenation status in this study was oxygen saturation（Sp O₂）.None of the patients developed hypoxic saturation during the course of the study.At each time point from T₀to T₅,there were no appreciable variations in Sp O₂between the three groups（P>0.05）.7 Ramsay sedation score comparisonAt T₀,there was no significant variance in the sedation scores between of three categories（P>0.05）;at T₁,T₂,T₃,T₄,and T₅,the ID group’s Ramsay sedation score was significantly higher than the C group’s（P<0.05）;there was no significant disparity when compared to the PD group（P>0.05）;and at T₁-T₅,the PD group’s sedation score was marginally higher than the C group（P>0.05）.8 Comparison of intraoperative and postoperative adverse reactionsThis research included hypotension,bradycardia,nausea,and vomiting as adverse reactions.The incidence rate of adverse reactions did not significantly vary between the three groups（P>0.05）.Conclusion:Perineural application of dexmedetomidine can better improve the postoperative analgesic effect and reduce the level of inflammatory factors in elderly patients undergoing femoral head replacement.