Objectives: To explore the clinical application of anterior lumbar plexus combined with parasacral nerve block under the dual guidance of ultrasound and nerve stimulator in elderly hip arthroplasty.
Methods: Forty elderly patients aged from 65 to 85 years old who underwent unilateral hip arthroplasty (Except for revision of hip joint) were randomly divided into two groups (n=20 in each group): ultrasound-guided anterior lumbar plexus combined with parasacral sciatic nerve block group (group A) and ultrasound-guided anterior lumbar plexus block group (group B). Both groups were assisted with sedation with different doses of dexmetopyrimidine and analgesia with different doses of sufentanil. Because the orthopaedic team of our hospital performed hip arthroplasty with mature technique and fixed operation time, the onset time of block in group An and B, heart rate and blood pressure at admission (T0), skin incision (T1), half hour after skin incision (T2) and skin suture(T3), intraoperative dosage ofdexmedetomidine and sufentanil, postoperative 1, 4, 8, 16, 24hVAS score and the first time of getting out of bed were recorded.
Results: the heart rate and blood pressure at T1, T2 and T3 in group A were significantly lower than those in group B (P < 0.05). The amount of sufentanil used during operation in group), A was significantly lower than that in group B (P < 0.05). The postoperative scores of 1,4,8,16 and 24hVAS in group), A were significantly lower than those in group B (P < 0.05), and the time of getting out of bed for the first time after operation was shorter than that in group B (P < 0.05).
Conclusion: compared with simple anterior lumbar plexus block, anterior lumbar plexus combined with parasacral sciatic nerve block in elderly patients with hip arthroplasty can make the intraoperative circulation more stable, the intraoperative dosage of opioids significantly reduced and the effect of early postoperative analgesia is better. it can also shorten the time for patients to get out of bed for the first time.