Analysis of the Effect of Ropivacaine Hydrochloride Combined with Fentanyl Subarachnoid Block in Elderly Patients Undergoing Total Knee Arthroplasty

LI Guoyou; JIN Kang

doi:10.16458/j.cnki.1007-0893.2025.08.003

Abstract：Objective To analyze the application effect of ropivacaine hydrochloride combined with fentanyl subarachnoid block(referred to as"lumbar anesthesia")in elderly patients undergoing total knee arthroplasty.Methods A retrospective study was conducted on 90 elderly patients who underwent total knee arthroplasty and were admitted to Qinyang Hospital of Traditional Chinese Medicine from January 2022 to December 2023.According to different anesthesia regimens,they were divided into a control group(44 cases)and an observation group(46 cases).Patients in the control group received spinal anesthesia with ropivacaine hydrochloride,while patients in the observation group received spinal anesthesia with ropivacaine hydrochloride combined with fentanyl.The anesthesia effect,pain degree,levels of serum stress response factors,immune function and occurrence of adverse reactions of the two groups of patients were compared.Results The anesthesia effect of the observation group was better than that of the control group,and the difference was statistically significant(Z=2.723,P=0.007).At each postoperative period,the visual analogue scale(VAS)scores of the patients in the observation group were lower than those in the control group,and the difference was statistically significant(P<0.05).At 48 hours after the operation,the levels of serum cortisol(COR)and adrenocorticotropic hormone(ACTH)in the observation group were lower than those in the control group,and the differences were statistically significant(P<0.05).At 48 hours after the operation,the level of CD4+and CD4+/CD8+of the patients in the observation group were higher than those in the control group,and the differences were statistically significant(P<0.05).There was no statistically significant difference in the total incidence of adverse reactions between the two groups of patients(P>0.05).Conclusion Ropivacaine hydrochloride combined with fentanyl for spinal anesthesia in elderly patients undergoing total knee arthroplasty can improve the anesthetic and analgesic effects,inhibit inflammatory stress responses,regulate immune function,and does not increase the risk of adverse reactions.