Clinical Application of Different Doses of Hydromorphone Slow-Release Analgesia in Lumbar Fusion in Elderly Patients.

Abstract

The aim of this study is to examine the analgesic efficacy of varying doses of hydromorphone hydrochloride in conjunction with absorbable gelatin sponge for postoperative pain management in elderly individuals undergoing lumbar fusion surgery. Additionally, the study aims to assess the sustained release analgesic properties of this combination and to determine the optimal dosage of hydromorphone hydrochloride for effective pain relief. A total of 113 elderly patients (aged≥65years old) meeting the criteria for 1-2-level posterior lumbar fusion surgery at Ganzhou City People's Hospital between July 2022 and August 2023 were randomly assigned to four groups: group A (0.2mg hydromorphone hydrochloride 1ml), group B (0.3mg hydromorphone hydrochloride 1.5ml), group C (0.4mg hydromorphone hydrochloride 2ml), and group D (0.9% normal saline 2ml) for standard anesthesia induction and maintenance. Prior to suturing the incision, gelfoam was utilized to administer epidural analgesia to each group. Following the surgical procedure, an intravenous analgesia pump was utilized for pain management. The baseline infusion rate was set at 0.5ml/h. Patient-controlled analgesia (PCA) was administered at a dose of 2ml, with a lockout interval of 20min, allowing the patient to self-administer as needed. Pain relief was assessed using the visual analogue scale (VAS) prior to surgery, as well as at 1day and 3days post-operation. The frequency of PCA requests within the initial 48-h postoperative period, the remedial analgesia with dezocine, postoperative adverse reactions, and duration of hospitalization were documented for analysis. The VAS scores of groups B and C were found to be significantly lower than those of group D 1day after the operation. Additionally, VAS scores at 3days post-operation, remedial rate of dezocine and PCA follow-up times at 48h in groups A, B, and C were significantly lower compared to group D (P<0.001). There was no statistically significant difference between group B and group C in VAS scores at 1day and 3days post-operation, as well as PCA follow-up times at 48h post-operation (P<0.001). Furthermore, the VAS scores of groups B and C were lower than those of group A at 1day and 3days post-operation (P<0.05). The PCA frequency of group C was also lower than that of group A at 48h post-operation (P<0.05). The combination of hydromorphone hydrochloride and absorbable gelatin sponge epidural analgesia has been shown to enhance postoperative pain management. A dosage of 0.4mg of hydromorphone hydrochloride may be considered an appropriate analgesic dose, as it can provide effective pain relief without eliciting adverse reactions. ChiCTR.org.cn(ChiCTR2200064863). Registered on October 20, 2022.