The Clinical Observation Of Ultra-sound Guided Lumbar Plexus And Sciatic Plexus Block Combined With General Anesthesia In Elderly Patients Undergoing Hip Replacement Surgery

Objective: Elderly patients were the major group who received hip surgeries.Choice of anesthesia method was considered to influent the outcome of those patients,especially the post-operative cognitive function of these patients.This study was conduct to observe the clinical effect of ultra-sound guided lumbar plexus and sciatic plexus block combined with general anesthesia on elderly patients received hip replacement surgery.Methods: Eighty elderly patients who received one side hip replacement surgery were randomly divided to ultra-sound guided lumbar plexus and sciatic plexus block combined with general anesthesia group(Group N)and general anesthesia group(Group G).Patients in Group G were received total intravenous anesthesia,and patients in Group N were received total intravenous anesthesia without muscle relaxant after ultra-sound guided lumbar plexus and sciatic plexus blocked.The airways of all the patients were controlled by laryngeal mask airway.The bispectral index of patients in both two groups was maintained in the range of 45-55.The dosage of sufentanil,the period from end of surgery to extubation,the visual analogue scale of 2 hours,4 hours,8 hours and 24 hours after surgery,and the dosage of patient controlled analgesia drugs were recorded.Also the period from end of surgery to off-bed activity and discharged from hospital,the mortality in 30 days after surgery were recorded.The incidences of postoperative delirium and postoperative cognitive dysfunction in patients post-operation were investigated.Also the severe cardiovascular and pulmonary complications were recorded.Results: No patient died in 30 days after surgery in both two groups.1 patient suffered from severe pulmonary infection.The dosage of sufentanil of Group N was less than Group G(P<0.05),the periods from end of surgery to extubation,the off-bed activity and discharged from hospital of Group N were shorter than Group G(P <0.05),The value of visual analogue scale of Group N were less than Group G in all time points(all P<0.01).Value of minimum mental state examination of Group N was greater than Group G in both of 3 days and 7days after surgery(P <0.05)and incidences of postoperative delirium and postoperative cognitive dysfunction in Group N were less than Group G(P <0.05).Conclusion: In elderly patients undergoing hip replacement surgery,compared with general anesthesia,ultra-sound guided lumbar plexus and sciatic plexus block combined with general anesthesia could reduce usage of opioids during operation,offer better analgesia effect,shorten the period of off-bed activity and discharged from hospital,reduce the incidences of postoperative delirium and postoperative cognitive dysfunction in the early stage after surgery.So this method may be worth to popularized in clinical work.