Application Of General Anesthesia Combined With Fascia Iliaca Compartment Block And ThroatSurface Anesthesia In Hip Surgery In The Elderly

ObjectiveTo evaluate the application effect of general anesthesia combined with fascia iliaca compartment block and throat surface anesthesia in hip surgery among the elderly.MethodsA total of 90 senile patients undergoing selective reduction intermal fixation for femoral intertrochanteric fracture were randomly divided into fascia iliaca compartment block group(F group),surface anesthesia group(S group),and fascia iliaca compartment block combined with surface anesthesia group(FS group)according to the random number table.Group F was given ultrasound-guided fascia iliaca compartment block(30 ml of 0.3%ropivacaine),and the patients were then moved to the operating bed,followed by tracheal intubation under intravenous anesthesia.S group was not performed fascia iliaca compartment block,instead,patients were given throat surface anesthesia using lidocaine atomization and tracheal tube coated with lidocaine mucilage,followed by tracheal intubation under intravenous anesthesia.FS group received ultrasound-guided iliac fascial space block(30 ml of 0.3%ropivacaine);thereafter,the patients were moved to the operating bed for surface anesthesia according to the same method in S group,followed by tracheal intubation under intravenous anesthesia.The anesthesia was performed by an associate chief physician who was blind to the experimental protocol.The induction method was as follows:0.2?0.4 ?g/kg sufentanil,intravenous injection of propofol at the rate of lmg/kg/min,which was adjusted to be lmg/kg/h when the patient BIS value reached 40-50;meanwhile,intravenous injection of cisatracurium besylate at the dose of 0.2 mg/kg was also applied,and tracheal intubation was carried out 3 min later.Anesthesia maintenance:continuous intravenous injection of propofol at the rate of 15-200 ?g/Kg/min,remifentanil at the constant rate of 0.05?g/kg/min,sufentanil was applied in the case of insufficient analgesia,and the BIS was maintained at 40-60.Intravenous injection of anesthetics was stopped upon the end of surgery.The mean arterial pressure(MAP)and heart rate(HR)in patients at 5 min after entering the operating room(TO),at the time of moving to the operating bed(Tl),immediately before tracheal intubation(T2),1 min after tracheal intubation(T3),at the time of posil:ion placement(T4),at the time of making skin incision(T5),30 min after beginning the surgery(T6),at the time of extubation(T7),and 30 min after surgery(T8)were recorded.In addition,the fasting blood glucose(FBG)levels at TO,T6,at 7:00 in the morning on day 1 following sxrgery(POD1)and on day 2 after surgery(POD2)were recorded.Besides,the resting and motion VAS scores at T8 and 24 h after surgery;and indexes such as the anesthetic dose,intraoperative vasoactive drug application,awaking and extubation time,coughing and restlessness score,and pharyngalgia,were also recorded.ResultsHemodynamicsDifferences in MAP among three groups at T0,T5 and T6 were not statistically significant.Compared with F group,MAP in FS group and S group at T7 was reduced(P<0.05);and compared with S group,MAP in FS group and F group was lowered at T1 and T8(P<0.05).Compared with TO,MAP in F group at T2 was notably reduced(P<0.05),while that at T7 was remarkably elevated(P<0.05).Compared with TO,MAP in S group at T1 and T8 was evidently elevated(P<0.05).Differences in HR among the three groups at TO and T6 were not statistically significant.Compared with F group,HR in FS group and S group at T3 and T7 was reduced(P<0.05),while that was increased at T2;and compared with S group,HR in FS group and F group was lowered at T1,T4 and T8(P<0.05).Compared with TO,HR in F group at T2 was notably reduced(P<0.05),while that at T7 was remarkably elevated(P<0.05).Compared with TO,HR in S group at T1,T4 and T5 was evidently elevated(P<0.05).Blood glucose levelDifferences in the blood glucose level among three groups were not statistically significant at TO,T6 and POD2.Compared with S group,the blood glucose levels in FS group and F group at PODI were remarkably reduced(P<0.05).The blood glucose levels in each group at T6 and PODI were higher than those at TO,and the differences were statistically significant.VAS scoreCompared with S group,the resting and motion VAS scores in FS group and F group were lowered at T8(P<0.05),and the resting VAS scores in F group and FS group were lower than that in S group 24 h after surgery(P<0.05),Doses of anesthetics and vasoactive drug,awaking and extubation timeCompared with F group and S group,the doses of intraoperative propofol and sufentanil in FS group were notably reduced(P<0.05).Compared with S group,the sufentanil dose in F group was decreased(P<0.05).Differences in the awaking and extubation time among three groups were of no statistical significance.23 cases(76.7%)in F group had applied ephedrine,which was markedly higher than the 4 cases(13.3%)in S group and 3(10.0%)in FS group.No atropine was applied in both groups.Comparison of coughing and restlessness score and pharyngalgiaThe coughing scores among three groups were significantly different(P<0.05).The coughing incidence at extubation in each group was as follows:70.0%(21/30)in F group,16.7%(5/30)in S group,and 13.3%(4/30)in FS group.Compared with F group,the incidence of coughing in FS group and S group showed statistically significant difference(P<0.05).The restlessness scores among three groups were significantly different(P<0.05).The restlessness incidence at extubation in each group was as follows:56.7%(17/30)in F group,20.0%(5/30)in S group,and 16.7%(5/30)in FS group.Compared with F group,the incidence of restlessness in FS group and S group showed statistically significant difference(P<0.05).The incidence of postoperative pharyngalgia in each group was as follows:43.3%(13/30)in F group,20.0%(6/30)in S group,and 26.7%(8/30)in FS group.Compared with F group,the incidence of pharyngalgia in S group and FS group was reduced(P<0.05),while difference between S group and FS group was not statistically significant(P>0.05).ConclusionsFascia lliaca compartment block can alleviate the motion pain and resting pain in patients when moving and changing the body position.A single block can not only lower the intraoperative stress response,but can also provide favorable postoperative analgesia.Intravenous induction alone can suppress the fluctuations in blood pressure and heart rate at the time of tracheal intubation,but it can also lead to hypotenison and reduction in heart rate.Surface anesthesia in the throat can reduce the intravenous anesthetic dose in induction,markedly decrease the hemodynanic fluctuations in tracheal intubation and extubation,and lessen the incidence of restlessness and pharyngalgia.Fascia iliaca compartment block combined with surface anesthesia can exert the advantages of the two,maintain stable hemodynamics,reduce the stress response,lessen the general anesthetic dose,promote better patient awaking,provide favorable postoperative analgesia,and improve patient comfort level.