| Objective: With the improvement of medical level,total hip arthroplasty has become the main treatment for femoral head necrosis,femoral neck fracture and other surgical diseases.The pain after total hip arthroplasty is intense,the safe and effective analgesia is the guarantee to promote the postoperative recovery of patients.This study was intended to investigate the perioperative analgesic effect of ropivacaine combined with dexmedetomidine on quadratus lumborum muscle block in elderly patients undergoing hip arthroplasty.Methods: Ninety patients with unilateral total hip arthroplasty were planned under general anesthesia in our hospital,The age range of these patients is from 65 to80 and the ASA grade is from I to III.All the patients were randomly divided into 3groups and there were 30 patiens in each group.They were simple general anesthesia group(the control group,group C),ropivacaine block group(group R)and compound drug block group(group RD).Patients in the group R and the group RD were treated with intraoperative lateral lumbar muscle block 30 min before admission in the anesthetic care unit.Patients in the group R and the group RD were injected with0.25% ropivacaine 20 ml and 0.25% ropivacaine +1μg/kg dexmedetomidine 20 ml,respectively.All patients in the 3 groups were treated with intravenous analgesia pump after surgery.At the same time,the data of the mean arterial pressure(MAP)and the heart rate(HR)were recorded before starting the anesthesia(T0);inserting laryngeal mask(T1),dermectomy(T2),medullary reamer(T3),and laryngeal mask removal(T4).Intraoperative consumption of remifentanil and propofol,extubation time,postoperative opiate consumption,number of remedial analgesia cases,and incidence of adverse reactions were recorded in the three groups.Resting VAS scores at 4h(T5),8h(T6),12h(T7),24h(T8),36h(T9),and 48h(T10)after surgery were assessed.The motor VAS score at T8,T9,and T10,as well as the maximum flexion and abduction of the hip joint were evaluated.Results: When it comes to the T0,the result did not reach statistical significance in MAP and HR of the 3 groups(P>0.05),and the MAP data of the 3groups at T1 and T4 was also out of statistical significance(P>0.05).At T2 and T3,MAP of the group C was higher than that of the group R and the group RD(P<0.01),but there was no significant difference between the group R and the group RD(P>0.05).From T1 to T4,the HR of group C was higher than that of group R and group RD(P<0.01),and there was no significant difference between group R and group RD(P>0.05).Intraoperative amount of remifentanil,amount of propofol,amount of postoperative sufentanil,number of cases of salvage analgesia,resting and motor VAS scores at each time point,group RD< group R< group C,the differences were statistically significant(P<0.05).The maximum flexion and abduction activity of hip joint at each time point were as follows: group RD> group R> group C,and the differences were statistically significant(P<0.05).The patients of group C were more likely to suffer from nausea,vomiting and remedial analgesia compared with that of the group R and group RD(P <0.05).The results in group RD and group R did not reach statistical significance(P>0.05).Conclusion: Ultrasound-guided quadratus lumborum muscle block can provide effective analgesia in the perioperative period of elderly patients with hip arthroplasty,while ropivacaine combined with dexmedetomidine combined with quadratus lumborum muscle block has a better effect and is conducive to postoperative recovery of patients. |
