Comparison of the effects of different analgesic methods in elderly patients undergoing hip surgery combined with low-molecular-weight heparin

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 groups: Group 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 0.05). The occurrence of post-operative nausea and vomiting (PONV) was higher in Group M and Group I than in Group E (P 0.05). 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. Key words: Anesthesia and analgesia; Heparin, low-molecular-weight; Arthroplasty, replacement, hip