The Clinical Application Of Ultrasound-guided Two-point Lumbar Paravertebral Injection Combined With Sacral Plexus Block In Total Hip Replacement For Elderly Patients

Objective:Objective to investigate the anesthetic effect of ultrasound-guided two-point lumbar paravertebral injection combined with sacral plexus block for total hip replacement in elderly patients.Methods:Selection in our hospital from January 2018 to October 2018 after undergoing elective total hip replacement patients with lateral approach,ASA?^?level,age 70 and older,or female,in accordance with the standards of selection design after screening,on the basis of the operation sequence number,number into the experimental group?group A?,dual number into the control group?group B?,30 cases in each group.The patients were aged between 70 and 91 years old,including 23males and 37 females.group A:Ultrasound-guided T12-L1 and L3-4 two-point lumbar paravertebral injection group,group B:ultrasound-guided single-point L3-4lumbar intermuscular space lumbar plexus block group.The VAS scores of patients in the two groups at the time of entering the operating room?T₀?,at the time of positioning?T₁?,at the time of skin incision?T₂?,at 5min?T₃?,12h?T₄?and 24h?T₅?aftertheoperationwererecorded.Anesthesiasatisfactionratingwas recorded.Intraoperative dosages of sufentanil were recorded.The MAP and HR values were recorded at the time of admission?T?₀?,5min after anesthesia?T?₁?,the time of skin incision?T?₂?,30min at the beginning of surgery?T?₃?,and 5min after surgery?T?₄?.Adverse reactions including local anesthetic poisoning,dizziness,headache,nausea,vomiting,bilateral block and postoperative urinary retention were recorded.Results:1.Anesthetic effect:in the comparison of VAS assessment between groups,the VAS score of group A was lower than that of group B?P<0.05?at the time of curettage?T₂?,5min after surgery?T₃?,12h after surgery?T₄?and 24h after surgery?T₅?at the time of curettage?T₂?,and the VAS score at other time points was not statistically significant between the two groups?P>0.05?.The anesthesia satisfaction rating of group A was better than that of group B?P<0.01?.Intraoperative sufentanil dosage in group A was less than that in group B?P<0.01?.2.Hemodynamic status:there was no significant difference in MAP and HR between the two groups?P>0.05?.For intra-group comparison,in group A,MAP was higher at T?₀,T?₁,T?₂than at T?₃,T?₄,with statistical difference?P<0.05?.In group B,MAP was higher at T?₀,T?₁than at T?₄,with statistical difference?P<0.05?.There was no significant difference in HR between group A and group B?P>0.05?.3.Occurrence of adverse reactions:there was no statistically significant difference in the incidence of adverse reactions between the two groups?P>0.05?.Conclusion:Compared with traditional single-point lumbar intermuscular lumbar plexus block combined with sacral plexus block for total hip arthroplasty in elderly patients,ultrasound-guided two-point lumbar paravertebral injection combined with sacral plexus block can effectively reduce the intraoperative dose of sufentanil,with better intraoperative and postoperative analgesic effects and higher anesthesia satisfaction of patients.