| Objcetive: To observe the effect of nerve stimulator guided Lumbar Plexus-sciaticNerve Blocking with Continuous epidural anesthesia in Total Knee Replacement ofElderly Patients.Methods: A total of twenty Patients aged65~80, weight60~80kg, ASAII~III whounderwent Total Knee Replacement were enrolled into the present study. Before thepatients going into the operating room, they received0.5mg Atropine and100mgPhenobarbital intramuscularly. Patients were randomly divided into two groups: LumbarPlexus-sciatic Nerve Blocking group(PNB group, n=10) and Continuous epiduralanesthesia group（(CEA group，n=10),On arrival in the operating room, the infusion wasstarted routinely，All patients received3l/min O2through mask. the patients werecontinuously monitored with automated non-invasive blood pressure （NABP）,lectrocardiogram（ECG） and pulse oximetry（SpO2）.0.02/kg midazolam and0.5ug/kgfentanyl were intravenously to the patients. MAP were recorded arrival in the operatingroom starting of the anesthesia（T0),5min after the blocking （T1）,10min after theblocking(T2),15min after the blocking(T3）,30min after the blocking(T4),45min afterthe blocking(T5),60min after the blocking(T6).PNB received Lumbar Plexus-sciaticNerve Blocking using0.5%ropivacaine50ml.the lumbar plexus nerve block30ml,sciatic nerve block20ml to complete operation. In CEA group, epidural catheter wasplaced at the L2–L3interspaces to the patients, and a test dose of3ml of1%lidocainefollowed by the mixture of1%lidocaine and0.5%ropivacaine15ml was given to thepatients. Analgesia levels were tested and controlled below T8level.5~8ml of themixture were added every40~60min.Operation area was tested by acupuncture of thepain and whether the patients can tolerance the tourniquet. Observe and record thehemodynamic changes before and after anesthesia in both groups, sensory nerve block and motor nerve block in the working time and keep time, postoperative side effects andpatient satisfaction.Results:20patients to participate in, to complete the test and statistical analysis.Patients of two groups in gender, age, weight, height, and operation time have nodifferences in statistical significance (P>0.05). Before anesthesia and block after5min,10min, MAP of the patients in two groups was no significant difference (P>0.05),15min after the block,30min,45min,60min, the hemodynamics of patients in PNB wasmore stabler than that in the CEA group (P <0.05), HR does not change significantly inboth groups (P>0.05).The sensory block and motor block time in two group has noobvious difference, but the PNB group of sensory block and motor block duration werelonger than CEA group significantly (P <0.05).1patient in PNB group and2patients inCEA group appeared intraoperative mild pain, which were given0.15mg, intravenousfentanyl propofol injection pump2mg/kg to finish the operation. Patients with the restof the block effect is perfect, two groups of patients are able to complete the operation.There were2cases of postoperative nausea and vomiting in CEA group,0.3mgRamosetron were given to the patients.1patient in PNB group has developedlightheadedness. There was no significant difference of the side effects in two groups (P>0.05).Conclusion: the nerve stimulator guided Lumbar Plexus-sciatic Nerve Blocking canmeet the entire lower limbs surgery, especially the tourniquet on lower limb surgery.Compared with epidural anesthesia and general anesthesia, peripheral nerve block canapply not only on the patients who have contraindications on vertebral canal anesthesiabut also the elderly with severe cardiovascular and respiratory system disease, andpatients with spinal deformity and dysfunction of blood coagulation. Peripheral nerveblock can also influence the blood flow smaller, keeping stability, and it can effectivelyreduce the use of gum opiums and incidence of side effects. At the same time it canimprove the patient’s comfort and shorten the postoperative recovery time, it can shortenthe time the patients havingrehabilitation training. |
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