Clinical Study On The Use Of Different Doses Of Nalbuphine Combined With Ropivacaine For Postoperative Nerve Block Analgesia In Elderly Patients After Total Hip Arthroplasty

BackgroundWith the deepening of our country’s population ageing and the increase of life expectancy,the elderly suffer more and more hip fractures and pains caused by falls,accidents and osteoarthritis.Total hip arthroplasty,as a radical surgery to treat hip disorders in elderly patients,is increasing year by year.The operation can effectively relieve hip pain,restore hip function and improve the quality of life of elderly patients after operation.However,the tissue damage caused by the operation and the implantation of the prosthesis can lead to severe pain after the operation.Poor postoperative pain control not only affects the early postoperative functional exercise in elderly patients,but also is associated with postoperative complications such as delirium and chronic pain.Therefore,in order to achieve satisfactory clinical efficacy and reduce the incidence of postoperative complications,adequate relief of postoperative pain plays a crucial role.Currently,patient-controlled intravenous analgesia is the main method of postoperative analgesia in THA,and the core of analgesic drugs is strong opioids.Intravenous use of strong opioids is often accompanied by systemic adverse effects,such as nausea,vomiting,respiratory depression,drowsiness and hypotension.The incidence of adverse reactions in elderly patients is greatly increased due to increased sensitivity to opioids and reduced liver and kidney function.Therefore,in elderly patients,postoperative analgesia after THA should focus on adequate analgesia while minimizing the use of intravenous strong opioids.Ultrasound-guided fascia iliac compartment block is safe and easy to perform in elderly patients,and can effectively relieve postoperative acute pain and reduce the use of intravenous opioids after THA Currently,the local anesthetics used for U-FICB are mostly ropivacaine,which has a duration of action of 6h～8 h,while the severe pain after THA mostly lasts until 24 h.Therefore,the insufficient duration of analgesia caused by using ropivacaine alone for U-FICB greatly limits the application of U-FICB in clinical practice.In recent years,the emergence of adjuvants such as dexmedetomidine,dexamethasone,nalbuphine,and colistin has prolonged the duration of action of local anesthetics and improved the applicability of peripheral nerve blocks in clinical practice.Nalbuphine is a κ-receptor agonist-μ-receptor agonist antagonist,and its analgesic effect produced by agonizing κ receptors is comparable to that of morphine,while it has a "ceiling" effect in terms of adverse respiratory depression,so it has certain advantages for postoperative analgesia in elderly patients.At present,a large number of studies have confirmed the safety and effectiveness of nalbuphine as an adjuvant for subarachnoid block,brachial plexus block,paravertebral nerve block and other regional block.However,there are few studies on the analgesic effect of nalbuphine as adjuvant in elderly patients after THA,and the dose-effect relationship between nalbuphine and U-FICB analgesia is still lacking.Therefore,this study compared different doses of nalbuphine combined with ropivacaine for postoperative U-FICB analgesia in elderly patients with THA,and explored the appropriate dose of nalbuphine as adjuvant for postoperative U-FICB analgesia in elderly patients with THA by observing the postoperative analgesic effect and adverse reactions,so as to provide reference for clinical accurate application.ObjectiveTo observe the analgesic effect and adverse reaction of different doses of nalbuphine combined with ropivacaine in elderly patients with U-FICB after THA,and to provide reference for clinical application.Method112 patients undergoing unilateral THA under elective general anesthesia at our institution from06/2021 to 09/2022 were recruited.101 patients were finally included in the group according to inclusion,exclusion and rejection criteria.All subjects were randomly divided into four groups according to the computer random number table method.Control group(Group C): Ropivacaine 100 mg;Group LN:nalbuphine 10 mg + ropivacaine 100 mg;Group MN: nalbuphine 15 mg + ropivacaine 100 mg;Group HN:nalbuphine 20 mg + ropivacaine 100 mg,both diluted to 30 ml with 0.9 % saline.Patients were admitted to the PACU and were administered U-FICB analgesia on the surgical side by the same experienced anesthesiologist who was unaware of the grouping,and the appropriate interventional drugs were given.All patients in the four groups were given rescue analgesia by self-controlled intravenous analgesia pump.When postoperative pain control was poor(VAS > 4),a single intravenous injection of 3～5 μg sufentanil was given first,and then the patient-controlled intravenous analgesia pump was started for continuous analgesia.When the subject developed nausea and vomiting,5 mg of toltestrone was injected intravenously.The following data were recorded:(1)general information of patients;(2)The starting time of patient-controlled intravenous analgesia pump,the total consumption of sufentanil 48 hours after operation and the total number of analgesia pump presses;(3)The VAS scores at rest and activity at different time points(4 h,8 h,12 h,24 h,48 h)after operation;(4)The concentrations of IL-6、TNF-α、IL-10 in patients12 h before,12 h and 24 h after surgery;(5)Time to first anal discharge and first ambulation after operation;(6)The occurrence of nausea and vomiting,drowsiness,bradycardia,hypotension at 48 h after operation.Result(1)Compared with group C,the postoperative self-controlled intravenous analgesic pump activation time of LN,MN and HN groups was significantly longer(P < 0.05),and the VAS scores of LN,MN and HN groups at 8 h,12 h and 24 h postoperatively(both at rest and active state),the total sufentanil consumption and the total number of analgesic pump presses of LN,MN and HN groups at 48 h postoperatively,and the concentrations of IL-6 and TNF-α of LN,MN and HN groups at 12 h and 24 h postoperatively were significantly lower(P < 0.05),the concentrations of IL-10 of LN,MN and HN groups at 12 h and 24 h postoperatively were significantly higher(P < 0.05),and time to first anal discharge and first ambulation of LN,MN and HN groups after operation were significantly shorter(P < 0.05);the incidence of bradycardia,nausea and vomiting at 48 h postoperatively was significantly lower in the LN and MN groups(P < 0.05).(2)Compared with the LN group,the postoperative self-controlled intravenous analgesic pump activation time of MN and HN groups was significantly longer(P < 0.05),and the VAS scores of MN and HN groups at 12 h,and 24 h postoperatively(both at rest and in active state),the total sufentanil consumption and the total number of analgesic pump presses of MN and HN groups at 48 h postoperatively,and the concentrations of IL-6 and TNF-α of MN and HN groups at 12 h and 24 h postoperatively were significantly lower(P < 0.05),and the concentrations of IL-10 of MN and HN groups at 12 h and 24 h postoperatively were significantly higher(P < 0.05);time to first anal discharge and first ambulation after operation were significantly shorter in the MN and HN groups were significantly shorter(P < 0.05);the incidence of drowsiness at 48 h postoperatively was significantly higher in the HN group(P < 0.05).(3)Compared with the MN group,the postoperative self-controlled intravenous analgesic pump activation time of HN group was significantly longer(P < 0.05),and the VAS scores of HN group at 8 h,12 h,and 24 h postoperatively(both at rest and in active state),the total sufentanil consumption and the total number of analgesic pump presses of HN group at 48 h postoperatively,and the concentrations of IL-6and TNF-α of HN group at 12 h and 24 h postoperatively were significantly lower(P < 0.05),and the concentrations of IL-10 at 12 h and 24 h postoperatively were significantly higher(P < 0.05)),time to first anal discharge and first ambulation of HN group after operation were significantly longer(P < 0.05),the incidence of drowsiness of HN group at 48 h after operation was significantly increased(P < 0.05).(4)There were no significant differences in concentrations of IL-6,TNF-α and IL-10 at 12 h before surgery and VAS scores of the four groups at 4 h and 48 h after surgery(P > 0.05),but a few patients had hypotension(P > 0.05).Conclusion(1)Nalbuphine combined with ropivacaine in U-FICB for postoperative analgesia after THA in elderly patients can dose-dependently prolong the duration of postoperative analgesia,reduce the postoperative inflammatory response,and decrease the use of postoperative intravenous opioids.(2)15mg nalbuphine combined with ropivacaine in U-FICB for postoperative analgesia after THA in elderly patients can significantly prolong the duration of postoperative analgesia,and the time of first anal discharge and first ambulation after surgery are the shortest,and the incidence of adverse reactions within48 h after surgery is the lowest,which can be promoted and applied in clinical practice.