Influence of ultrasound guided nerve block combined with sevoflurane laryngeal mask general anesthesia on perioperative stress and occurrence of postoperative delirium in elderly patients with hip fractures

Bai Wenjuan; Yue Huiyu; Dang Shajie

doi:10.3760/j.issn.1673-4777.2025.02.017

Abstract：Objective To explore the influence of ultrasound guided peripheral nerve block combined with sevoflurane laryngeal mask general anesthesia on perioperative stress and occurrence of postoperative delirium in elderly patients with hip fractures.Methods A total of 266 elderly patients with hip fracture admitted to Yan'an University Affiliated Hospital from January 2020 to June 2023 were prospectively selected and divided into group A and group B by envelope method,with 133 cases in each group.Group A was given laryngeal mask ventilation and sevoflurane inhalation general anesthesia,while group B was given ultrasoundguided peripheral nerve block combined with sevoflurane laryngeal mask general anesthesia.The changes in stress indicators levels[cortisol,superoxide dismutase(SOD),angiotensin-Ⅱ(Ang-Ⅱ)]and visual analogue scale(VAS)scores at 5 min before operation and 2,12,24 h after operation,and Mini-Mental State Examination(MMSE)score and delirium occurrence on the 1st,2nd and 3rd day after operation were compared between the two groups.The occurrence of perioperative adverse reactions was recorded.Results The levels of cortisol,Ang-Ⅱ and SOD at 2,12 and 24 h after operation in both groups were higher than those at 5 min before operation but the levels in group B were lower than those in group A in each time point(all P＜0.05).At 2,12 and 24 h after operation,the VAS scores of the two groups were lower than those at 5 min before operation,and the VAS scores of group B were lower than those of group A at each time point(all P＜0.05).The MMSE scores of group B were higher than those of group A on the 1st,2nd and 3rd day after operation[(20±5)vs(18±4),(21±5)vs(19±4),(24±4)vs(21±5)],and the incidences of delirium were lower than those of group A(all P＜0.05).The incidences of intraoperative hypotension,restlessness during recovery and respiratory depression in group B were lower than those in group A(all P＜0.05).Conclusion Ultrasoundguided peripheral nerve block combined with sevoflurane laryngeal mask general anesthesia is more conducive to reducing postoperative stress and pain in elderly patients with hip fracture,and has positive significance in reducing the incidence of postoperative delirium,intraoperative hypotension and restlessness during recovery.