Effect Of Lumbosacral Plexus Block Combined With Dexmedetomidine On Rehabilitatinn Of Elderly Patients Undergoing Proximal Femoral Nail Anti-rotation (PFNA)

Objective To evaluate the effectiveness of ultrasound and nerve stimulator-guided lumbosacral plexus block combined with the use of dexmedetomidine in elderly patients undergoing Proximal Femoral Nail Antirotation.Methods A total of 60 patients（including male and female,aged 70 to90 years,American Society of anesthesiologists grading II^IV）received elective PFNA were randomly divided into tracheal intubation combined with inhalation anesthesia（group G）and ultrasound and nerve stimulator-guidedlumbosacralplexusblockfollowingwith dexmedetomidine infusion（group N）.Recorded heart rate（HR）,blood pressure（BP）for both groups at the time entering the theater（T₀）,immediately after tracheal intubation or after dexmedetomidine infusion（T₁）,skin incision moment（T₂）and 30 minutes after skin incision（T₃）.Visual analogue scale（VAS）scores were assessed for both groups at the time point of 2,6,12,24 and 48 hours after surgery.The use of patientcontrolledintravenousanalgesia（PCIA）,assessmentof consciousness status 3 days after surgery,adverse reactions were recorded for both groups as well.The following post-surgery data were recorded:the time of first feeding,first urination and first ambulation;the length of hospitalization;the expense of hospital stay.Results HR and BP of the group G changed more significantly at T₁,T₂,T₃ than T₀（P<0.05）.The group N have lower post-surgery 2,6,12,24 and 48 hours VAS scores and less application of PCIA as well（P<0.05）.The group N had lower CAM-CR scores and less adverse reactions of nausea and vomiting and dizziness than the group G（P<0.05）.Compare to group G,the group N were early in terms of post-operation first feeding,first urination and first ambulation.The length of hospitalization was shorter and the cost of the hospital stay was lower in the group N than the group G（P<0.05）.Conclusion Ultrasound and nerve stimulator-guided lumbosacral plexus block combined with low dose of dexmedetomidine,patients with stablehemodynamics,postoperativeanalgesiaeffect,lessadverse reactions,rapid recovery after surgery,can fully meet the needs of elderly patients undergoning PFNA.