Effect Of Lumbar Plexus Block On Perioperative Insulin Resistance In Obese Patients Undergoing Total Hip Arthroplasty

OBJECTIVE: This study aimed to investigate the effect of lumbar plexus block on perioperative insulin resistance in obese patients undergoing total hip arthroplasty(THA)under general anesthesia.Methods: Totally 80 patients undergoing THA under general anesthesia were divided into obese group(F group)and normal body weight group(group C)according to the BMI index.Patients in these two groups were randomly divided into two subgroups: Patients receiving lumbar plexus block(F2,C2)and those who did not receive nerve block(F1,C1).Blood glucose,insulin,IL-6,TNF-? were measured and the HOMA-IR and ISI were calculated according to blood glucose and insulin before operation(T0),at the end of the operation(T1)and 24 hours after the operation(T2).The Harris Hip Score was recorded before and after surgery.Results: There was no significant difference among the four groups on demographic data(P>0.05).In group F1 and C1,the Ins concentration at T1 was significantly higher than that of T0(P<0.05),the levels of HOMA-IR,IL-6 and THF-? at T1 and T2 were significantly higher than those at T0(P<0.05),and the levels of ISI at T1 and T2 were significantly lower than that at T0.When compared with group C1,FBG at T1 and INS at T2 in group F1 were significantly higher(P<0.05).When compared with group C1,ISI were significantly lower and HOMA-IR,IL-6 and THF-? were significantly higher at T1 and T2 in group F1(P<0.05,all).FBG,HOMA-IR,IL-6 and THF-? at T1 and T2 in group F2 were significantly higher and ISI was significantly lower than those in group F1(P<0.05,all).While FBG and HOMA-IR at T1 and T2 in group F2 were significantly lower and ISI was significantly higher than those in group C2(P<0.05,all).The Harris Hip Scores after operation in all groups were significantly higher than those before operation(P<0.05,all).The Harris Hip Score after operation in group F1 was significantly lower than that in group C1,and that in F2 group was significantly higher than that in group F1(P<0.05,both).Conclusion: 1.Perioperative insulin resistance in obese patients undergoing THA under anesthesia was more significant than that in patients with normal body weight.The recovery rate of hip function in obesity is lower than that in patients with normal body weight.2.Lumbar plexus block might reduce the perioperative insulin resistance in obese patients undergoing THA and improve hip function recovery.3.Lumbar plexus block could reduce the perioperative inflammatory response in obese patients undergoing THA,which might be the mechanism to reduce perioperative insulin resistance.