Analgesic effect of ropivacaine of lumbar epidural anesthesia in elderly patients for hip and knee arthroplasty

doi:10.3969/j.issn.2095-4344.2015.13.005

Abstract

Abstract:

BACKGROUND: Analgesia in different ways can be selected for the elderly in hip and knee arthroplasty. Considering the actual situation of the elderly patients, choice of anesthesia should be reasonable in order to achieve fast acting, long lasting time and good analgesic effect.
OBJECTIVE: To explore the analgesic effect of ropivacaine of lumbar epidural anesthesia on elderly knee arthroplasty.
METHODS: A total of 78 elderly patients aged 80-96 years, who were treated with hip and knee arthroplasty in the Shenyang Orthopaedic Hospital from September 2011 to September 2014, were enrolled in this study. They were equally and randomly assigned to control group and observation group, and separately administered continuous epidural anesthesia and lumbar epidural anesthesia with ropivacaine. The excellent and good rate, onset time, anesthetic induction, frequency of use of Duffing mixture, and adverse reactions were compared between the two groups.
RESULTS AND CONCLUSION: The excellent and good rate of analgesic effect was higher in the observation group (97%) than in the control group (87%) (P < 0.05). Onset time was significantly shorter, the dose of anesthetic was significantly less, frequency of use of Duffing mixture was significantly less in the observation group than in the control group (P < 0.05). The difference was not significant in adverse reactions between the two groups (P > 0.05). Above results indicated that lumbar epidural anesthesia of ropivacaine obtained good
analgesic effects during elderly knee arthroplasty.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

全文链接：

Key words: Anesthesia, Epidural, Anesthesia, Spinal, Anesthetics, Arthroplasty, Replacement, Hip, Arthroplasty, Replacement, Knee

CLC Number:

R318

Wang Yu, Zhu Yun-zhang, Liu Gang. Analgesic effect of ropivacaine of lumbar epidural anesthesia in elderly patients for hip and knee arthroplasty[J]. Chinese Journal of Tissue Engineering Research, 2015, 19(13): 1990-1994.

Figures/Tables 2

References

[1] 李永乐,王颖,武广义,等.股神经阻滞联合帕瑞昔布静注在老年膝关节置换术后的镇痛效果研究[J].中国医药导报,2012,9(14): 105-106,111.
[2] 周红梅,祝胜美.静脉注射帕瑞昔布联合股神经阻滞用于老年病人膝关节置换术后镇痛及膝关节功能康复的效果[J].中华麻醉学杂志,2011,31(8):929-931.
[3] Shigeru T, Atsushi S, Yumiko I,et al. A local anesthetic, ropivacaine, suppresses activated microglia via a nerve growth factor-dependent mechanism and astrocytes via a nerve growth factor-independent mechanism in neuropathic pain.Molecular Pain. 2011;7(1):2.
[4] 单海华,朱常花,谢红,等.超声引导下罗哌卡因连续股神经阻滞用于20例全膝关节置换术后康复镇痛的疗效分析[J].重庆医学, 2012,41(13):1312-1314.
[5] 陆慧红,李桂凤,白浪,等.全膝关节置换后局部浸润的持续镇痛效果[J].中国组织工程研究,2014,(4):529-534.
[6] 李蕊.罗哌卡因腰-硬联合麻醉在高龄患者髋部及下肢骨科手术中的应用[J].中华实用诊断与治疗杂志,2013,27(1):72-73.
[7] 张霞飞,周燕,董建民,等.罗哌卡因复合曲马多用于老年全髋置换术后硬膜外镇痛20例[J].医药导报,2008,27(9):1061-1062.
[8] 赵文宝,万磊,李彦平,等.应用不同比重罗哌卡因单侧腰麻对下肢手术麻醉效果的比较性观察[J].临床和实验医学杂志,2014, 13(11):934-937.
[9] 周雁,王薇,王东信等.右美托咪定对老年单侧膝关节置换术后谵妄发生率的影响[J].中国医药导报,2014,11(14):77-81.
[10] 王诚,李琦,王宇冬,等.罗哌卡因腰椎硬膜外联合麻醉在老年下肢骨关节置换术中的应用[J].中国老年学杂志,2012,32(19): 4318-4319.
[11] 敬勇君,姬桂荣,张原,等.0.5%罗哌卡因在80岁以上高龄患者下肢骨科手术腰-硬联合麻醉中的应用[J].中国医药导报,2010, 07(4):63,65.
[12] 袁文华.腰麻-硬膜外联合麻醉在老年人髋关节置换术中的应用[J].中国医药导报,2009,6(36):180.
[13] 敬勇君,姬桂荣,张原,等.0.5%的等比重罗哌卡因在高龄患者下肢骨科手术腰-硬联合麻醉中的应用[J].中国实用医药,2011, 06(27):174-175.
[14] Bharti N, Praveen R, Bala I.A dose-response study of caudal dexmedetomidine with ropivacaine in pediatric day care patients undergoing lower abdominal and perineal surgeries: a randomized controlled trial.Paediatr Anaesth. 2014;24(11): 1158-1163.
[15] 王玺,余湘元,朱建华,等.不同麻醉方法对老年患者人工髋关节置换手术后认知功能的影响[J].医学临床研究,2014,31(1): 115-117.
[16] 孙立,田晓滨,陈涛,等.局部浸润镇痛在老年全髋关节置换术后多模式镇痛中的作用及安全性[J].中华关节外科杂志(电子版), 2014, 8(2):151-155.
[17] 欧阳丽珍.低浓度罗哌卡因复合舒芬太尼用于高龄患者术后硬膜外镇痛[J].中国医药指南,2014,(34):183-183,184.
[18] 贾东林,李水清,南兴东,等.罗哌卡因或利多卡因持续股神经阻滞用于膝关节置换术后患者康复镇痛的临床研究[J].中国疼痛医学杂志,2008,14(4):214-217.
[19] 陆志东,李鹏.人工全髋关节置换后口服选择性环氧和酶2抑制剂联合罗哌卡因注射的镇痛效果[J].中国组织工程研究与临床康复,2010,14(43):7991-7994.
[20] 王佳,徐涛,李世忠,等.罗哌卡因腰麻用于中老年患者膝关节置换术的半数有效量[J].实用医学杂志,2012,28(4):645-646.
[21] 严广斌,余楠生,卢永辉,等.罗哌卡因复合液关节周围注射对膝关节置换术后镇痛的效果评价[J].中国骨与关节外科,2013,(3): 258-261.
[22] 张大志,王东信,穆东亮,等.单次坐骨神经联合连续股神经阻滞镇痛对膝关节置换术后谵妄发生率的影响[J].中国药物警戒,2013, 10(4):199-202.
[23] Kang H. The effect of dexmedetomidine added to preemptive ropivacaine infiltration on post-operative pain after inguinal herniorrhaphy: a prospective, randomized, double-blind, placebo-controlled study. Eur Surg, 2012;44 (4):274-280.
[24] 马国威.罗哌卡因或利多卡因持续股神经阻滞用于膝关节置换术后患者康复镇痛的临床研究[J].健康之路,2014,(7):115-116.
[25] 骆永强.罗哌卡因腰硬联合麻醉在半髋关节置换术中的应用[J].浙江临床医学,2013,15(12):1922-1923.
[26] 袁锋,蔡俊丰,马敏,等.关节局部注射罗哌卡因结合静脉PCA泵对全膝关节置换术后的镇痛研究[J].生物骨科材料与临床研究, 2013,10(2):22-24.
[27] 梁坤辉.罗哌卡因联合地佐辛在下肢关节置换术后镇痛中的应用[J].黑龙江医学,2012,36(10):745-747.
[28] 李飞,张柏银.神经刺激仪定位下行腰丛-坐骨神经联合阻滞在老年患者膝关节置换术中的临床应用[J].中外医学研究,2014, 12(18):29-30.
[29] Parikh GP, Shah VR, Vora KS,et al.Ultrasound guided peritubal infiltration of 0.25% Bupivacaine versus 0.25% Ropivacaine for postoperative pain relief after percutaneous nephrolithotomy: A prospective double blind randomized study. Indian J Anaesth. 2014;58(3):293-297.
[30] 卢春媛,吕国义.股神经、坐骨神经联合阻滞在老年患者膝关节置换术后的镇痛效果观察[J].山东医药,2014,54(3):53-55.
[31] 李玉锦,赵丽娜,杨庆国,等.连续股神经阻滞复合氯诺昔康用于膝关节置换术后镇痛[J].中国疼痛医学杂志,2012,18(7):418-421.
[32] 陆志东,李鹏.人工全膝关节置换过程中及围术期镇痛对关节功能恢复的影响[J].中国组织工程研究与临床康复,2010,14(48): 9086-9089.
[33] 王怀江,张大志,李世忠,等.连续股神经阻滞镇痛与静脉镇痛在全膝关节置换术后镇痛效果的比较[J].中华医学杂志,2010,90(33): 2360-2362.
[34] 王心田,马武华,李荣胜,等.轻比重罗哌卡因腰麻用于老年病人人工关节置换术的量-效关系[J].临床麻醉学杂志,2008,24(1): 23-25.
[35] Kim BG, Kang H.The effect of preemptive perianal ropivacaine and ropivacaine with dexmedetomidine on pain after hemorrhoidectomy: a prospective, randomized, double-blind, placebo-controlled study.Indian J Surg. 2014; 76(1):49-55.
[36] 张昊华,张洪,周一新,等.全膝关节置换术围手术期多模式镇痛方案的临床研究[J].中华骨科杂志,2008,28(8):647-650.
[37] 齐鹏亮,佟刚,于小虎,等.舒芬太尼复合罗哌卡因腰-硬联合麻醉在高龄髋关节置换术中的应用[J].江苏大学学报(医学版), 2010, 20(6):543-545.
[38] Manuar MB, Majumdar S, Das A, et al.Pain relief after Arthroscopic Knee Surgery: A comparison of intra-articular ropivacaine, fentanyl, and dexmedetomidine: A prospective, double-blinded, randomized controlled study.Saudi J Anaesth. 2014; 8(2):233-237.
[39] 魏小伍,梁亚霞,汤瑞昌,等.轻比重罗哌卡因单侧腰麻-硬膜外联合麻醉在高龄髋关节置换术中应用[J].中华实用诊断与治疗杂志, 2010,24(2):173-174.
[40] 王春爱,赵振文,王承祥,等.局部浸润罗哌卡因联合静脉镇痛对全膝关节置换术后镇痛及早期康复的影响[J].临床骨科杂志,2014, 17(3):274-276.
[41] 周育南.罗哌卡因腰椎硬膜外联合在老年下肢骨关节置换术中的麻醉效果分析[J].临床合理用药杂志,2013,6(33):114-115.