de Visme V, Picart F, Le Jouan R, Legrand A, Savry C, Morin V
Department of Anesthesia, Centre Hospitalier de Cornouaille, Quimper, France.
Reg Anesth Pain Med. 2000 Mar-Apr;25(2):158-62. doi: 10.1053/rapm.2000.0250158.
This prospective randomized study was designed to determine the hemodynamic effects and quality of combined lumbar and sacral plexus block compared with plain bupivacaine spinal anesthesia in the elderly for repair of proximal femoral fractures.
Twenty-nine elderly patients ranging in age from 68 to 97 years were randomly assigned to 2 groups: a spinal anesthesia group with single-shot 3 mL 0.5% plain bupivacaine, and a combined block group with 30 mL lidocaine 1.33% with epinephrine for the posterior lumbar plexus block and 10 mL same mixture for the parasacral block and an iliac crest block with 5 mL lidocaine 1%.
No need for general anesthesia was encountered in either group. Anesthesia was judged unsatisfactory in 1 of 15 patients in the combined block group. The initial decrease of mean arterial pressure was 38% in the spinal group and 27% in the block group and was not significantly different. A more prolonged hemodynamic effect was found in the spinal group, indicated by the more frequent use of ephedrine to stabilize blood pressure (P<.05). Patients over 85 years had a significantly larger decrease in blood pressure than younger patients (P<.01).
Plain bupivacaine spinal anesthesia and combined lumbar/sacral plexus block provided adequate anesthesia for repair of hip fracture in the elderly. Hypotension was induced by both the combined peripheral nerve block and plain bupivacaine spinal anesthesia in aged patients; hypotension was found to be longer lasting after spinal anesthesia and of a larger magnitude in patients over 85 years of age.
本前瞻性随机研究旨在确定老年患者股骨近端骨折修复术中，腰丛联合骶丛阻滞与单纯布比卡因脊麻相比的血流动力学效应及麻醉质量。
29例年龄在68至97岁之间的老年患者被随机分为两组：一组为单次注射3 mL 0.5%单纯布比卡因的脊麻组，另一组为联合阻滞组，其中后腰丛阻滞使用含肾上腺素的1.33%利多卡因30 mL，骶旁阻滞及髂嵴阻滞使用相同混合液10 mL及1%利多卡因5 mL。
两组均未出现需全身麻醉的情况。联合阻滞组15例患者中有1例麻醉效果不满意。脊麻组平均动脉压初始下降38%，联合阻滞组为27%，差异无统计学意义。脊麻组血流动力学效应持续时间更长，表现为麻黄碱用于稳定血压的频率更高（P<0.05）。85岁以上患者血压下降幅度明显大于年轻患者（P<0.01）。
单纯布比卡因脊麻和腰丛联合骶丛阻滞为老年患者髋部骨折修复提供了充分的麻醉。老年患者中，联合外周神经阻滞和单纯布比卡因脊麻均可诱发低血压；脊麻后低血压持续时间更长，且85岁以上患者低血压幅度更大。
