Effect Analysis Of High Iliofascial Space Block Combined With Sacral Plexus Block In Femoral Surgery In Elderly Patients

Objective:To evaluate the effect of ultrasound-guided high iliofascial space block combined with sacral plexus block in internal fixation of intramedullary nail for femoral fracture in elderly patients.Methods:A total of 120 elderly patients who underwent elective intramedullary nail fixation for unilateral femoral fracture from February 2020 to August 2021 were selected,American Association of Anesthesiologists(ASA)gradeⅡ-Ⅲgrade,random digital table was divided into two groups: High fascial iliac compartment block+Sacral block(in S group)and simple lumbar hemp group(in T group).The two groups of patients were compared blood pressure,heart rate at pre-anesthesia(T1),10 minute after anesthesia(T2),at the beginning of the operation(T3),at intramedullary fixation(T4),at the end of the operation(T5),two hour after surgery(T6),compared the visual simulation pain,intraoperative sufentanil use,postoperative analgesic pump use,operator and patient satisfactionResults:(1)At 10 min after anesthesia,the MAP and VAS scores decreased significantly in group T(P <0.05).(2)Pain was decreased at the 10 min after anesthesia in the T group compared with the S group,and no pain sensation remained at postoperative 2h in the S group,the time of first patient-controlled intravenous analgesia pump pressing in the S group was significantly prolonged,and the total number of 24 h pressing was significantly decreased(P <0.05).(3)Both groups had postoperative mini-mental state examination scores decreased compared to preoperative,subsequently slowly increased and returned to initial after 7d,the S group increased significantly at 24 h,48h and 72 h after surgery,three patients had nausea and vomiting,one patient had intraoperative chest suffocation,one patient had postoperative headache in group T,and two patients had puncture site congestion in group S patients,with no other adverse reactions.Conclusion:Ultrasound-guided high iliofascial space block combined sacral block can meet the requirements of intramedullary nail internal fixation of femoral fracture in elderly patients,hemodynamics is more stable,postoperative analgesic effect is lasting,slight postoperative cognitive function impact,less adverse reactions and high safety.