Reduced Concentrations of NSE, S100, A, and Proinflammatory Cytokines in Elderly Patients Receiving Ultrasound-Guided Combined Lumbar Plexus-Sciatic Nerve Block during Hip Replacement.

OBJECTIVE

The increase of hip fractures is related to the aging of the population, which has caused a huge medical burden in many countries. Hip replacement has been approved as a highly successful surgical intervention for the patients with hip fractures. Different anesthesia choices in the surgical intervention are associated with the prognosis of patients. This study focused on investigating the application of ultrasound-guided combined lumbar plexus-sciatic nerve block in elderly patients with hip fractures.

METHODS

In this retrospective study, 62 elderly patients received combined spinal-epidural anesthesia and 58 elderly patients underwent ultrasound-guided combined lumbar plexus-sciatic nerve block during the surgery. Hemodynamic monitoring including pulse oxygen saturation (SpO), heart rate and blood pressure, the assessment of pain intensity using Visual Analogue Scale (VAS), cognitive function assessment through Montreal Cognitive Assessment (MoCA) and biomarkers consisting of serum levels of neuron specific-enolase (NSE), S100 beta protein (S100-), and amyloid beta protein (A), as well as immune function by interleukin-6 (IL-6), interleukin-1 (IL-1), tumor necrosis factor- (TNF-), and high sensitivity C-reactive protein (hs-CRP) were detected in this study. Furthermore, length of hospital stay (LOS) and adverse reactions including hematoma, hypotension, nausea, and vomit were analyzed.

RESULTS

The findings indicated that comparing with the patients receiving combined spinal-epidural anesthesia, those undergoing ultrasound-guided combined lumbar plexus-sciatic nerve block showed significantly lower level of heart rate, higher level of SpO, and lower level of diastolic pressure and systolic pressure at 5 minutes and 30 minutes after anesthesia and after surgery ( < 0.05), indicated obviously lower VAS score at 12, 24, and 48 hours after surgery ( < 0.05), and revealed higher MoCA score at 12 days after surgery ( < 0.05). A significantly higher level of NSE, S100, A, IL-6, IL-1, TNF- and hs-CRP was revealed in the two groups receiving different anesthesia methods at 10 days after surgery compared with that before surgery ( < 0.05). However, the patients receiving ultrasound-guided combined lumbar plexus-sciatic nerve block had obviously lower expression of NSE, S100, A, IL-6, IL-1, TNF- and hs-CRP compared with the group accepting combined spinal-epidural anesthesia ( < 0.05). The two groups indicated no significant difference in incidence of hypotension and vomit, etc. ( < 0.05), but showed remarkable difference referring to total incidence of adverse reactions and LOS ( < 0.05).

CONCLUSION

The application of ultrasound-guided combined lumbar plexus-sciatic nerve block in hip replacement contributes to the stability of hemodynamics and alleviation of postoperative pain intensity. It can reduce cognitive and immune impairment of the elderly patients with hip fractures.