| Background:Ultrasound-guided nerve block has been widely used in various types of surgical anesthesia.Compared with the traditional blind puncture nerve block,ultrasound-guided nerve block is safer and more efficient.Studies have shown that ultrasound-guided iliac fascia block can specifically block the innervated nerves in the surgical area,stabilize the intraoperative vital signs,facilitate the early recovery of patients,reduce the dosage of opioid anesthetic drugs and thus reduce the adverse reactions.However,current studies at home and abroad mainly focus on the influence of iliac fascial block combined with general anesthesia on patients'intraoperative vital signs,and the postoperative hemodynamics of patients with iliac fascial block combined with general anesthesia is still unclear.Objective:To study the postoperative hemodynamic changes,postoperative pain scores,intraoperative use of anesthetic drugs,and postoperative nausea and vomiting in elderly patients undergoing hip replacement under ultrasound-guided iliac fascial block combined with general anesthesia,and to compare them with patients undergoing general anesthesia alone.To investigate the effect of ultrasound-guided iliac fascia block combined with general anesthesia on perioperative management of patients.Methods:This study selected 40 elderly patients who were hospitalized in the second Department of the first affiliated Hospital of Dalian Medical University from October2018 to January 2019 for total hip replacement.The ASA(American Society of Anesthesiologists)will be graded as I-III,ranging from 65 to 90 years old,and the BMI(Body Mass Index)will be 18.6~29.7 kg/m~2.Patients were randomly divided into two groups:general anesthesia group(A)and iliac fascial block combined with general anesthesia group(B),with 20 patients in each group.Preoperative visits were conducted by anesthesiologists for patients in each group to explain their conditions to the patients,and the patients agreed to anesthesia after understanding their conditions and signed the informed consent for anesthesia.Intraoperative anesthesia was performed by the same anesthesiologist in all patients,and the surgery was performed by the same group of surgeons.Normal induction of general anesthesia was performed in group A,and 30ml of ropivacaine(0.3%)was given to iliac fascia block in group B before induction of general anesthesia.Patients in both groups were only maintained by intravenous anesthesia.Intraoperative BIS(bispectral index of EEG)value was controlled between 40 and 60 to ensure stable intraoperative vital signs and stable respiratory circulation.On the basis of sufficient sedation and analgesia.If intraoperative blood pressure fluctuations exceed 20%of preoperative blood pressure.Vasoactive drugs can be used for regulation.Observe and record the maximum and minimum systolic blood pressure,diastolic blood pressure and heart rate after the patient enters the operating room for 20 minutes(T0)and during the operation(T1).Intraoperative total dosage of propofol,sufentanil and remifentanil.At the same time record the operation time,intraoperative fluid intake and output volume,intraoperative bleeding volume,intraoperative blood transfusion.After recovery,the patient was sent to the anesthesia recovery room for 20-30 minutes for observation,and returned to the ward with VAS?4.SBP,DBP,HR,Visual Analogue Scale(VAS),postoperative VAS,postoperative nausea and vomiting,and postoperative delirium were observed and recorded at 0.5h(T2),6h(T3),and 20h(T4)after the operation.All the scores of the above patients were performed by the same anesthesiologist,who was not clear about the patient's anesthesia mode and specific conditions.Results:1.Comparison of systolic blood pressure between group A and group B:0.5 h after surgery,SBP in group A was higher than that in group B,showed statistically significant difference(P<0.001);6 h after surgery,SBP in group A was higher than that in group B,showed statistically significant difference(P<0.001).2.Heart rate comparison between group A and group B:6 hours after surgery,HR in group A is higher than that in group B,showed statistically significant difference(P<0.001).3.Comparison of resting VAS scores between group A and group B:6 hours after surgery,The score of group A was higher than that of group B,showed statistically significant difference(P<0.001).4.The VAS scores after the activities in group A and group B were compared:0.5h after the operation,The score of group A was higher than that of group B,showed significant statistical significance(P<0.001).At 6 hours after surgery,The score of group A was higher than that of group B,was statistically significant(P<0.001).At12 hours after surgery,The score of group A was higher than that of group B,was statistically significant(P<0.001).5.Compared with group B,the intraoperative use of propofol,remifentanil and sufentanil in group A was significant(P<0.05).6.Neither group had postoperative delirium.Conclusion:Compared with the general anesthesia group,the elderly patients in the iliac fascia block combined with general anesthesia group had stable postoperative blood pressure and heart rate,which was conducive to the stable and safe perioperative period of the elderly patients,in line with the concept of rapid recovery.In addition,in the iliac fascial block combined with general anesthesia group,the postoperative pain score after rest and activity is small,intraoperative opioids and intravenous anesthetic dosage are reduced,and the postoperative analgesic effect is better and the satisfaction is higher than that of general anesthesia alone,which is worthy of clinical promotion. |
PDF Full Text Request