ABSTRACT
Objective To explore the sedative effects of a low dose of dexmedetomidine (DEX) during percutaneous kyphoplasty (PKP) in the elderly patients.Methods Forty elderly patients with ASA grade Ⅱ-Ⅲ grade who scheduled PKP were divided into DEX group and control group by random digits table method,each group 20 cases.DEX group received an infusion of 0.5 μg/kg for 10 min before the operation,then the infusion speed was adjusted to 0.2 μ g/ (kg·h).An equivalent volume of 0.9％ sodium chloride was administered in control group.Systolic blood pressure(SBP),diastolic blood pressure(DBP),heart rate (HR),and pulse oxygen saturation (SpO2) were recorded at the beginning of DEX infusion (T0),10 min(T1),30 min(T2),60 min(T3) after DEX infusion and the end of operation (T4),Ramsay scores was also recorded.Results HR,SBP,DBP in DEX group at T1-T3 was significantly lower than that T0 and the same time in control group [(65.6 ± 14.6),(63.4 ± 10.2),(66.7 ± 10.5) times/min vs.(81.4 ± 11.2) times/min and (75.3 ±6.9),(72.8 ± 11.4),(73.8 ±9.6) times/min; (127.5 ± 10.2),(125.4 ± 12.6),(122.4 ±7.8) mm Hg(1 mm Hg =0.133 kPa) vs.(152.5 ± 11.8) mm Hg and(145.1 ± 10.6),(137.2 ± 11.3),(142.6 ± 8.8) mm Hg; (73.7 ± 8.9),(70.3 ± 9.9),(70.3 ± 11.5) mm Hg vs.(90.5 ± 11.0) mm Hg and(86.2 ± 11.6),(82.6 ± 10.9),(78.8 ±8.7) mm Hg,P ＜0.05].The Ramsay scores in DEX group at T1-T3 were significantly higher than those T0 and the same time in control group [(3.6 ± 0.8),(4.2 ± 0.8),(3.7 ± 0.5) scores vs.(2.0 ± 0.0)scores and (1.7 ± 0.6),(1.9 ± 0.4),(1.6 ± 0.5) scores,P ＜ 0.05].HR,SBP,DBP in DEX group at T4 was significantly lower than that T0,HR in DEX group at T4 was significandy lower than that in control group,difference was statistically significant(P ＜ 0.05).Bradycardia and applications vasopressors did not occur in two groups.There was no significant difference in SpO2 between DEX group and control group(P＞ 0.05).Conclusion It is both feasible and safe that sedative effect of a small dose of DEX during PKP in the elderly patients.
ABSTRACT
Objective To explore the effects and feasibility of minimal local analgesic dose of hyperbaric levobupivacaine in elderly patients undergoing unilateral spinal anesthesia during lower limb orthopedic surgery.Methods Seven hundred and fifty-six elderly patients who scheduled lower limb orthopedic surgery were assigned to levobupivacaine group (383 patients) and bupivacaine group (373 patients) by random digits table method.Haemodynamic change were monitored before,during and after anesthesia.The level and duration of sensory and motor block in each group were evaluated.Results Compared with bupivacaine group,the sensory block and motor block onset time was significantly longer in levobupivacaine group [(5.9 ± 1.4) min vs.(4.2 ± 0.3) min,(11.7 ± 3.0) min vs.(9.1 ± 3.3) min] (P ＜0.05),but the motor block duration was shorter [(152.8 ± 17.5) min vs.(195.4 ± 18.7) min] (P ＜ 0.05).The scores of maximum motor block in levobupivacaine group was significantly lower than that in bupivacaine group[(1.1 ±0.3) min vs.(2.3 ±0.6) min](P＜ 0.05).There was no significant difference in peak sensory block and haemodynamic between two groups (P ＞ 0.05).Conclusions Although levobupivacaine may be less potent than bupivacaine,it may be preferred for elderly patients with lower limb surgery because of satisfactory spinal anesthesia,good hsemodynamic stability and fast motor block regression.
ABSTRACT
Objective To evaluate the effects of intravenous analgesia with dezocine combining sufentanil in hip and knee arthroplasty for elderly patients.Methods Ninety patients with ASA Ⅱ ～ Ⅲ and aged ≥ 65 years who were scheduled for hip and knee arthroplasty under CSEA and treated with intravenous analgesia post-operation were selected and divided into three group (20 cases):group Ⅰ (sufentanil 2.5μg/kg + droperidol 2.5 mg),group Ⅱ (sufentanil 2.0 μ g/kg + dezocine 10 mg + droperidol 2.5 mg) and group Ⅲ (intramuscular dezocine 10 mg and sufentanil 2.0 μ g/kg + droperidol 2.5 mg),which were diluted to be 100 ml by adding saline.VSA,Ramsay score as well as side effects were recorded at 6,12 and 24 h after operation.75 mg meperidine was administered intramuscularly as rescue medication when VAS was above 5.Results Compared with group Ⅰ and Ⅲ,group Ⅱ showed better outcomes regarding to the VAS and less side effects.Ramsay score 6 h after operation and the amount of patients who needed meperidine in group Ⅲ were higher than those in the other two groups (P ＜ 0.05).Conclusion Dezocine combining with sufentanil in elderly patients underwent low limb arthroplasty shows better postoperative analgesia effects with less side effects,and it's worth for clinical application.
ABSTRACT
To identify the role of spinal cyclooxygenase (COX)-1 in the development and maintenance of postoperative pain, we examined the changes of COX-1 protein expression in lumbar spinal cord by immunohistochemistry and Western blot technique in rat plantar incision model at different time points (pre-incision or 2 h, 4 h, 6 h,12 h, 1 d, 2 d, 3 d, 5 d and 7 d after incision). We also studied the anti-allodynic effects of the COX inhibitors by intrathecal administration of non-selective COX inhibitors (ketorolac), selective COX-1 (SC-560) or COX-2 inhibitor (NS-398) immediately or 2 h, 24 h after incision. The mechanical allodynia was evaluated by using paw withdrawal threshold (PWT) response to mechanical stimulation on pre-incision, 2 h, 1 d, 2 d, 3 d, 5 d and 7 d after incision or 30 min after drug treatment. The result showed that COX-1 immunoreactive cells mainly focused in the superficial laminae of lumbar spinal dorsal horn and expression of spinal COX-1 protein increased after incision, peaked at 4 h (P＜0.01) and lasted for 12 h. Postoperative treatment with both SC-560 and ketorolac significantly alleviating the mechanical allodynia induced by skin incision, but NS-398 had no such effect. This study demonstrates that spinal COX-1 involves in the development and maintenance of postoperative hypersensitivity and intrathecal COX-1 inhibitor has anti-allodynic effect on incision pain in the rat.