Analgesic and sedative effects of different femoral nerve blocks of patients with hip fracture at operative position

Objective To compare the analgesic and sedative effects of dexmedetomidine combined with 0.375% ropivacaine and their use alone in femoral nerve block for patients with hip fracture at operative position. Methods Totally 150 hip fracture patients with internal fixation were randomly divided into three groups, with 50 cases in each group. Group A was treated with 0.375% ropivacaine for femoral nerve block, group B was treated with intravenous injection of 0.2 μg/kg dexmedetomidine, and group C was treated with 0.2 μg/kg dexmedetomidine combined with 0.375% ropivacaine for femoral nerve block. The mean arterial pressure(MAP), heart rate(HR)and pulse oxygen saturation(SpO₂)were compared among the three groups at the time points of entering the room(T₀), before taking position(T₁), taking position(T₂), and at the end of spinal anesthesia(T₃). The analgesic effect ［assessed by Visual Analogue Scale(VAS)］ and sedative effect ［assessed by modified Observer's Assessment of Alertness/Sedation(OAA/S)］ were compared among the three groups. Adverse reactions of the three groups were recorded. Results Levels of MAP and HR at T₁, T₂ and T₃ were significantly lower than those at T₀ in the group A and the group C(P<0.05), levels of MAP and HR at T₁ and T₃ were significantly lower than those at T₀ in the group B(P<0.05), and MAP at T₂ in the group B was significantly higher than that in the group A and the group C(P<0.05). The - levels of HR at T₃ in the group B and the group C were significantly lower than that in the group A (P<0.05). The levels of HR at T₁ and T₂ in the group C were significantly lower than that in the group A and the group B(P<0.05). The VAS scores at T₂ in the group A and the group C were significantly lower than those at T₀ in the same groups and at T₂ in the group B(P<0.05), but there was no significant difference between the group A and the group C(P>0.05). The OAA/S scores at T₁ in the group B and the group C were significantly higher than that at T₀ in the same groups and at T₁ in the group B(P<0.05), but there were no significant differences between the group B and the group C(P>0.05). No adverse reactions were observed in the group A, but there were 1 case(2.00%)with nausea and vomiting in the group B and 1 case(2.00%)with vertigo in the group C. There was no significant difference in the incidence of adverse reactions among the three groups(P>0.05). Conclusion Dexmedetomidine combined with 0.375% ropivacaine has exact sedative and analgesic effects at taking position in hip fracture patients with intraspinal anesthesia, which has less influence on hemodynamics and fewer adverse reactions.