Application Of Ultrasound-guided Superior Inguinal Ligament Iliofascial Block Combined With Sciatic Nerve Block In Total Hip Replacement

Objective:Study on ultrasound-guided Suprainguinal fascia iliaca block（SFICB）combined with Sciatic nerve block（Sciatic nerve block）SNB in Total hip replacement（THA）.Methods:A total of 84 patients,aged 40-75 years,BMI18-30 kg/m²,ASA Grade I-III,underwent elective total hip replacement under general anesthesia from September2021 to October 2022 were selected.They were randomly divided into supringuinal ligament iliac fascia block and sciatic nerve block group（F+S group）,supringuinal ligament iliac fascia block group（F group）and general anesthesia group（C group）,with 28 cases in each group.In F+S group,superior inguinal ligament iliac fascia block(0.25%ropivacaine 30 m L was performed first,followed by sciatic nerve block（0.375%ropivacaine 20 m L）under ultrasound guidance.Group F received ultrasound-guided iliac fascia block above inguinal ligament（0.25%ropivacaine 30m L）;Group C received general anesthesia.HR and MAP levels were recorded for all patients at the time of entry（T₀）,10 minutes after anesthesia（T₁）,5 minutes after surgery（T₂）,and at the end of surgery（T₄）.The NRS score at rest and exercise at 6 h,12 h,24 h and 48 h after surgery,the amount of Sufentanil used during surgery,the number of effective analgesic pump compressions within 24 h after surgery,and the number of zocine relief patients within 24 h after surgery were recorded in the three groups.The occurrence of anesthetic poisoning,nausea and vomiting in the three groups were recorded.The expression levels of IL-1βand TNF-αin serum of all patients were determined by ELISA at the time of entry（T₀）,30 min after operation（T₃）,and at the end of operation（T₄）.Results:1.MAP and HR:Intra-group comparison:Compared with T₀,MAP and HR in groups C,F and F+S were decreased at T₁（P<0.05）.Compared with T₀,MAP and HR in group C were increased at T₂（P<0.05）.Compared with T₀,HR in F+S group was decreased at T₂（P<0.05）.Compared with T₀,HR in F+S group was lower at T₄（P<0.05）.Intergroup comparison:Compared with group C,MAP and HR of patients in group F and F+S were decreased at T₂（P<0.05）,and there was no statistical difference between the two groups at other time points（P>0.05）.Compared with F group,MAP and HR in F+S group showed no statistical difference at each time point.2.NRS score:at rest or during activity,NRS score in group F and F+S was decreased at all postoperative time points compared with group C（P<0.05）;Compared with F group,NRS score in F+S group was decreased at all postoperative time points（P<0.05）.3.Intraoperative sufentanil dosage and postoperative situation:Compared with Group C,intraoperative Sufentanil dosage of patients in group F and F+S was decreased（P<0.05）.Compared with F group,the intraoperative dosage of sufentanil in F+S group was decreased（P<0.05）.Compared with group C,the number of effective analgesic pump compression in group F and Group F+S was decreased within 24 h after surgery（P<0.05）.Compared with F group,the number of effective analgesic pump compressions in F+S group decreased within 24 h after surgery（P<0.05）.Compared with C group,the number of patients in F+S group was lower 24h after operation（P<0.05）.4.Adverse reaction:Compared with group C,the incidence of postoperative nausea and vomiting in group F+S was decreased（P<0.05）;There was no significant difference in the incidence of postoperative nausea and vomiting between F group and F+S group（P>0.05）.5.Expression levels of inflammatory cytokines:Intra-group comparison:compared with T₀,the expression levels of IL-1βand TNF-αin group C were increased at T₃and T₄,with statistical significance（P<0.05）.Comparison between groups:at T₃and T₄,the expression levels of IL-1βand TNF-αin group F and F+S were lower than those in group C,and the difference was statistically significant（P<0.05）.Conclusion:Ultrasound-guided iliac fascia block combined with sciatic nerve block in the application of total hip replacement can reduce hemodynamic fluctuations,reduce the use of analgesic drugs,reduce the expression of inflammatory factors,and reduce the incidence of postoperative complications.