背景:当禁用神经轴麻醉时,复合麻醉可能是髋关节手术的一种有希望的选择。腰骶丛阻滞,股神经和股外侧皮(LFC)神经阻滞联合全身麻醉(GA)通常用于老年患者进行髋部骨折手术的关节置换术。然而,没有研究在围手术期比较这两种麻醉策略。
方法:将41例老年髋部骨折患者随机分为A组(n=20)和B组(n=21)。A组接受股神经阻滞,LFC神经阻滞,GA,B组接受腰丛神经阻滞,骶丛阻滞,GA。主要结果是血流动力学事件的发生率以及血压(BP)和心率(HR)的变化。次要结果包括时间和药物消耗,输液和出血量,手术后睁眼时间,术后质量恢复率。
结果:与B组相比,A组显示术中低血压的发生率较低(p<0.001),较高的BP[包括平均动脉压(MAP),收缩压血压(SBP),和舒张压血压(DBP)]诱导后(IN),中期手术的HR更高。A组的神经阻滞(p<0.001)和麻黄碱消耗所需的时间明显缩短(p<0.001),而舒芬太尼消耗量高于B组(p=0.002).观察期间其他术中参数和术后质量恢复率无明显差异。
结论:我们的试点数据表明,与腰丛和骶丛神经阻滞相比,股神经和LFC神经阻滞可以提供更稳定的术中血流动力学和与GA下髋部骨折行关节置换术的老年患者相当的术后恢复.需要更大样本量的进一步研究才能获得更有力的证据。
BACKGROUND: Combined anesthesia can be a promising option for hip surgery when neuraxial anesthesia is contraindicated. Lumbar and sacral plexus blocks, and femoral nerve and lateral femoral cutaneous (LFC) nerve blocks in combination with general anesthesia (GA) are commonly used in elderly patients undergoing arthroplasty for hip fracture surgery. However, no study has compared these two anesthetic strategies in the perioperative period.
METHODS: A total of 41 elderly patients scheduled for arthroplasty for hip fracture surgery were randomized into group A (n = 20) and group B (n = 21). Group A received femoral nerve block, LFC nerve blocks, and GA, and group B received lumbar plexus block, sacral plexus block, and GA. Primary outcomes were incidences of hemodynamic events and changes in blood pressure (BP) and heart rate (HR). Secondary outcomes included time and drug consumption, infusion and bleeding volume, eyes opening time after surgery, and postoperative quality recovery rate.
RESULTS: Compared with group B, group A showed a lower incidence of intraoperative hypotension (p < 0.001), higher BP [including mean arterial pressure (MAP), systolic BP (SBP), and diastolic BP (DBP)] following induction (IN), and higher HR from mid-surgery. Time required for nerve blockade (p < 0.001) and ephedrine consumption was significantly shorter in group A (p < 0.001), while sufentanil consumption was higher as compared to group B (p = 0.002). No significant differences in other intraoperative parameters and postoperative quality recovery rate were reported during the observation.
CONCLUSIONS: Our pilot data indicate that compared with lumbar and sacral plexus blocks, femoral nerve and LFC nerve blocks may provide more stable intraoperative hemodynamics and a comparable postoperative recovery for elderly patients undergoing arthroplasty for hip fracture under GA. Further studies with a larger sample size are needed to derive stronger evidence.