Selective Lumbar Nerve Root Block For Hip Surgery Anesthesia In Elderly Patients:a Retrospective Cohort Study

Objective:To analyze the effects of ultrasound-guided Selective lumbar Nerve Root Block（SNRB）combined with Sacral Plexus Block（SPB）and ultrasound-guided Lumbar Plexus Block（LPB）combined with SPB on the intraoperative anesthesia and postoperative analgesia of hip surgery in elderly people,as well as the effects on patient prognosis and the incidence of related complications,provide a basis for clinical treatment and support further research.Methods:This study is a dual-center retrospective cohort study.A total of 79 patients who underwent hip surgery under SNRB or LPB anesthesia in Qilu Hospital of Shandong University and Ningjin County People’s Hospital from July 2016 to December 2021 were collected.A total of 61 patients were eventually enrolled in the cohort after screening.According to the method of nerve block,they were divided into selective lumbar nerve block group（S group）and lumbar plexus block group（L group）.The number of patients included in group S was 30,and the number of patients in group L was 31.General data were collected:age,gender,surgery type,American Society of Anesthesiologists（ASA）classification,preoperative body temperature,preoperative waiting time,preoperative comorbidities,etc.;Intraoperative data were collected:intraoperative anesthesia method,intraoperative opioids Drug usage,intraoperative fluid infusion volume,intraoperative blood transfusion volume,operation duration,etc.;Postoperative data were collected:whether additional analgesic drugs were used after surgery and the time of first use,24 hours（T₁）and 48 hours after surgery（T₂）pain visual analogue scale（VAS）,postoperative ICU occupancy rate,the first time to get out of bed after surgery,postoperative complications,discharge time,total cost during hospitalization,etc.All data in this study were analyzed using SPSS 25 software.If the measurement data in the research data obeys the normal distribution,the data is expressed in the form of mean ±standard deviation（x± s）,and the analysis method adopts the independent sample t test for comparison between groups;if the measurement data in this study does not obey the normal distribution If the data were normally distributed,the data were expressed as the median（interquartile range）[M(P₂₅,P₇₅)],and the comparison between data groups was performed using the Mann-Whitney U test.The enumeration data of this study are expressed in the form of rate（%）,and the data are compared between groups by means of the χ² test;in this study,the additional postoperative analgesic drug use time and the first postoperative time to get out of bed were compared.Log Rank test was performed,and Kaplan-Meier survival curves were drawn.All statistical tests were two-sided,and a P value less than 0.05 was considered statistically significant.Results:1.General information:There were no significant differences in age,gender,surgical type,ASA classification,preoperative body temperature,and preoperative waiting time between the two groups（P>0.05）.The preoperative comorbidities between the two groups included hypertension and diabetes,nervous system disease,respiratory system disease,arrhythmia,coronary heart disease had no significant difference（P>0.05）.2.Primary outcomes:Comparing the postoperative additional analgesic drug usage rate and time between the two groups,the additional analgesic drug usage rate in group S was lower than that in group L（30.0%vs 61.3%,P<0.05）;Kaplan-Meier Survival analysis showed that the use of additional analgesics in group S was significantly later than that in group L（Log Rank P<0.05）.3.Secondary outcomes:The VAS score at T₁ time between the two groups of patients was significantly lower than that in the L group[5.00（3.00～6.00）vs 3.00（2.00～4.00）,P<0.05];The cost in group S was significantly lower than that in group L（28099.36±6479.58 vs 32686.39 ± 8219.25,P<0.05）;There were no significant differences in intraoperative opioid use,duration of surgery,intraoperative fluid infusion,intraoperative blood transfusion,the VAS score at T₂ time,postoperative ICU occupancy,time to first postoperative bed activity,total number of days in hospital,total costs during hospitalization,or postoperative complication rates between the two groups（P>0.05）.Conclusions:Compared with LPB,SNRB can significantly reduce the use of additional analgesic drugs after hip surgery in the elderly,and SNRB has a longer analgesic effect,and SNRB can save patients’ hospitalization costs.