The Efficacy Of Modified Fascia Iliaca Compartment Block Combined With Sciatic Nerve Block In Patients Undergoing Internal Fixation Of Lower Limb Fracture

Objective:To evaluate the anesthesia efficacy of modified fascia iliaca compartment block（FICB）combined with sciatic nerve block（SNB）in patients undergoing internal fixation of lower limb fracture.Methods:Sixty American Society of Anesthesiologists physical statusⅠorⅡpatients of both sexes,aged 5881 years old,with body mass index of 18.524.0 kg/m2,scheduled for elective internal fixation of lower limb fracture,were divided into 2 groups（n=30 each）using a random number table:improved fascia iliaca compartment block combined sciatic nerve block group（group NB）and combined spinal and epidural analgesia group（group CSEA）.Exclusion criteria:Patients with anaphylaxis of local anesthetic,systemic infectious diseases,quasi puncture site infection,spinal deformity,nerve damage of lower limbs,mental sickness,disturbance of consciousness,history of substance abuse,hemorrhagic disease,coagulant function abnormality,severe liver and kidney dysfunction.In group NB,ultrasound-guided improved fascia iliaca compartment block was performed in the supine position,and 1%lidocaine and 0.375%ropivacaine mixture 40 ml was injected into the iliac fascia clearance and surrounding the femoral nerve;the operation limb was located on the upper lateral position and the sciatic nerve block was performed using the gluteal muscle approach,and 1%lidocaine and 0.375%ropivacaine mixture 20 ml was injected into surrounding sciatic nerve.In group CSEA,combined spinal and epidural analgesia was performed with the L344 clearance,and0.5%bupivacaine 2 ml was injected into subarachnoid space,and 2%lidocaine 58 ml was injected into epidural space according to the anesthetic effect every 4060 min,the epidural catheter was removed end of the surgery.The SBP,DBP,and HR of two groups were record before the anesthesia blocks onset（T0）,5 min after anesthesia blocks（T1）,10 min after anesthesia blocks（T2）,20 min after anesthesia blocks（T3）,30 min after anesthesia blocks（T4）,60 min after anesthesia blocks（T5）.The surgery working time,the completion time and onset time and working time of sensory block,the anesthesia efficacy of two groups were record,the ephedrine usage rate,the tolerance to tourniquet,the postoperative adverse reactions,including postoperative nausea and vomiting,headache and urinary retention were also recorded.Results:Compared with the T0,the SBP and DBP were decreased obviously at T2 in group CSEA（P<0.05）,while the SBP and DBP had no obvious change at T2 in group NB,but compared with group CSEA were significantly higher at the same time（P<0.05）.Compared with group CSEA,the onset time and working time of sensory block were both significantly longer in group NB（P<0.05）.Group CSEA had more excellent anesthetic effect than group NB,but there was no statistically significant difference,there was no difference in the sum of the excellent and good anesthesia efficacy of the two groups.The utilization rate of ephedrine in group NB was significantly lower than that in group CSEA（P<0.05）.Group NB was worse than group CSEA in the tolerance of tourniquet,but there was no statistically significant difference.In groups NB,patients with postoperative none of complications such as nausea and vomiting,headache and urinary retention,the incidence of urinary retention was significantly lower（P<0.05）.Conclusion:Modified fascia iliaca compartment block combined with sciatic nerve block has excellent anesthesia efficacy in internal fixation of lower limb fracture below the knee joint,when compared with combined spinal and epidural analgesia,which ensure more stable intraoperative hemodynamics,provide a more long time of anesthesia,ensure less anesthesia complications occurring.Ultrasound-guided modified fascia iliaca compartment with block combined sciatic nerve block suitable for the anesthesia of internal fixation of lower limb fracture under knee joint.