Ultrasound-Guided Lumbar Plexus Block In The Clinical Application Of Hip Replacement

Objective:Observed advantage of surgery under ultrasound and nerve stimulator guided lumbar plexus block combined with general anesthesia comparative purely general anesthesia in unilateral hip replacement surgery.Methods:Sixty ASA Ⅰ～Ⅱ patients who scheduled for single hip arthroplasty under general anesthesia were randomly divided into two groups (A and B). The group B patients apply general anesthesia and the group A guided by ultrasound and nerve stimulator to receive lumber plexus block with 0.375% ropivacaine 20ml combined with general anesthesia. Given the patients patient-controlled intravenous analgesia (PCIA) after surgery and pull out the endotracheal tube. Maintained the VAS score less than or equal to 3. Recorded the heart rate (HR) and mean arterial pressure (MAP) after admission to operating room 5min(To), the beginning of surgery(T1), reaming(T2), immediately after the surgery was completed(T3),30min(T4) and 60min(Ts). In the use of sedation and analgesia dose intraoperatie were recorded. Record the VAS score in 4,8,24 and 48 hours and usage of PCIA after operation. The complications after the surgery during 48 hours were realized.Result:Compared with the T0, T1, T2 and T3 in group B higher mean arterial pressure (MAP) than group A(P< 0.05). T4, T5, compared with T2 MAP had reduced (P< 0.05). In group A, Ti compared with T0 the HR and MAP had reduced(P< 0.05). T2-T5 compared with T0 and T1-T5 compared with each other there was no statistically significant difference. The propofol and remifentani dosage in A group were reduction compared with group B (P< 0.05). PCA dosing frequency and intramuscular tramadol during 48 hours in group A less than B (P< 0.05). Compared with group B,4 h,8 h,24 h of VAS score of group A is low.Conclusion:Ultrasonic joint nerve stimulator guided lumber plexus block has stable hemodynamics in unilateral hip replacement and reduce postoperative analgesia drug use, but 20ml 0.375% ropivacaine lumber plexus block analgesia effect cannot assure in operation, maybe the Capacity is insufficient.