| Objective:To explore the effect of general anesthesia and general anesthesia combined with lower extremity nerve block on the postoperative cognitive function of elderly patients after total knee replacement?TKA?.By comparing the two groups of anesthesia,we will find a more safe and effective anesthesia for the elderly patients with TKA,and we will provide theoretical guidance for the clinical anesthesia of such patients,so as to achieve the role of neuroprotection.Methods:From January 2019 to June 2019,80 elderly patients who were admitted to the joint surgery department of the Affiliated Hospital of Qingdao University to undergo total knee arthroplasty?TKA?were selected as the study subjects,all of whom were aged 65?75years and ASA was classified as grade I?II.According to different anesthesia methods,all patients were divided into two groups,group A and group B,40 patients in each group.Patients in group A were anesthetized by general anesthesia combined with lower extremity nerve block?adductor tube block+IPACK block?,while patients in group B were anesthetized by general anesthesia alone.After entering the room,vital signs were monitored,oxygen was inhaled by mask for 2 L/min,radial artery puncture was performed,and vein channel of upper limb was opened.The patients in the Group A of the affected limb received 0.375%ropivacaine for 20 ml,ultrasound-guided adductor tube block and IPACK block respectively before anesthesia induction.Ten minutes after the injection,the anteromedial patella,the middle medial crus,the area around the medial malleolus?innervated by the saphenous nerve?,the posterior area of the knee joint?innervated by the common peroneal nerve,the tibial nerve and the obturator nerve joint branch?were tested for temperature sense and light touch respectively.If the temperature sense or light touch decreased,the block was successful.After anesthesia induction and anesthesia maintenance,the vital signs were kept stable during the operation.In group B,anesthesia induction and maintenance were performed directly,and vital signs were kept stable during operation.At the end of the operation,the infusion of propofol was stopped and the intravenous analgesia pump was connected.Observation index record including as follow:?1?The mean arterial pressure?MAP?,heart rate?HR?,end-expiratory carbon dioxide partial pressure?PetCO2?,pulse oxygen saturation?SpO2?and bispectral index?BIS?were recorded at the beginning of the operation?t0?,15 minutes after operation?t1?,30 minutes after operation?t2?,60 minutes after operation?t3?and at the end of operation?t4?.?2?The visual analogue scores?VAS?of the two groups were recorded.?3?The dosage of propofol and sufentanil and the time of extubation were recorded.?4?MMSE score was used to evaluate cognitive function 1 day before operation,1 day after operation,3 days after operation and 5 days after operation.Meanwhile the cases of postoperative cognitive dysfunction?POCD?was recorded.Record the occurrence of intraoperative awareness,and the occurrence of nerve injury related to lower limb nerve block puncture.Results:There was no significant difference between the two groups in general baseline data such as gender,age,height,weight,body mass index?BMI?and personal history?P>0.05?;There was no significant difference in MAP,HR,PetCO2 and SpO2 between the two groups at t0,t1,t2,t3 and t4;The BIS values of group A at t0,t1,t2,t3 and t4 were significantly higher than those of group B?P<0.05?;In the comparison of VAS of 1 day after operation,the score of group A was significantly lower than that of group B?P<0.05?;during the operation,the difference of propofol dosage,sufentanil citrate dosage and awake extubation time between the two groups was statistically significant?P<0.05?;In the comparison of MMSE on the 1 day before operation,3 day after operation and 5day after operation,there were no significant difference?P>0.05?.In the comparison of MMSE on the first day after operation,the score of group A was significantly higher than that of group B?P<0.05?;The MMSE score of group B in the 1 day after operation was significantly lower than that before the operation?P<0.05?;The incidence of POCD in group A was significantly lower than that in group B?P<0.05?.During the operation,there was no intraoperative knowledge and no nerve injury related to lower limb nerve block puncture.Conclusion:Compared with general anesthesia alone,general anesthesia combined with lower limb nerve block anesthesia has less impact on cognitive function,reducing the incidence of cognitive dysfunction. |
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