Application Of Ultrasound-guided Anterior Iliopsoas Space Block In Hip Surgery In Elderly Patients

BackgroundCurrently,ultrasound-guided lumbar plexus block is widely used for the perioperative analgesia of hip fracture operation.However,traditional posterior lumbar plexus block may cause discomfort such as increased pain when patients turn over.The authors proposed a new method to avoid turning over,anterior iliopsoas muscle space block in supine position.The authors hypothesized that this method would provide equal analgesia for hip operation,and compared it with the traditional posterior lumbar plexus block in this study.MethodsIn this randomized,single-blind,parallel-group,single-center study,27 elderly patients scheduled for unilateral hip fracture operation were included in the analysis.The experimental group(anterior iliopsoas space group,n=15,67.87 +2.695 years old)received ultrasound-guided anterior iliopsoas space block with 0.33% ropivacaine 30 mL,while the control group(posterior lumbar plexus group,n=12,76.67 +2.775 years old)received ultrasound-guided posterior lumbar plexus block with 0.33% ropivacaine 30 mL.The sacral plexus was blocked ultrasound-guided by lateral approach with 0.33% ropivacaine 30 mL in supine position in both groups.After the onset of nerve block,2 mg/kg propofol and 0.5 mg/kg fentanyl were given intravenous induction and 4# Ambu laryngeal mask was implanted.Sevoflurane inhalation anesthesia was given during the operation to maintain the end-of-breath concentration of 0.7 MAC.After spontaneous breathing was restored,fentanyl was administered intravenously when the patient’s breathing frequency was more than 20 times per minute.The main observation index was the dose of fentanyl after induction,and the secondary index was the VAS score during recovery after anesthesia.ResultsThe dosage of fentanyl that was used after induction during the operation made no difference between two groups(22.67 ± 4.827 μg vs 20.83 ± 7.829 μg).The VAS score at awakening from anesthesia was less in the anterior Iliopsoas space group than in the posterior lumbar plexus group(1.000 ± 0.4024 vs 2.500 ± 0.5573,P < 0.05).ConclusionsUltrasound-guided anterior iliopsoas muscle space block and posterior lumbar plexus block have the same analgesic effect in elderly hip fracture surgery,but the VAS score at awakening is lower than that of the latter,which can provide sufficient perioperative analgesia for such surgery.