超声引导腰骶丛神经阻滞和脊椎麻醉应用于老年膝关节置换术的效果比较

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Abstract Objective To compare the effect of ultrasound-guided lumbosacral plexus block and spinal anesthesia in elderly patients undergoing total knee arthroplasty.Methods A total of 76 patients who underwent total knee arthroplasty in the First People's Hospital of Zhaotong from September 2020 to March 2022 were selected as the research objects.According to the random number table method,they were divided into lumbosacral plexus block(LSPB)group(38 cases)and spinal anesthesia(SA)group(38 cases).The LSPB group was treated with ultrasound-guided lumbosacral plexus block,and the SA group was treated with spinal anesthesia.The mean arterial pressure(MAP)at admission(T1),5 min after anesthesia(T2),15 min after anesthesia (T3),skin incision (T4) and 60 min after skin incision (T5) were compared between the two groups.The duration of anesthesia,operation time,intraoperative blood loss and infusion volume were compared between the two groups.The visual analogue scale (VAS)scores of pain at 4,8,12 and 24 h after operation were compared between the two groups.The intraoperative consumption of Sufentanil,Ephedrine and Norepinephrine were compared between the two groups.The incidences of urinary retention,headache,nausea and vomiting at 72 h after operation were compared between the two groups.Results The MAP of LSPB group at T2,T3,T4 and T5 were higher than those of SA group,and the differences were statistically significant (P＜0.05).The VAS scores at 4,8,12 and 24 h after operation in LSPB group were lower than those in SA group,and the differences were statistically significant (P＜0.05).There were no significant differences in operation time and intraoperative blood loss between the two groups(P＞0.05).The duration of anesthesia in the LSPB group was longer than that in the SA group,and the infusion volume was less than that in the SA group,and the differences were statistically significant (P＜0.05).The intraoperative use of Ephedrine,Norepinephrine and infusion volume in LSPB group were lower than those in SA group,and the differences were statistically significant (P＜0.05).The incidence of headache,nausea and vomiting and urinary retention in the LSPB group were lower than those in the SA group 72 h after operation,with statistically significant differences (P＜0.05).There was no significant difference in the dosage of Sufentanil between the two groups (P＞0.05).Conclusion Ultrasound-guided lumbosacral plexus block has a good anesthetic effect in elderly patients undergoing total knee arthroplasty,with less influence on intraoperative blood pressure,better postoperative analgesia and fewer postoperative complications.

Key words： Ultrasound-guided Lumbosacral plexus block Spinal anesthesia Elderly

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