Comparison Of Combined Lumbar And Sacral Plexus Block With Sedation Anesthesia Versus General Anesthesia On Postoperative Myocardial Injury In Elderly Patients Undergoing Hip Fracture Surgery

Objective: High morbidity and mortality in elderly patients with hip fracture are associated with postoperative cardiovascular adverse events.This prospective,randomized controlled clinical trial was performed to investigate the effects of combined lumbar and sacral plexus block with sedation anesthesia and general anesthesia on postoperative myocardial injury in elderly patients with hip fracture.Methods:A total of 220 patients with hip fracture were randomly divided into two groups:combined lumbar and sacral plexus block with sedation anesthesia(CLSB)and general anesthesia(GA).CLSB was located in lumbar and sacral plexus under ultrasound,and target-controlled infusion(TCI)of propofol with low-dose sufentanil was used to maintain the Ramsay score of 4-5.GA was performed tracheal intubation after normal induction.We recorded troponin I(c Tn I),high-sensitivity troponin T(hs-c Tn T)and Pro-BNP before operation(PD-1)and 1 day after operation(POD1),intraoperative anesthesia complications,intraoperative bleeding,operative time,the occupancy rate of intensive care unit(ICU)after operation and the length of hospital.Results: The total incidence of Myocardical Injury after Noncardiac Surgery(MINS)was 12.15% 24 hours after elderly hip fracture surgery,CLSB vs GA(13.08% vs11.21%,P=0.676).However,compared with GA,the incidence and frequency of hypotension were significantly reduced in CLSB(49.53% vs 77.57%,P=0.000;0.93±1.20 vs 1.68±1.44,P=0.000).The incidence of MINS was related with age,preoperative cardiac insufficiency,preoperatively MINS and the frequency of hypotension(P<0.05),unadjusted hazard ratio(u HR)respectively(1.149;95%CI,1.046-1.263,P=0.004),(8.226;95%CI,3.442-21.594,P=0.000),(6.665;95%CI,1.662-26.642,P=0.007),(1.303;95%CI,0.999-1.699,P=0.051).Meanwhile,it also was connected with Pro-BNP levels before and after surgery(P < 0.05).The regression analysis showed significant difference in Pro-BNP<806 ng/L and ≥806ng/L before and after surgery,u HR respectively(8.944;95% CI,2.007-39.855,P=0.004),(8.077;95% CI,1.826-35.718,P=0.006).The value of hs-c Tn T in predicting and diagnosing MINS before and after hip fracture operation in elderly patients was superior to c Tn I and Pro-BNP.Conclusion: There was no difference about two anethesia groups in the occurrence of MINS 24 hours after elderly hip fracture surgery,but the frequency of hypotension was more in general anesthesia group.Perioperative monitoring hs-c Tn T in elderly(≥85ys)hip fracture patients with cardiac insufficiency helps early detecting MINS.