Mei Bin, Zha Hanning, Lu Xiaolong, Cheng Xinqi, Chen Shishou, Liu Xuesheng, Li Yuanhai, Gu Erwei
Department of Anesthesiology, First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, China.
Clin J Pain. 2017 Dec;33(12):1053-1059. doi: 10.1097/AJP.0000000000000502.
Peripheral nerve block combined with general anesthesia is a preferable anesthesia method for elderly patients receiving hip arthroplasty. The depth of sedation may influence patient recovery. Therefore, we investigated the influence of peripheral nerve blockade and different intraoperative sedation levels on the short-term recovery of elderly patients receiving total hip arthroplasty.
Patients aged 65 years and older undergoing total hip arthroplasty were randomized into 3 groups: a general anesthesia without lumbosacral plexus block group, and 2 general anesthesia plus lumbosacral plexus block groups, each with a different level of sedation (light or deep). The extubation time and intraoperative consumption of propofol, sufentanil, and vasoactive agent were recorded. Postoperative delirium and early postoperative cognitive dysfunction were assessed using the Confusion Assessment Method and Mini-Mental State Examination, respectively. Postoperative analgesia was assessed by the consumption of patient-controlled analgesics and visual analog scale scores. Discharge time and complications over a 30-day period were also recorded.
Lumbosacral plexus block reduced opioid intake. With lumbosacral plexus block, intraoperative deep sedation was associated with greater intake of propofol and vasoactive agent. In contrast, patients with lumbosacral plexus block and intraoperative light sedation had lower incidences of postoperative delirium and postoperative cognitive decline, and earlier discharge readiness times. The 3 groups showed no difference in complications within 30 days of surgery.
Lumbosacral plexus block reduced the need for opioids and offered satisfactory postoperative analgesia. It led to better postoperative outcomes in combination with intraoperative light sedation (high bispectral index).
外周神经阻滞联合全身麻醉是老年髋关节置换术患者较为理想的麻醉方法。镇静深度可能会影响患者的恢复。因此，我们研究了外周神经阻滞和不同术中镇静水平对老年全髋关节置换术患者短期恢复的影响。
年龄≥65岁行全髋关节置换术的患者被随机分为3组：单纯全身麻醉无腰骶丛阻滞组，以及2个全身麻醉加腰骶丛阻滞组，每组镇静水平不同（浅或深）。记录拔管时间及术中丙泊酚、舒芬太尼和血管活性药物的用量。分别采用意识模糊评估法和简易精神状态检查表评估术后谵妄和术后早期认知功能障碍。通过患者自控镇痛药物用量和视觉模拟评分评估术后镇痛效果。记录出院时间和30天内的并发症情况。
腰骶丛阻滞减少了阿片类药物的用量。采用腰骶丛阻滞时，术中深度镇静与丙泊酚和血管活性药物用量增加有关。相比之下，腰骶丛阻滞且术中浅镇静的患者术后谵妄和术后认知功能下降的发生率较低，出院准备时间较早。3组患者术后30天内并发症无差异。
腰骶丛阻滞减少了阿片类药物的需求，提供了满意的术后镇痛效果。与术中浅镇静（高脑电双频指数）联合使用可带来更好的术后结果。
