Applicability And Effectiveness Of Ultrasound Combined Nerve Stimulator-guided Lumbosacral Plexus Block In Supine Versus Lateral Position During Surgeries For Lower Limb Fracture

Objective Lower limb fractures account for approximately one third of all fractures and may result in substantial mortality and morbidity.And thus has become an important public health concern.Lumbosacral plexus block（LSPB）is a popular regional block technique,which can be used for anesthesia in lower limb fracture surgery.It injects local anesthetic into the vicinity of lumbar plexus and sacral plexus to block its conduction and block the skin sensation dominated by its branches,so as to achieve the effect of lower limb anesthesia.It is particularly important to improve the comfort of patients and reduce the occurrence of adverse events.The purpose of this study was to compare the applicability and effectiveness of ultrasound combined nerve stimulator-guided lumbosacral plexus block（LSPB）in supine versus lateral position during the lower limb fracture surgery.Methods A total of 126 patients with the lower limb fractures,aged 18-75 years were recruited at the Chaohu Hospital affiliated to Anhui Medical University from October2020 to October 2021.Patients were divided into the S group and the L group by the random number table method and received LSPB guided by ultrasound combined nerve stimulator in supine and lateral positions,respectively.Preoperative records: gender,age,height,weight,ASA grade,lower limb fracture type.The anesthesia method is general anesthesia combined with LSPB.The anesthetic drugs mainly include ropivacaine,dexmedetomidine,etomidate,sufentanil,rocuronium,propofol,etc.The primary outcome examined was the maximum VAS pain score at position placing for LSPB,the time of position placing,the time for nerve block and the number of puncture attempts,the dose of sufentanil used in surgery.And the secondary outcomes were the heart rate and mean arterial pressure at different time point,the VAS score at 1,12,and 24 h following surgery,postoperative satisfactory degree to analgesia,nerve block results and adverse events.Results 1.There was no significant difference in age,BMI index,ASA grade and gender between the two groups（P>0.05）.2.The maximum pain score at position placing,the time of position placing for nerve block,the time for lumbar plexus block and the time of puncture attempts were significantly lower in the S group compared with those of the L group（all P<0.05）.However,the time for sacral plexus block was higher in the S group compared with that of the L group（P<0.05）.3.Times of puncture attempts for sacral plexus,dose of sufentanil used,the heart rate and mean arterial pressure at different time points,VAS scores,the satisfactory postoperative degree to analgesia and adverse events of nerve block did not significantly differ between the two groups（all P>0.05）.Conclusion 1.LSPB in supine position can reduce maximum VAS pain score and time of position placing.2.Compared with the traditional trigeminal LPB in lateral position,the time for nerve block and a number of puncture attempts in SIFI block is less.3.The dosage of sufentanil in two group was consistent,the intraoperative hemodynamics were stable,the satisfaction of postoperative analgesia was high,and the incidence of adverse events was less.4.LSPB in the supine position can avoid the inconvenience and pain of orthopedic patients who change their positions repeatedly,and avoid fracture dislocation,vascular and nerve injury during moving.It is simple to apply and has definite anesthetic effects.Meanwhile,it has a high comfort level and therefore should be widely applied.