Comparison of efficacy of ropivacaine combined with dexmedetomidine with different concentration in hip capsular peripheral nerve block in elderly patients with hip fractures
Objective To compare the clinical effects of ropivacaine combined with different concentrations of dexmedetomi-dine for perineural nerve block around the hip joint capsule(PNGB)in elderly patients with hip fracture.Methods According to the sample size estimation,the minimum sample size was 153.A total of 153 elderly patients with hip fracture who were treated in the Anesthe-siology Department of Jiangxi Provincial Hospital of Integrated Tradi-tional Chinese and Western Medicine from June 2021 to December 2022 were divided into low,medium and high dose groups by comput-er random number generation table,51 cases in each group.PNGB was administered with 0.375%ropivacaine combined with 0.5,1 and 1.5µg/kg dexmedetomidine,respectively.Anesthesia induction was performed 20 min later.The main indexes[T0(before entry into the room),T1(at the beginning of anesthesia induction),T2(at the end of endotracheal intubation),T3(at the end of surgery)mean arterial pressure(MAP),heart rate(HR),and anesthetic effect],secondary indexes(nerve block effect,anesthesia recovery time),and safety indexes(anesthesia adverse reactions)were compared among the three groups.Results One hundred and fifty-three pa-tients all successfully completed the operation and study.The mean arterial pressure(MAP)of low,medium and high dose groups at T1 were(86.37±9.69)mmHg,(86.15±9.47)mmHg and(81.43±9.84)mmHg,respectively,at T2 were(96.03±9.01)mmHg,(96.30±8.97)mmHg and(100.57±9.54)mmHg,respectively,and at T3 were(90.68±10.77)mmHg,(91.53±10.69)mmHg and(96.79±9.19)mmHg,respectively.The heart rate(HR)of low,medium and high dose groups at T1 were(73.06±8.97)times·min-1,(72.78±8.13)times·min-1 and(68.02±7.98)times·min-1,respectively,at T2 were(84.86±9.18)times·min-1,(83.57±9.35)times·min-1 and(89.17±9.24)times·min-1,respectively,and at T3 were(79.19±8.15)times·min-1,(79.12±8.74)times·min-1 and(83.52±8.29)times·min-1,respectively.The grade I anesthesia effect of low,medium and high dose groups were 66.67%,90.20%and 84.31%,respectively.The onset time of nerve block of low,medium and high dose groups were(15.85±4.19)min,(11.21±3.01)min and(10.47±3.19)min,respectively.The anesthesia recovery time were(10.24±2.21)min,(10.47±2.54)min and(13.59±2.37)min,respectively.The incidence of bradycardia in low,medium and high dose groups were 1.96%,3.92%and 13.73%,respectively.Compared with low,medium dose groups,the MAP and HR of high dose group were lower at T1 and higher at T2 and T3(P<0.05).The grade I anesthesia effect of medium dose group and high dose group were higher than that of low dose group(P<0.05).The onset time of nerve block was shorter than that of low dose group(P<0.05).The anesthesia recovery time and the incidence of bradycardia of low,medium dose groups were shorter than that of high dose group(P<0.05).Conclusion In elderly patients with hip fracture,rop-ivacaine combined with 1µg/kg dexmedetomidine has better effect and safety.
hip fractureropivacainedexmedetomidineperineural nerve block around the hip joint capsule
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