Application of lumbar plexus and sciatic nerve blockade combined with small dose of propofol in intertrochanteric femur fracture repair in elderly patients
10.3760/cma.j.issn.1671-8925.2016.09.015
- VernacularTitle:腰丛联合坐骨神经阻滞复合小剂量丙泊酚麻醉在高龄患者股骨粗隆间骨折手术中的应用
- Author:
Benling SANG
1
;
Jiaxin LI
Author Information
1. 民航总医院麻醉科
- Keywords:
Lumbar plexus and sciatic nerve blockade;
Propofol;
Elderly patient;
Intertrochanteric fracture with closed intramedullary pin fixation
- From:
Chinese Journal of Neuromedicine
2016;15(9):945-950
- CountryChina
- Language:Chinese
-
Abstract:
Objective To compare the clinical effects of lumbar plexus and sciatic nerve block combined with small dose of propofol anesthesia or intravenous general anesthesia on intertrochanteric fractures with closed intramedullary pin fixation in elderly patients.Methods Thirty elderly patients with American Society of Anesthesiologists grade Ⅲ and intertrochanteric fractures by closed intramedullary pin fixation,admitted to our hospital from December 2013 to December 2015,were averagely divided into nerve blockade combined with small dose of propofol group and general anesthesia group.Mean arterial pressure (MAP) and heart rate (HR) were compared at the pre-anesthesia (T0),intraoperative times (skin incision immediately [T1],and 15 min [T2],30 min [T3] and 45 min [T4] after operation being began) and postoperative times (5 min after surgery in the nerve blockade combined small dose of propofol group or 5 min after removing laryngeal mask airway in the general anesthesia group [T5]3,30 min after postoperative recovery [T6]) in the two groups of patients.Alert/sedation (OAA/S) scale scores were recorded at the pre-anesthesia and postoperative times.And the vascular active drug dosages,postoperative recovery time to a modified Aldrete score ≥9 points in the recovery room,initiation of meal time,initiation of postoperative pain time and occurrence dynamics of nausea and vomiting were recorded.Results In the patients of the intravenous general anesthesia group,the MAP and HR at T1,T2,T3 and T4 were significantly lower as compared with those at T0,T5 and T6 (P＜0.05);as compared with those in the intravenous general anesthesia group,the MAP and HR in the nerve blockade combined with small dose ofpropofol group at T1,T2,T3 and T4 were significantly higher (P＜0.05).The OAA/S scale scores in the intravenous general anesthesia group at T6 were significantly lower as compared with those before anesthesia,and statistically lower than those in the nerve blockade combined with small dose ofpropofol group (3.6±0.8 vs.4.3±0.8,P＜0.05).The vascular active drug dosages were significantly lower,postoperative recovery timewere significantly shorter,initiation of meal time was significantly shorter and postoperative analgesia time was statistically longer,and incidence of nausea and vomiting was statistically lower (36％ vs.0％) in the nerve blockade combined with small dose of propofol group as compared with those in the intravenous general anesthesia group (P＜0.05).Conclusion Umbar plexus and sciatic nerve blockade combined small dose of propofol as anesthesia technique used in elderly patients with ASA grade Ⅲ and intertrochanteric fractures by closed intramedullary pin fixation has advantages of reliable effect,easily intraoperative management,and less complications after surgery.
