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Objective:To investigatethe effectiveness and safety of poly-patterns of ketamine and clonidine in the preempive analgesia for total hip replacement and provide a convenient and practical pathway for easing pain after THR.Methods:30 patients grading ASAI-Ⅲand undergoing selective THR operation were randomly divided into 3 groups,group A,B and C, 10 cases in each one.They were treated as follows,respectively:The patients in Group A were injected with 2%lidocaine 20mg/cm;The patients in group B also were injected with 2%lidocaine 20mg/cm, after the anagesia were confirmed effective and the analgesia range were controled under T10,then injected with ketamine 0.6mg/kg;The patients in group C were injected with 2%lidocaine,after the analgesia were confirmed effective,injected with ketamine 0.6mg/kg and clonidine lug/kg.All patients were accepted epidural analgesia at L2-3with O2 inhalation during the whole operation.No other analgesic and sensative were admitted in the vein.The patients in three groups were monitored regularly SBP,DBP,HR,SPO2,CVP and the level of blood sugar, Cortisol,tumor necrosis factor-α,Angiotesin-ⅡOn the time before anesthesia（T0）,at in cision（T1）,at the moment of disposing of bone cement（T2）,after operation ending（T3）and 24 hours after operation （T4）.respectively recorded VAS scores on the time of 2h,4h,6h,12h, 24h after operation,also recorded sensation and movement recovery time after the operation and observed side effects such as nausea,vomit, chilling and excited talking during the operation.Results1.Hemodynamics indexs:The SBP,DBP in group A were significant difference（P＜0.05）in T2,T3 time point compared with preoperation;In comparision among groups there were remarkably significant difference（P＜0.01）of DBP at the time point T1,T2,T3 compared between group A,C and B,and significant different（P＜0.05） between group A and C.showing that preemptive analgesia can keep the stabilize of hemodynamics during and after the operation.2.Stress response:①The level of blood sugar in three groups were all achieved the pinnacle at T2,and that of group B and C resumed to nomal range on the whole 24 hours after operation.There were significant difference（P＜0.05）in T1,T2,T3,T4 time point compared with preoperation in group A.In comparision among groups,there were significant difference between group B,C and A in T1,T2,T3 time point （P＜0.05）.②The concentration of cortisol in three groups were increased at T1 and all achieved the pinnacle at T2.The concentration of cortisol in group B and C was maintained fundermentally steady during surrounding-operation,no significant fluctuation（P＞0.05）.There were transparant step-up on the concentration of cortisol in group A in T1,T2, T3,T4 time point compared with preoperation（P＜0.05 or P＜0.01）.In comparision among groups,there were significant or remarkably significant difference（P＜0.05 or P＜0.01）between group B,C and A in T1, T2,T3,T4 time point.③There were no difference about the level of TNF-αin T1,T2,T3 time point within three groups whether in comparision among groups or in group.But there were significant difference in T4 time point compared between group B,C and A（P＜0.05）.④The concertration of Angiotensin -Ⅱin three groups were all increased at T1 time point and achieved the pinnale at T2,then resumeto normal range on the whole 24 hours after operation.There were remarkably significant difference of Ang-Ⅱconcertration in Group A in T1,T2,T3 time point and in group B,C in T2 time point compared with preoperation（P＜0.01）; comparision among groups,there were remarkably significant difference （P＜0.01）in T1,T2,T3,T4 time point between group B,C and A,and significant difference in T1,T2,T3,T4 time point between group B and C （P＜0.05）.Showing that the preemptive analgesin can improve the time and degree of immune restraining after operation.3.The VAS scores in each time point within 24 hours after operation in group A were all more than those in group B and C,representing siginificant difference（P＜0.05 or P＜0.01）.there were remarkably significant difference（P＜0.01）in VAS scores in 12hr after operation between group B and C.It was showed that preemptive analgesia can transparently relieve pain after operation and rise whole satisfaction of patients.4.The time of sensation and movement recovery were remarkably longer in group C compared with group A and B,showing significant difference（P＜0.01）.There were no significant difference in side effect after operation in three groups（P＞0.05）,showing the practicability and safety of ketamine 0.6mg/kg and clonidine 1ug/kg in the preemptive analgesia for THR.Conclusion1.The application of ketamine 0.6mg/kg combined with clonidine lug/kg in the preemptive analgesia for THR can transparently relieve pain after operation and rise whole satisfaction of patients. 2.The application of ketamine 0.6mg/kg and clonidine lug/kg in preemptive analgesia for THR can maintain the stablilize of the hemodynamics.3.Preemptive analgesia for THR can improve the time and the degree of immune response after operation and do not rise side effects.
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