Application Value of Nalbuphine Combined with Ropivacaine for Epidural Anesthesia in Open Fracture Surgery of the Tibia and Fibula

Abstract

Background: Open fracture of the tibia and fibula is a common fracture. Most patients with this fracture need surgical treatment, but the optimal anesthesia scheme remains inconclusive. Epidural anesthesia with nalbuphine and ropivacaine is used for intraoperative analgesia, but its efficacy in patients undergoing surgery for open fracture of the tibia and fibula remains unclear. This study aims to explore the application of nalbuphine combined with ropivacaine for epidural anesthesia in such patients. Methods: The data of 172 patients with open fractures of the tibia and fibula admitted to Zibo Central Hospital from February 2020 to February 2021 were selected for retrospective analysis. Among them, 9 patients failed in anesthesia, and the remaining patients were divided into the experimental group (EG, n = 79) and the control group (CG, n = 84) according to anesthetic drug. All patients underwent internal fracture fixation, patients of the CG were given 0.2 μg/mL of sufentanil and 0.2% of ropivacaine for epidural anesthesia, while patients of the EG received 0.2 mg/mL of nalbuphine and 0.2% of ropivacaine. Hemodynamic indices of patients in both groups were recorded before anesthesia (T1), 15 min after anesthesia (T2), 30 min after anesthesia (T3) and 24 hours (h) after surgery (T4) to compare postoperative pain score, the levels of inflammatory factors and immune function indexes. Results: There was no intergroup difference in the hemodynamic indices at T1 and T4 (p > 0.05). While the heart rate and mean arterial pressure in both groups showed a downward trend at T2 and T3, the EG was notably higher than the CG (p < 0.001). The EG showed significantly lower serum levels of Interleukin-10 (IL-10) and tumor necrosis factor-α (TNF-α) than the CG at 3 h, 6 h and 12 h after surgery (p < 0.001). There were significant differences in postoperative pain scores between the two groups at 3 h, 6 h and 12 h after surgery (p < 0.001). Higher levels of cluster of differentiation 4 (CD4⁺) and CD4⁺/CD8⁺ existed in the EG than the CG at the end of surgery, 24 h after surgery and 48 h after surgery (p < 0.001). The severity of adverse events in both groups was grade 1, with no difference in the incidence of nausea and vomiting and urinary retention between the two groups (p > 0.05). However, the incidence of pruritus in the EG was significantly lower than in the CG (p < 0.05). Conclusion: Nalbuphine combined with ropivacaine for epidural anesthesia stabilized the hemodynamic indices of patients undergoing surgery for open fracture of the tibia and fibula, improved the levels of inflammatory factors after surgery, exerted a small effect on immune cells, and reduced pain degrees of patients, which is worthy of clinical promotion.