Application of ropivacaine combined with dexmedetomidine guided by ultrasound in quadratus lumborum block in elderly hip replacement

ObjectiveTo evaluate the perioperative analgesic effects of ropivacaine combined with dexmedetomidine guided by ultrasound in quadratus lumborum block in elderly hip replacement.

MethodsA total of 90 patients treated with unilateral total hip replacement under general anesthesia of laryngeal mask was randomly divided into the control group(group C, laryngeal mask general anesthesia group), group R(ropivacaine block group) and group RD(compound drug block group)(30 cases in each group).The quadratus lumborum block in group R and group RD were performed in the anesthetic intensive care unit before 30 min of admission, and the group R and group RD were injected with 20mL of 0.25% ropivacaine, and 20 mL of 0.25% ropivacaine containing 1 μg/kg dexmedetomidine, respectively.The heart rate(HR) and mean arterial pressure(MAP) in three groups were recorded before induction, laryngeal mask airway(LMA) insertion, dermectomy, reaming and removal of LMA.The amount of intraoperative remifentanil and propofol, extubation time, postoperative analgesia of sufentanil and parecoxib were recorded in three groups.The postoperative adverse reactions in all cases were recorded.The rest VAS scores after 4, 8, 12, 24, 36 and 48h of operation, movement VAS scores after 24, 36 and 48h of operation, and maximum flexion and abduction range of hip joint after 24, 36 and 48h of operation were evaluated in three groups.

ResultsAt T0, there was no statistical significance in MAP and HR among three groups(P>0.05).At T1 and T4, there was no statistical significance in MAP among three groups(P>0.05).At T2 and T3, the MAP in group R and group RD was lower than that in group C(P < 0.01), and there was no statistical significance in the MAP between group R and group RD(P>0.05).At T1-T4, the HR in group R and group RD was lower than that in group C(P < 0.01), and there was no statistical significance in the MAP and HR between group R and group RD(P>0.05).The intraoperative usage amount of remifentanil and propofol, postoperative usage amount of sufentanil, number of cases of remedial analgesia, VAS scores of rest and movement in group C, group R and group RD gradually decreased at each time point, and the differences of those among three groups were statistically significant (P < 0.05 to P < 0.01).The maximum flexion and abduction range of hip joint in group C, group R and group RD gradually increased at each time point, and the differences of those among three groups were statistically significant(P < 0.05 to P < 0.01).The incidence rates of nausea and vomiting, and remedial analgesia in group R and group RD were lower than those in group C(P < 0.05 to P < 0.01), and the difference of which between group RD and group R was not statistically significant(P>0.05).

ConclusionsThe perioperative analgesic effect of ropivacaine combined with dexmedetomidine guided by ultrasound in quadratus lumborum block in elderly hip replacement is ideal, which is conducive to postoperative rehabilitation.