Application of ultrasound-guided fascia iliaca compartment block combined with sacral plexus block in elderly patients undergoing total hip arthroplasty via posterolateral approach / 临床麻醉学杂志

ABSTRACT

Objective To evaluate the efficacy of ultrasound-guided fascia iliaca compartment block combined with sacral plexus block in elderly patients undergoing posterolateral approach total hip arthroplasty (THA).Methods Sixty patients,24 males and 36 females,aged 65-90 years,ASA physical status Ⅱ or Ⅲ,undergoing THA via posterolateral approach were randomized into two groups with 30 cases in each group.Group SA received unilateral hypobaric spinal anesthesia with 2.0-2.5 ml local anesthetics (2 ml of 0.5% bupivacaine mixed 1 ml of sterile water for injection).Group NB received ultrasound-guided fas-cia iliaca compartment block (50 ml of 0.4% ropivacaine)combined with sacral plexus block (20 ml of 0.5% ropivacaine).The onset time and success time of sensory and motor block were evaluated.The visual analogue scale (VAS)at entring into the operating room (T0 ),1 min before positioning change (T1 ),posi-tioning change (T2 ),skin incision (T3 ),30 min after skin incision (T4 ),end of surgery (T5 ),24 h post-operatively (T6 ).The use of dopamine and atropine and incidence of complications were recorded. Results Compared with group SA,the onset time and success time of sensory and motor nerve block of group NB were longer (P <0.05).The VAS decreased at T1 ,T2 ,T6 and increased at T3 ,T5 in group NB (P <0.05).The use of dopamine in group NB (6.7%)was less than that in group SA (26.7%).Head-ache,nausea, vomiting, urinary retention were significantly decreased in group NB (P < 0.05 ). Conclusion Ultrasound-guided fascia iliaca compartment block combined with sacral plexus block re-lieves the pain caused by positioning changes.This technique may be used in elderly patients undergo-ing THA via posterolateral approach with less use of vasoactive drugs,better postoperative analgesic effects,fewer complications and higher degree of patient satisfaction.