Clinical Application Of Lumbar Plexus Combined General Anesthesia In Elderly Hip Replacement

Objective To investigate the effects of combined lumbar plexus block with general anesthesia on hemodynamics.Methods Sixty ASA Ⅱ～Ⅲ,aged 65 to 85 years patients who scheduled for single hip arthroplasty under general anesthesia were randomly divided into two groups(A and B).And the group A patients only apply general anesthesia.During the operation,propofol,remifentanil,and sevoflurane were used to maintain anesthesia.And the group B guided by nerve stimulator to receive lumber plexus block with 0.5%ropivacaine 4ml/kg combined with general anesthesia.Postoperatively,Group A had self-controlled intraveno us administration of sufentanil to relieve pain.Group B used administrated 0.5%ropivacaine though indwelling catheter by themselves.Two groups of patients were treated for relieving pain for 48 hours.Recorded the mean arterial pressure(MAP)and the heart rate(HR)after admission to operating room(T0),the beginning of surgery(T1),reaming(T2),immediately after the surgery was completed(T3),30min(T4).Recorded the data of the Resting Visual Analogue Scale(RVAS)and Initiative Visual Analogue Scale(IVAS)score in4,8,12,24 and 48hours,other adverse reactions and Length of hospital stay.Result In group B,Ti compared with T0 the MAP and HR had reduced(P<0.05).T2,T3,T4 compared with To and T1-T4 compared with each other there was no statistically significant difference.In group A,compared with theT0,T1 and T2 the MAP and HR had higher(P<0.05).T3,T4,compared with T2 MAP and HR had reduced(P<0.05).Compared with the T1-T3 in group A higher MAP than group B(P<0.05).The RVAS scores at 4h,8h,12h,24h,and 48h in group A were 3.11±0.57、4.87=10.85、5.27±0.74、4.15±0.77、3.29±0.61,and in group B were2.17±0.58,3.15±0.75,3.64±0.95,3.26±0.84,and 2.07±0.58,there was statistically significant difference(P<0.05).The IVAS scores in group A were 3.90±0.71、4.93±0.78、5.20±0.76、4.33±0.75、3.80±0.71and in group B were3.20±0.61、4.36±0.76、4.43±1.04、3.56±0.93、3.30±0.65.There were 3 cases of adverse reactions such as nausea,vomiting and pruritus in group B and 19 cases in group A,there were significantly more in groupA than in group B(P<0.05).Postoperative hospital stayB was 5.4±1.1 and group A was 6.9±1.6,There was a statistically significant difference(P<0.05).Conclusion Combined use of nerve stimulators under lumbar plexus block combined general anesthesia provides better hemodynamic stability in older hip replacements,Pos toperative continuous lumbar plexus nerve block was more effective than intravenous self-control analgesia,reducing postoperative adverse reactions and shortening hospital stay.