Regional nerve block versus general anaesthesia in elderly patients undergoing surgery for traumatic lower limb fractures
10.3760/cma.j.cn115455-20240328-00283
- VernacularTitle:区域性神经阻滞与全身麻醉对老年创伤性下肢骨折手术患者的麻醉效果
- Author:
Kan ZHANG
1
;
Yadong LI
1
Author Information
1. 延安市人民医院麻醉科，延安 716000
- Publication Type:Journal Article
- Keywords:
Nerve block;
Anesthesia, general;
Fracture fixation;
Hemodynamics;
Analgesia
- From:
Chinese Journal of Postgraduates of Medicine
2025;48(6):569-573
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To compare the effects of regional nerve block and general anaesthesia in elderly patients undergoing traumatic lower limb fracture surgery.Methods:A total of 100 patients over 60 years old with traumatic lower extremity fracture who received surgical treatment in Yan′an People′s Hospital from October 2021 to October 2023 were prospectively selected as the study objects and divided into two groups with 50 cases in each group by random number table method. The control group was given general anesthesia, and the observation group was given regional nerve block. Both groups were given patient controlled intravenous analgesia (PCIA) after surgery. Perioperative hemodynamic indexes, surgical conditions, postoperative visual analogue scale (VAS) score, analgesia recovery rate and stress response indexes before and after surgery were compared between the two groups, and the incidence of complications were compared between the two groups.Results:The mean arterial pressure (MAP) and heart rate (HR) at the beginning of 5 min (T 1) and at the end of the operation (T 2) were decreased compared with the time point before entry (T 0), and there were no statistical differences of MAP, HR at 30 min after the operation (T 3) between the two groups ( P>0.05). The MAP and HR at T 1 and T 2 time points in the observation group were higher than those in the control group, there were statistical differences ( P<0.05). The amount of infusion in the observation group was lower than that in the control group: (443.63 ± 31.47) ml vs. (645.25 ± 45.85) ml, there was statistical difference ( P<0.01). There were no statistical differences in operation time and postoperative hospital stay between the two groups ( P>0.05). The VAS scores in the observation group at 6, 12, 24 and 48 h after surgery were lower than those in the control group: (3.21 ± 0.61) scores vs. (3.89 ± 0.74) scores, (3.45 ± 0.67) scores vs. (4.12 ± 0.78) scores, (2.57 ± 0.47) scores vs. (3.04 ± 0.64) scores, (1.96 ± 0.34) scores vs. (2.34 ± 0.45) scores; and the analgesic relief rate was lower than that in the control group: 8.00%(4/50) vs. 24.00%(12/50), there were statistical differences ( P<0.05). The levels of cortisol (Cor), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and β-endorpeptide (β-EP) at 24 h postoperative in the observation group were lower than those in the control group: (134.74 ± 28.94) ng/L vs. (158.52 ± 35.63) ng/L, (102.53 ± 15.41) μg/L vs. (128.95 ± 18.74) μg/L, (47.54 ± 5.72) ng/L vs. (59.74 ± 6.98) ng/L, (38.74 ± 4.17) μg/L vs. (45.75 ± 5.12) μg/L, there were statistical differences ( P<0.05). There was no statistical difference in complication rate between the two groups ( P>0.05). Conclusions:Regional nerve block can stabilize the intraoperative hemodynamics, reduce the stress response of the body and have a good analgesic effect in the operation of lower extremity fracture in the elderly.
