Comparison of the effects of different analgesic methods in elderly patients undergoing hip surgery combined with low-molecular-weight heparin / 中华老年医学杂志

ABSTRACT

Objective To compare the effects of different analgesic methods in patients undergoing hip surgery followed by low-molecular-weight heparin administration.Methods A total of 94 ASA Ⅰ-Ⅱ patients undergoing hip surgery with combined spinal and epidural anesthesia (CSEA) who had received a single dose of 2 mg epidural morphine were randomized into 3 groupsGroup M (n=30,patients receiving a single dose of epidural morphine combined with intramuscular tramadol if VAS≥4),Group E [n=34,patients receiving a single dose of epidural morphine combined with patient-controlled epidural analgesia (PCEA)],and Group Ⅰ [n=30,patients receiving a single dose of epidural morphine combined with patient-controlled intravenous analgesia (PCIA)].Infusion quantity during operation,bleeding volume and postoperative drainage volume,visual analogue scales (VAS) 24 h and 48 h after operation,Ramsay sedation scores,and nausea and vomiting were recorded.Venous blood samples were taken at admission,the end of operation,and 24 h,48 h and 7 d after operation for hemorheological data,coagulation tests and blood platelet counts (PLT).Color Doppler ultrasonography of lower limb vessels was conducted by the same clinician before and 7 days after operation.Results VAS at 48 h after operation were higher in Group M than in Group E and Group Ⅰ,and there were more patients refusing to initiate ambulation because of pain in Group M than in Group E and Group Ⅰ (P＜0.01).Ramsay scores at 24 h and 48 h in Group Ⅰ were higher than those in Group M and Group E,and there was no significant difference in Ramsay scores between Group M and Group E (P＞0.05).The occurrence of post-operative nausea and vomiting (PONV) was higher in Group M and Group Ⅰ than in Group E (P＜0.05),and there were more patients refusing to initiate ambulation because of nausea and vomiting in Group M and Group Ⅰ than in Group E (P＜0.01).There was no significant difference in DVT occurrence,hemorheological parameters or coagulation function between the 3 groups (each P＞0.05).Conclusions A single dose of epidural morphine does not achieve satisfactory analgesia,as evidenced by a large proportion of patients refusing to initiate rehabilitation training due to pain,and the incidence of PONV is high in elderly patients undergoing hip surgery.A single dose of epidural morphine combined with PCIA offers enhanced analgesia,but it also results in increased PONV.A single dose of epidural morphine combined with PCEA provides improved analgesia and reduced PONV,but shows no added advantage with the application of low-molecular-weight heparin in deep venous thrombosis prevention.