Ultrasound-guided Multiple Nerve Blocks: A Safe and Effective Anesthetic Modality in Geriatric Hip Fracture Patients.

OBJECTIVES: The aim was to compare the feasibility of ultrasound-guided multiple nerve blocks (fascia iliaca compartment block+sacral plexus block+superior cluneal nerve block) with general anesthesia in geriatric hip fracture patients. METHODS: Ninety-four patients were randomly divided into 2 groups: group N received ultrasound-guided multiple nerve blocks and group G received general anesthesia. Primary outcome measures included perioperative Pain Threshold Index (PTI) and Numerical Rating Scale. Secondary outcome measures comprised the following: (1) perioperative Delirium Index and Short Portable Mental Status Questionnaire; (2) perioperative Comfort Index; (3) perioperative opioid consumption (within 72 hours postoperatively); and (4) postoperative side effects (within 72 h postoperatively). RESULTS: Eighty-seven patients completed the study. Baseline PTI was comparable between the groups. However, intraoperative PTI was significantly lower in group N than in group G. Preoperative and postoperative Comfort Index scores were comparable between the groups. Moderate delirium (24 to 72 h postoperatively) was significantly higher than the baseline in group G. Early moderate delirium (24 h postoperatively) was significantly higher in group G than in group N. Severe delirium was comparable between the groups and within each group. High intraoperative PTI was associated with high opioid consumption. The intravenous sufentanil dose in group G was twice of that in group N. Incidence of nausea and vomiting was similar between the groups. DISCUSSION: Ultrasound-guided multiple nerve blockade may be an alternative to the common anesthetic procedures used for geriatric hip fracture patients. It provided satisfactory intraoperative pain management and reduced early postoperative cognitive disorders.

Clinical application of a novel developed pressure bladder indicator in lumbar epidural puncture.

STUDY OBJECTIVE: A novel pressure bladder indicator was developed, and this study aimed to evaluate the clinical application of the pressure bladder indicator by measuring the epidural space pressure and bladder working pressure on patients undergoing lumbar epidural puncture. DESIGN: Randomized, prospective, double-blinded study PATIENTS: 130 patients SETTING: The Second Hospital of Shandong University INTERVENTIONS: In this study, 60 patients undergoing surgical procedures under lumbar epidural anesthesia were enrolled to detect epidural pressure, and other 70 patients who were undergoing lumbar epidural anesthesia or combined spinal-epidural anesthesia were enrolled to evaluate the pressure bladder indicator. MEASUREMENTS: After successful breakthrough of ligamentum flavum by traditional methods, a pressure transducer was connected to an epidural needle tail and a monitor to measure the epidural pressure at L1-L5 in 60 patients. The working pressure of the bladder was also measured by a transducer. Then lumbar epidural puncture was performed with the pressure bladder indicator in other 70 patients. MAIN RESULTS: The lumbar epidural pressure of the 60 patients was 9.8 ± 4.3 mm Hg, and the bladder working pressure of the pressure bladder indicator was 122 ± 15 mm Hg. All these 70 patients were confirmed with successful bladder indication and lumbar epidural puncture. Thus, the coincidence ratio was 100%. CONCLUSIONS: The novel developed pressure bladder indicator was a reliable and useful technique to conduct successful lumbar epidural puncture.