Clinical Observation Of Femoral Nerve Block Combined With The General Anesthesia In Elderly Patients Undergoing Total Knee Arthroplasty

Peripheral nerve block is an anesthetic and analgesic technique which hasexact local blocking effects and relatively small impact on systems of the wholebody. This application is used for several decades in clinical. With thedevelopment of nerve stimulator and ultrasound-guided technology, the successrate and effects of peripheral nerve block has greatly improved. This techniqueis playing a more and more important role in the elderly patients undergoingorthopedic anesthesia. Femoral nerve block (FNB) is a widely used lowerextremity peripheral nerve blocking technique. The current clinical observationwas most about single-injection femoral nerve block (sFNB) or continuousfemoral nerve block (cFNB) on unilateral lower limb surgery, but bilateral lowerlimb surgery was still using general anesthesia or spinal anesthesia.This study isto evaluate the clinical effects of sFNB combined with laryngeal mask anesthesiain elderly patients under going unilateral total knee arthroplasty (UTKA)，furthermore，to observe the safety and effectiveness of bilateral sFNB combinedwith general anesthesia in elderly patients undergoing simultaneous bilateral totalknee arthroplasty (SBTKA) This study provided a new clinical evidence forSBTKA anesthesia in elderly patients.Part I The application of sFNB combined with LMA in elderly patientsundergoing UTKAObjective：To observe the application of sFNB combined with LMA inelderly patients with UTKA. Methods: Sixty elderly patients elective for UTKAwere randomly divided into sFNB+LMA group (group FLA)、sFNB+generalanesthesia group (group FGA) and general anesthesia group (group GA). HR andMAP was observed at all time points, tourniquet application time and operativetime, the intra-operative dosage of propofol, fentanyl, remifentanil were recorded in three groups. The intra-operative cardiovascular events and the use ofvasoactive drμｇs，the time of awareness and extubation were also observed.the resting state VAS score at the time of post-operation6h,24h,48h,72h，themotion state VAS score at the time of post-operation24h,48h,72h the times ofpressing analgesia pump and adverse reaction of postoperation were also recorded.Results: The dosage of propofol, remifentanil, fentanyl in group FLA and groupFGA were significantly lower than group GA(P<0.01), the recovery time andextubation time were shorter than group GA (P<0.05); hemodynamics in groupFLA and group FGA at T3, T4, T5points of SBP was significantly lower thangroup GA (P<0.05), the points of HR was lower in group FLA and group FGAthan group GA at T5(P<0.05); peri-operative adverse reaction, agitation and painafter extubation in group FLA and group FGA were significantly lower than ingroup GA (P<0.01). Extubation coμｇh, throat pain was significantly lower ingroup FLA (P<0.01); VAS score at the time of postoperation6h,24h and themotion state VAS score at the time of postoperation24h,48h were significantlylower than group GA (P <0.05). The number of pressing PCIA pump wassignificantly less in group FLA and FGA than group GA.(P<0.05), there was nodifference in adverse reaction at the time of operation (P>0.05). Conclusion:sFNB combined with general anesthesia, especially combined with LMA is betterchoice than general anesthesia which can reduce intraoperative and postoperativemedication, shorten awake and extubation time, reduce early postoperative VASscores, It can be used as a better choice on the aged in UTKA. Part Ⅱ The application of bilateral sFNB combined with generalanesthesia in elderly patients undergoing SBTKAObjective：To evaluate the safety and efficacy of bilateral sFNB combinedwith general anesthesia in elderly patients with SBTKA. Methods: Fifty elderlypatients elective for SBTKA were randomly divided into bilateral sFNB+ general anesthesia group(group FGA) and general anesthesia group (group GA).HR and MAP were recorded at all time points, the time of tourniquetapplication,the time of operative, the intra-operative dosage of propofol,remifentanil and fentanyl were also recorded. It was also observed onintra-operative cardiovascular events and the use of vasoactive drμｇs. The timeof awareness and extubation were also observed. The resting state VAS score atthe time of post-operation6h,24h,48h,72h, the motion state VAS score at thetime of post-operation48h,72h, the times of pressing analgesia pump andadverse reaction of postoperation were also recorded. Results: Forty-five elderlypatients completed the study. The dosage of propofol, remifentanil, fentanyl ingroup FGA were significantly lower than group GA (P <0.01), the recovery timeand extubation time were significantly shorter than group GA (P <0.01);hemodynamics in group FGA at T4, T5, T6, T7points of SAP was lower thanthat in group GA (P<0.05); point of HR in group FGA was lower than that ingroup GA(P<0.05) at T7, peri-operative adverse reaction、agitation and painafter extubation in group FGA were significantly lower than in group GA(P<0.01). VAS score at the time of postoperation6h,24h,48h and the motionstate VAS score at the time of postoperation48h were significantly lower thanthose in group GA (P <0.05), The number of pressing PCIA pump wassignificantly less in group FGA than in group GA.(P<0.05). Sleepiness, theincidence of nausea and vomiting in group FGA was significantly less than thatin group GA (P<0.05); period of perioperative stress response did not differsignificantly (P>0.05) Conclusion: Bilatera sFNB combined with generalanesthesia is a better choice than general anesthesia which can reduceintraoperative and postoperative medication, shorten awake and extubation time,reduce early postoperative VAS scores, and has fewer adverse reactions, It can beused in Elderly safely in SBTKA.