| Objective:By studying the analgesic effect of different doses of hydromorphone sustained release analgesia on elderly patients after lumbar fusion surgery,the incidence of adverse reactions and the improvement of postoperative restlessness,the appropriate dose of hydromorphone for epidural sustained release analgesia was explored.Methods:120 eligible patients from the Spinal Surgery Department of Ganzhou People’s Hospital in 2022(January November)who plan to undergo lumbar fusion surgery in the elderly were randomly divided into four groups:A,B,C,and D with 30 patients in each group.Routine anesthesia induction and maintenance were performed.A piece of soaked gelatin sponge(6 X 2cm)were given epidural sustained release analgesia.2.5ml of 0.3 mg hydromorphone hydrochloride(Group A),2.5ml of 0.45 mg hydromorphone hydrochloride(Group B),2.5ml of 0.6 mg hydromorphone hydrochloride(Group C)and 2.5ml of 0.9%normal saline(Group D)were taken respectively.Among them,2 cases of 0.3 mg hydromorphone hydrochloride group(Group A)were removed due to massive bleeding during operation,1 case of 0.45 mg hydromorphone hydrochloride group(Group B)was removed due to massive bleeding during operation,and 28 cases of 0.3 mg hydromorphone hydrochloride group(Group A)were finally removed 29 patients in the 0.45mg hydromorphone hydrochloride group(Group B),30 patients in the 0.6mg hydromorphone hydrochloride group(Group C),and 30 patients in the 0.9%normal saline group(Group D).After operation,the intravenous analgesia pump was connected.The formula of all intravenous analgesia pumps was the same(sufentanil 100ug+dexamethasone 10mg+0.9%saline diluted to l00mL),the background dose was 0.5mL/h,PCA 2mL,and the locking time was 20min.After the patient wakes up naturally and reaches the indication of extubation,the tracheal catheter is removed,and the postoperative follow-up is carried out.The analgesic effect of the patient at 2h,6h,24h,48h and 72h after the operation is evaluated by visual analogue score(VAS),and the sedative effect of the patient at 2h,6h and 24h after the operation is evaluated by Ramsay score,and the additional times of PCA within 48h after the operation,postoperative adverse reactions,postoperative anal exhaust and hospital stay are recorded.Results:There was no significant difference in general data among the four groups of patients undergoing lumbar fusion surgery(P>0.05),and the experimental research results between the four groups were comparable.1.The VAS scores and 48 hour PCA frequency of patients in the hydromorphone hydrochloride group(A,B,C groups)were significantly lower than those in the 0.9%saline control group(D group)at 2 hours,6 hours,24 hours,48 hours,and 72 hours after surgery,with a statistically significant difference(P<0.001).The VAS scores and 48 hour PCA frequency of patients in Group B and C were not significantly different(P>0.05)and were lower than those in Group A,with a statistically significant difference(P<0.05);2.The Ramsay scores of four groups of patients undergoing lumbar fusion surgery were not statistically significant at 24 hours after surgery,but the Ramsay scores of Group B and Group C were significantly higher than those of the 0.9%saline control group(Group D)at 2 hours and 6 hours after surgery,with a statistically significant difference(P<0.05).There was no statistically significant difference between Group B and Group C(P>0.05);3.The average arterial pressure(MAP)of the four groups of patients undergoing lumbar fusion surgery before anesthesia induction was not statistically significant,but the MAP of Group A was significantly lower than that of the control group(Group D)at 2 hours and 6 hours after surgery,with a statistically significant difference(P<0.05).The MAP of Group B and Group C was significantly lower than that of the control group(Group D)at 2 hours,6 hours,and 24 hours after surgery,with a statistically significant difference(P<0.05).There was no statistically significant difference(P>0.05)between Group B and Group C;4.All four groups of patients did not experience respiratory depression within 72 hours after surgery.Among other adverse reactions,the incidence of nausea and vomiting(PONV)in the four groups was not statistically significant(P>0.05).However,the comparison showed that hydromorphone hydrochloride increased the incidence of skin itching,and as the dosage increased,the incidence of dizziness,drowsiness,and skin itching also increased.Among them,the incidence of skin itching in Group C was significantly higher than that in the other three groups,The difference was statistically significant(P<0.05),while the difference between Group A and Group B was not statistically significant(P>0.05);5.Comparison of postoperative satisfaction among four groups of patients:The difference in patient satisfaction between the four groups was statistically significant(P<0.05).The hydromorphone hydrochloride group(A,B,C groups)had higher patient satisfaction with pain relief compared to the control group(D group),with a statistically significant difference(P<0.05).Among them,the satisfaction with pain relief between Group B and Group C was significantly higher than the other two groups,with a statistically significant difference(P<0.001),There was no statistically significant difference in pain satisfaction between Group B and Group C(P>0.05).Conclusion:Epidural sustained-release analgesia with hydromorphone hydrochloride can improve postoperative pain and postoperative restlessness of patients,and improve patient satisfaction.Moreover,0.45mg hydromorphone hydrochloride is the appropriate dose of epidural gelfoam sustained-release analgesia obtained in this experiment,which ensures good analgesic effect while reducing adverse reactions. |
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