The Effect Of General Anesthesia Combined With Lumbosacral Plexus Obstruction On Perioperative Stress In Elderly Patients Undergoing Total Hip Replacement

Background The hip fracture is a common clinical disease,because of decreased bone mineral density(BMD)and low immune function,the old people are easy to suffer from hipfracture due to external forces.The hip fracture bring some influenceon for the lives and health of patients.The surgery is a common method of treating hip fracturesat present.The proper stress response can protect organism from hurt.The excessive stress can weakenbody function,especially for the old people.If perioperative stress cannot be controlled at an appropriate level,it will significantly increase the incidence of perioperative complications.Therefore,the importance and urgency of exploring the perioperative stress response of hip fractures for the old people are self-evident.Objective The study uses general anesthesia combined with lumbar plexus block and sacral plexus block under the guidance of ultrasound to explore the effect of the stress response and rehabilitation for the old people who accept total hip replacementbecause of the hip fracture.At the same time,the experimental results provide a reference for the choice of anesthesia method.Methods The 80 old patients who suffer from the femoral neck fractures and require artificial total hip arthroplasty from December 2018 to January 2020 were selected in our hospital.Aged 65-70 years,ASAII-III,weight 55-65 kg,the patients were divided into experimental group(group GN,n = 40)which received general anesthesia combined with nerve block(lumbarplexus and sacral plexus)and control group(group G,n = 40)which received general anesthesia alone.Group GN received nerve block of lumbar plexus and sacral plexus under the guidance of ultrasound after general anesthesia..In group G,nerve block was not treated after general anesthesia.After surgery group GN and group G were treated with 100?g sufentanil and the sufentanil were diluted with physiological saline to 100 ml for PCIA.Mean arterial pressure(MAP)and heart rate(HR)were observed at the moment of 15 min before intubation(T0),the moment of intubation(T1),10 minutes after the beginning of operation(T2),at the end of surgery(T3),6 hours after operation(T4)and 24 hours after operation(T5).The levels of serotonin,cortisol,noradrenaline,gastrin,epinephrine and dopamine in the venous blood were determined and observed at the moment of T0?T2?T3? T4?T5.Duration of operation,the volume of intraoperative fluid,the volume of intraoperative urine,the doses of remifentanil and cis-atracurium besylate in both groups were observed.VAS score,the total postoperative consumption of sufentanil,the time of first compression in using the analgesic pump,total numbers of compressions,PONV score,the first time out of bed,the length of stay and the level of comfort after surgery were observed.Results 1)There were not significant differences in general information between the two groups(P> 0.05).The dose of remifentanil was significantly less in the group GN than the dose of remifentanil in the group G,and the differences were statistically significant(P <0.05)2)The HR at the moment of T0-T1 and the MAP at the moment of T0?T1?T4?T5 in the group GN were similar with that in the group GN,and the differences were not statistically significant(P> 0.05).The levels of HR at the moment of T2-T5 and MAP at the moment of T2-T3 in the group GN were lower than that in the group G,and the differences were statistically significant(P<0.05).The fluctuations of intraoperative HR and MAP in the group GN and the group G were within 20%,and the variation rates of HR and MAP between the group GN and the group G were not statistically different(P> 0.05).3)There were not statistically significant differences in the concentrations of 5-HT,norepinephrine,epinephrine,dopamine,cortisoland gastrin at the moment of T0 between the group GN and the group G(P> 0.05).The concentrations of 5-HT,norepinephrine,epinephrine,dopamine,cortisol and gastrin at the moment of T2-T5 in the group GN were much lower than the concentrations in the group G,and the differences were statistically significant(P <0.05).4)The score of rest VAS in the group GN was lower than the rest VAS in the group G within 6 hours after operation,and there were statistical differences(P<0.05).The differences of the rest VAS in the group GN and the G group were not obvious at the moment of 12 hours and 24 hours after operation,and the difference was not statistically significant(P> 0.05).The scores of active VAS of patients in the group GN were significantly lower at the moment of 12 and 24 hours after operation,and there were statistically significant differences(P <0.05).5)The total amount of sufentanil consumed by patients in the group GN at the moment of 6h,24 h and 48 h after operation was lower than that of the group G patients at 6h,24 h and 48 h after operation,and the differences were statistically significant(P <0.05).6)The time of pressing the analgesia pump for the first time in the group GN was later than that of the group G,and the number of press in the group GN was fewer than that of the group G.the difference were statistically significant(P <0.05).7)The incidence of postoperative severe nausea and vomiting was 2.9% in the group D and 5.4% in group C,respectively.The incidence of postoperative nausea and vomiting(PONV)in the group GN was lower than that in the G group,and the difference were statistically significant(P <0.05)8)The patients in the group GN got out of bed earlier than the group G,and the total bedtime in the group GN was shorter than that in the group G.there were statistical differences(P <0.05).9)The postoperative comfort of patients in the group GN was higher than that in the group G,and there were statistical differences(P <0.05).Conclusion Compared with the traditional general anesthesia alone,general anesthesia combined with lumbar plexus block andsacral plexus block under the guidance of ultrasound for total hip replacement in the old patients significantly makes hemodynamics stabler and reduces the perioperative stress.At the moment of activity and rest,the levels of pain were lower.The total amount of sufentanil consumed was lower.The time of pressing the analgesia pump for the first time was later and the number of press was fewer.The occurrence of postoperative nausea and vomiting complications was lower.The old patients got out of bed and exercised for improving functionas early as possible after operation.