Effect of Ultrasound-guided Iliofascial Space Block Combined with Combined Lumbar and Epidural Anesthesia in Elderly Patients Undergoing Hip Joint Surgery

XU Rui; ZHENG Kang

doi:10.14033/j.cnki.cfmr.2024.01.004

Abstract：To investigate the effect of ultrasound-guided iliofascial space block combined with combined lumbar and epidural anesthesia in elderly patients undergoing hip joint operation.Method:A total of 102 patients who received hip joint operation in Nanjing City Pukou District Traditional Chinese Medicine Hospital from January 2021 to April 2023 were selected as the study objects,patients received hip replacement or reduction internal fixation.According to random number table method,the patients were divided into control group and observation group,with 51 cases in each group.The control group was given combined lumbar and epidural anesthesia,and the observation group was given ultrasound-guided iliofascial space block on the basis of combined lumbar and epidural anesthesia.The mean arterial pressure,heart rate,postoperative analgesic medication[postoperative Sufentanil dosage,intravenous patient-controlled analgesia(PCIA)start pressing time and pressing times],stress response indicators[superoxide dismutase(SOD),advanced oxidation protein products(AOPP),glutathione peroxidase(GSH-Px),malondialdehyde(MDA)],visual analogue scale(VAS)score,mini-mental state examination(MMSE),central nervous system specific protein(S100-β),β-amyloid protein 1-40(Aβ1-40)levels,adverse reactions and satisfaction were compared between two groups.Result:There were no significant differences in mean arterial pressure and heart rate between two groups before anesthesia,at the beginning of operation and at the end of operation(P>0.05);the mean arterial pressure and heart rate in the observation group at the subarachnoid block position were lower than those in the control group,and the differences were statistically significant(P<0.05).The postoperative Sufentanil dosage in the observation group was less than that in the control group,the time of PCIA start pressing was later than that in the control group,and the PCIA pressing times was less than that in the control group,the differences were statistically significant(P<0.05).The levels of SOD and GSH-Px in the observation group at 5 d after operation were higher than those in the control group,and the levels of AOPP and MDA were lower than those in the control group,the differences were statistically significant(P<0.05).The VAS scores of the observation group at 12 h,1 d and 3 d after operation were lower than those of the control group,and the differences were statistically significant(P<0.05).The MMSE scores of the observation group at 6 h,1 d and 2 d after operation were higher than those of the control group,and the differences were statistically significant(P<0.05).The levels of S100-β and Aβ1-40 in the observation group at 6 h and 1 d after operation were lower than those in the control group,and the differences were statistically significant(P<0.05).The incidence of adverse reactions in the observation group was lower than that in the control group,and the total satisfaction was higher than that in the control group,the differences were statistically significant(P<0.05).Conclusion:The use of ultrasound-guided iliofascial space block combined with lumbar epidural anesthesia in undergoing hip joint operation can improve the mean arterial pressure and heart rate indexes during anesthesia,reduce the dosage of postoperative analgesics,alleviate the body's stress response,reduce postoperative pain,improve postoperative cognitive function,reduce the incidence of complications,and increase the satisfaction rate.