Clinical study of administration of dexmedetomidine combined sufentanil for postoperative analgesia in senile patients with total hip replacement

Objective Exploring the suitable protocol of dexmedetomidine(Dex) combined sufentanil intravenous infusion for controlled infusion analgesia(PCIA) in senile patients with total hip replacement. Methods The ninety elderly patients(65-89 y), ASAⅠ-Ⅲ, with total hip replacement were randomly divided into 3 groups(n=30). Group of sufentanil(group S): sufentanil 0.04 μg·kg-1·h-1 and tropisetron 5 mg, group of Dex 1(group D1): sufentanil 0.04 μg·kg-1·h-1, tropisetron 5 mg and Dex 0.02 μg·kg-1·h-1, group of Dex 2(group D2): sufentanil 0.04 μg·kg-1·h-1, tropisetron 5 mg and Dex 0.05 μg·kg-1·h-1, drugs in all groups were dissolved in sterile saline solution with total volume 150 ml. All patients′ anesthesia were performed by spinal block in L3-L4. Sufentanil with 5 μg intravenous injection was administrated in all of groups 10 min before the end of operation. The time of operation and anesthesia, amount of bleeding during operation, the incidence of adverse reactions(pruritus, nausea and emesis) for postoperative analgesia, the Bruggrmann comfort scale(BCS) scores, and the consumptions of sufentanil for 48 h analgesia were recorded. In addition, VAS scores and Ramsay scores were also recorded at postoperative 4, 8, 12, 24, 48 h. Results At the 8-48 h after operation, Ramsay scores of group S[(1.7±0.5),(1.6±0.6),(1.6±0.5),(1.8±0.5)] were lower than Ramsay scores of group D1[(2.2±0.6),(2.0±0.5),(2.2±0.5),(2.2±0.5)] and group D2[(2.3±0.5),(2.3±0.4),(2.4±0.5),(2.3±0.5)] (P<0.05). Ramsay scores of group D1 showed no significant difference with Ramsay scores of group D2. VAS scores of group D1[(0.7±0.8),(0.7±0.8)] were lower at the 12 h and 24 h after operation than VAS scores of group S[(1.3±1.1),(1.4±1.0)](P<0.05). But VAS cores of group D2[(0.8±0.6), (0.8±0.6), (0.6±0.7), (0.7±0.7)] were lower at 8-48 h than VAS scores of group S(P<0.05). In addition, BCS score for 48 h analgesia, group D1(3.2±0.7) was higher than score of group S(2.1±0.5)(P<0.01). BCS score of group D2(3.6±0.6) was significantly higher than scores of all of group S and group D1(P<0.05). The consumption amount of sufentanil for 48 h analgesia of group S[(2.02±0.10) μg/kg] was apparently much compared with group D1[(1.96±0.61) μg/kg] and group D2[(1.94±0.39) μg/kg](P<0.05). Consumption amount of sufentanil of group D2 had no significant difference with consumption amount of sufentanil of group D1. Conclusions The protocol of Dex 0.05 μg·kg-1·h-1 combined with sufentanil 0.04 μg·kg-1·h-1 intravenous infusion for postoperative analgesia in elderly patients with total hip replacement has better analgesic effect, greater patient satisfaction, and reduces the total consumption amount of sufentanil. It is a safe and feasible clinical application. Key words: Aged; Hip replacement; Postoperative analgesia; Dexmedetomidine; Sufentanil