Application Of Fascia Iliaca Compartment Block Combined With Spinal Anesthesia In Elderly Patients With Hip Fracture Surgery

Objective:To summarize the medical records of elderly patients over 70 years old who have undergone hip fracture surgery in the Second Hospital of Shanxi Medical University in the past 2 years,and to observe the efficacy and safety of fascia iliaca compartment block combined with spinal anesthesia in elderly patients with hip fracture surgery.Methods:The patients with unilateral hip fractures over 70 years old who received surgical treatment from January 2015 to December 2016 were reviewed,and the patients with multiple injuries or more than two surgeries,preoperative liver and kidney dysfunction,chronic pain,long-term use of analgesic drug history,preoperative combined arrhythmia,preoperative use of sedative drugs and patients with postoperative analgesia pump or other analgesics other than tramadol in general wards were excluded,a total of 419 cases,the average age was 80.8±6.2 years.According to the anesthesia method,they were divided into 2 groups,The S group was simple spinal anesthesia(282 cases),and the F group was ultrasound-guided fascia iliaca compartment block before spinal anesthesia(137 cases).Gender,age,preoperative complications,type of surgery and postoperative into the number of ICU and orthopedic ward,and other general data were collected by consulting medical records,compare the dosage of fentanyl into the operating room to the preoperative period(D1),and systolic blood pressure(SBP),diastolic blood pressure(DBP),heart rate(HR),the maximum rate of change;24 h after surgery time period(D2)into the intensive care unit patients with remifentanil dosage,the dosage of tramadol in orthopedic ward patients and the occurrence of adverse reactions.Results:1.Compared with the group S,the dosage of fentanyl in the D1 time period of the group F was significantly decreased(P<0.05),and the maximum change rate of SBP,DBP and HR was also significantly decreased(P<0.05);2.In the D2 time period,the dosage of remifentanil in the patients in the intensive care unit was decreased(P<0.05),the amount of tramadol in the patients in the orthopedic ward was decreased(P<0.05)and the incidence of postoperative adverse reactions was also low(P<0.05).Conclusion:Fascia iliaca compartment block combined with spinal anesthesia can reduce the dosage of preoperative opioids and help to maintain the stability of preoperative hemodynamics in elderly patients;and reduce the dosage of postoperative opioids after24 hours and reduce the related drugs adverse reactions,high security.