Optimization strategy of anesthesia in elderly patients undergoing hip fracture surgery: combination of esketamine and fascia iliaca compartment-subarachnoid block
10.3760/cma.j.cn131073.20230316.00617
- VernacularTitle:老年患者髋关节周围骨折手术麻醉的优化策略：艾司氯胺酮联合髂筋膜间隙-蛛网膜下腔阻滞
- Author:
Manman QI
1
;
Yan LI
;
Tiange ZHANG
;
Mengya GAO
;
Wenbo SUN
Author Information
1. 沧州市中心医院麻醉科，沧州 061000
- Keywords:
Aged;
Hip joint;
Ketamine;
Ilium;
Fassia;
Subarachnoid space;
Nerve block
- From:
Chinese Journal of Anesthesiology
2023;43(6):728-731
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To evaluate the efficacy of esketamine combined with fascia iliaca compartment-subarachnoid block in optimizing anesthesia in elderly patients undergoing hip fracture surgery.Methods:Sixty-two American Society of Anesthesiologists Physical Status classification Ⅱ or Ⅲ elderly patients of either sex, aged 60-85 yr, with body mass index of 18.5-30.0 kg/m 2, were divided into 2 groups ( n=31 each) using a random number table method: fascia iliaca compartment-subarachnoid block group (FS group) and esketamine combined with fascia iliaca compartment-subarachnoid block group (ES group). In FS group, patients underwent ultrasound-guided fascia iliaca compartment block at 30 min before the operation of subarachnoid anesthesia on the surgical side. In ES group, esketamine 0.25 mg/kg was intravenously administered at 5 min before skin incision based on the fascia iliaca compartment-subarachnoid block. Patient-controlled intravenous analgesia was used for postoperative analgesia, and tramadol 1 mg/kg was intravenously given for rescue analgesia when numerical rating scale score > 4. The pressing times of patient-controlled analgesic pump, the number of rescue analgesia and consumption of tramadol were recorded within 48 h after operation. The occurrence of postoperative adverse reactions (respiratory depression, nausea and vomiting, dizziness, drowsiness, pruritus, illusion, nightmares) was recorded. Results:Compared with FS group, the consumption of postoperative tramadol was significantly decreased, and the pressing times of patient-controlled analgesic pump and the number of rescue analgesia were reduced in ES group ( P<0.05). There were no significant differences in the incidence of postoperative adverse reactions between the two groups ( P>0.05). Conclusions:Combination of esketamine with fascia iliaca compartment-subarachnoid block for hip fracture surgery can raise postoperative analgesia and optimize clinical management strategies in elderly patients.
