Department of Anaesthesiology, Nuclear Industry 215 Hospital of Shaanxi Province, Shaanxi, People's Republic of China; Department of Anaesthesiology, Xidian Group Hospital, Shaanxi, People's Republic of China.
Department of Anaesthesiology, Nuclear Industry 215 Hospital of Shaanxi Province, Shaanxi, People's Republic of China.
Pain Physician. 2024 Jul;27(5):E579-E587.
Hip fracture surgeries in elderly patients often require spinal or general anesthesia, posing risks of severe hypotension and inadequate pain management. The optimal anesthesia type for minimizing these risks remains undetermined. Preliminary studies suggest that a combination of fascia iliaca block (FIB) and low-dose low-specific-gravity spinal anesthesia (LLSA) might offer a solution, but comprehensive evidence is lacking.
This study aimed to assess the efficacy of combining FIB with LLSA for reducing severe hypotension and enhancing analgesia during hip fracture surgery in elderly patients.
A prospective, randomized controlled trial was conducted.
An operating theatre of a tertiary hospital.
The study comprised 68 patients. They were separated into 2 equal parallel groups 34 patients each: the FIB+LLSA group and the general anesthesia (GA) group. Patients aged 75-96 undergoing primary hip arthroplasty for hip fracture were randomized to receive either FIB+LLSA or GA. The primary outcome was the incidence of severe hypotension; secondary outcomes included postoperative pain, use of rescue analgesia, vasopressor dosage, and complications.
We found a significantly lower incidence of severe hypotension in the FIB+LLSA group compared to the GA group (32.4% vs 67.6%). Additionally, postoperative pain scores were significantly lower, and the need for rescue analgesia was reduced in the FIB+LLSA group. Vasopressor use during surgery was also significantly lower in the FIB+LLSA group. The hospital stay was shorter in the FIB+LLSA group, with an average of 5.9 days compared to 6.7 days in the GA group.
The study's limitations include its single-center nature, which may limit the generalizability of the findings. Additionally, the inability to conduct a double-blind study could introduce biases, though measures were taken to minimize this. The sample size might not be sufficient to determine the broader implications of LLSA.
Combining FIB with LLSA for elderly patients undergoing hip fracture surgery significantly reduces the incidence of severe intraoperative hypotension and postoperative pain. It also decreases the need for rescue analgesia and shortens hospital stays, suggesting that FIB+LLSA could be a beneficial regional anesthesia technique for elderly hip fracture surgery patients, aligning with enhanced recovery protocols.
老年患者髋关节骨折手术通常需要脊髓或全身麻醉，这会带来严重低血压和疼痛管理不足的风险。为了将这些风险降至最低，最佳的麻醉类型仍未确定。初步研究表明，腹横肌平面阻滞（TAPB）联合小剂量轻比重腰麻（LLSA）可能是一种解决方案，但缺乏全面的证据。
本研究旨在评估 TAPB 联合 LLSA 用于减少老年髋关节骨折手术中严重低血压和增强镇痛的效果。
前瞻性、随机对照试验。
一家三级医院的手术室。
研究纳入 68 名患者。将他们分为两组，每组 34 名患者：TAPB+LLSA 组和全身麻醉（GA）组。接受初次髋关节置换术治疗髋关节骨折的 75-96 岁患者被随机分为 TAPB+LLSA 或 GA 组。主要结局是严重低血压的发生率；次要结局包括术后疼痛、需要使用解救性镇痛、血管加压药剂量和并发症。
与 GA 组相比，TAPB+LLSA 组严重低血压的发生率明显更低（32.4% vs 67.6%）。此外，TAPB+LLSA 组术后疼痛评分明显更低，需要使用解救性镇痛的情况也更少。TAPB+LLSA 组术中使用血管加压药的情况也明显更低。TAPB+LLSA 组的住院时间更短，平均为 5.9 天，而 GA 组为 6.7 天。
研究的局限性包括其单中心性质，这可能限制了研究结果的普遍性。此外，无法进行双盲研究可能会引入偏倚，尽管已经采取了措施来尽量减少这种情况。样本量可能不足以确定 LLSA 的更广泛影响。
对于接受髋关节骨折手术的老年患者，TAPB 联合 LLSA 可显著降低术中严重低血压和术后疼痛的发生率。它还减少了解救性镇痛的需求，并缩短了住院时间，这表明 TAPB+LLSA 可能是老年髋关节骨折手术患者有益的区域麻醉技术，符合加速康复方案。
