The Application Of Ultrasound-guided Fascia Iliaca Compartment Block Combined With Sacral Plexus Block In Elderly Patients Undergoing Total Hip Arthroplasty

Objective:To evaluate the efficacy of ultrasound-guided fascia iliaca compartment block combined with sacral plexus block in elderly patients undergoing posterolateral approach total hip arthroplasty?THA?.Methods:Sixty elderly patients undergoing THA with posterolateral approach were equally randomized into two groups with 30 cases each.Group SA received unilateral hypobaric spinal anesthesia with 2.0².5 ml local anesthetics?2 ml of 0.5%bupivacaine mixed 1 ml of sterile water for injection?.Group NB received ultrasound-guided fascia iliaca compartment block?50 ml of 0.4% ropivacaine?combined with sacral plexus block?20 ml of 0.5% ropivacaine?.We evaluated the onset time and success time of sensory and motor block.The visual analogue scale?VAS?at entring into the operating room?T₀?,1 min before positioning change?T₁?,positioning change?T₂?,skin incision?T₄?,30 min after skin incision?T5?,end of surgery?T₆?,24 hours postoperatively?T₇?,and MAP and HR at T₀^T₂,5 min after anethesia?T3?,T₄^T₆ were recorded.Patient satisfaction with anesthesia methods,the use of dopamine and atropine and incidence of complications were recorded..Results:?1?anesthesia efficacyThe onset and success times of sensory and motor nerve block of group NB were longer than that in group SA?P<0.05?.The VAS scale ratings decreased at T₁,T₂,and T₇ and increased at T₄ and T₆ compared to group SA?P<0.05?.VAS scores at T₂ decreased in group NB,and increased in group SA compared with T₀.Patient satisfaction in group NB was higher than that in group SA?P<0.05?.?2?hemodynamic indicesMAP decreased at T₂ and increased at T3 in group NB?P<0.05?compared to group SA.MAP decreased at T3 in group NB,and increased at T₂ and decreased at T3 in group SA compared with T₀?P<0.05?.There was no significant difference in HR in group NB compared to group SA at the same time.Compared with T₀,HR at T₂ and T3 were no significant difference in group NB,but increased significantly in group SA?P<0.05?.Compared to group SA,the use of dopamine decreased significantly in group NB?P<0.05?,there was no significant difference in the use of atropine?P>0.05?.?3?the incidence of complicationsCompared to group SA,headache,nausea,vomiting,urinary retention decreased in group NB?P<0.05?,but there was no significant difference in local anesthetics toxicity?P>0.05?.Conclusions:Ultrasound-guided fascia iliaca compartment block combined with sacral plexus block can relieve the pain and hemodynamic fluctuation caused by positioning change and can be applied to elderly patients undergoing posterolateral approach THA with more stable hemodynamic,less use of vasoactive drugs,better postoperative analgesic effects,fewer complications and higher patient satisfaction.