Effect Of Balanced Spinal Anesthesia On Early Postoperative Activity In Patients With Joint Replacement

Objective: To observe the clinical effect of balanced spinal anesthesia in promoting early active activity after joint replacement surgeryMethods:A total of 84 elderly patients who received unilateral hip and knee replacement under spinal anesthesia in the Affiliated Hospital of Yan ’an University from April 2022 to March 2023 and met the inclusion criteria were selected,3patients with intraoperative alteration of anesthesia were excluded,1 patient refused to use PCIA after surgery,and 1 patient suffered fracture after surgery.A total of 5patients were excluded,and 79 patients were finally included.They were randomly assigned to the room temperature group and the warmed group.The room temperature group(control group)was treated with(22.0 ～ 25.0℃)1% ropivacaine1.0 ml(10 mg)+ cerebrospinal fluid 1.0 ml.Warmed group(experimental group):(36.0 ～ 37.5℃)1% ropivacaine 1.0 ml(10 mg)+ 1.0 ml cerebrospinal fluid.The proportion of the affected limb muscle strength of grade IV or above 3 hours after anesthesia(%),the time to restore normal muscle strength after anesthesia(h),the first active turn over time after surgery(h),the active limb activity after surgery,and the influence on the rapid recovery of patients in each group were compared.Results:The recovery time of muscle strength in the warmed group was shorter than that in the room temperature group(4.1 h VS 7.3 h),and there was a statistically difference(P < 0.05).The proportion of grade IV and above muscle strength in the affected side at 3h after anesthesia was 48.7% in the warmed group,which was higher than that in the room group(27.5%),with no statistical difference(P > 0.05).The onset time of sensory nerve block,plane fixation time and sensory duration in the warmed group were shorter than those in the room temperature group,and the difference was statistically significant(P < 0.05).Fixed anesthesia plane: The anesthesia plane of the two groups was mainly concentrated at the T10 and T12 levels,and there was no statistical difference(P > 0.05).Onset of motor nerve block:The onset time of motor block in warmed group was earlier than that in room temperature group(2 min VS 3 min),with statistical difference(P < 0.05).The muscle strength score at the time of leaving the room was statistically different(P <0.05).The proportion of patients with grade IV and V in the warmed group(38.5%)was higher than that in the room temperature group(17.5%).Muscle release score:The proportion of "satisfied with muscle release(muscle release score ≥8 points)" in the warmed group was 72% higher than that in the room temperature group was45%,and the difference between the two groups was statistically significant(P <0.05).Systolic blood pressure,diastolic blood pressure and heart rate showed the same fluctuation trend,there were no statistically significant difference(P > 0.05).The first time of turning over was 3.0 h in the warmed group and 4.4h in the room temperature group,with statistical significance(P < 0.05).Number of spontaneous turning over in bed and active exercise of affected limb within 6h after surgery:higher in the warmed group than that in the room temperature group,with statistical significance(P < 0.05).The active flexion Angle of knee joint in the warmed group(70(60,80)°)was greater than that in the normal temperature group(52.5(43.8,71.3)°)at 6 hours after anesthesia,and there was a statistically significant difference(P < 0.05).However,there was no significant difference at 24 h after anesthesia(P > 0.05);VAS scores at rest and exercise in the warmed group were significantly lower than those in the room temperature group,there was a statistically significant difference(P < 0.05).First drinking time: Compared with the room temperature group(2.0(1.2,3.9)h),the warmed group(1.3(1.0,1.8)h)drank earlier,with statistical significance(P < 0.05).First feeding time after surgery: there was no significant difference between the two groups(P > 0.05).Length of stay: There was no statistical significance between the two groups(P = 0.05),but the length of stay in the warmed group tended to shorten compared with the room temperature group(9 d VS 12 d).Conclusion: Balance spinal anesthesia technique used in joint replacement surgery,postoperative patients with muscle recovery time shortened,on the basis of meet the requirements of the operation,sensory and motor work fast,can alleviate patients postoperative pain at the same time,to promote the purpose of early exercise,actively promote speeding recovery.