|
|
The Effect of Presacral-Retro-Psoas Space Block-Selective Nerve Root Block on the Dosage of Anesthetics in General Anesthesia for Below-Knee Osteoporotic Fractures and Its Clinical Significance |
GENG Wei, et al |
The First Affiliated Hospital of Suzhou University, Jiangsu Suzhou 215000, China |
|
|
Abstract Objective: To investigate the effect of presacral-retro-psoas space block-selective nerve root block on the dosage of anesthetics during general anesthesia in patients with osteoporotic fractures below the knee and its clinical significance. Methods: From January 2020 to June 2021,70 patients with osteoporotic fractures below the knee who were treated in the Department of Orthopaedic Surgery of our hospital and received surgical treatment were selected as subjects,and divided into general anesthesia group according to different anesthesia methods (n=37,Simple general anesthesia) and combined group (n=33,presacral-retro-psoas space block-selective nerve root block assisted by general anesthesia).The fluctuations of hemodynamic indexes [heart rate (HR),systolic blood pressure (SBP),diastolic blood pressure (DBP),mean arterial pressure (MAP)] in the combined group before and after nerve block were observed; the pain at each time point after the operation was compared between the two groups Differences in visual analogue scale (VAS) score,perioperative anesthetic dosage,postoperative recovery and other indicators. Results: There were no significant differences in HR,SBP,DBP and MAP fluctuation at 5min,10min and 20min after nerve block in combined group compared with before the block (P>0.05).The dosage of remifentanil in the combined group was (0.77±0.03) mg,less than that in the general anesthesia group (0.90±0.05) mg (P<0.05),and the number of relief analgesia of sufentanil in the combined group was (0.84±0.14) times,less than that in the general anesthesia group (1.30±0.27) times (P<0.05).There were significant differences in VAS scores at all time points in the rest and exercise states in the combined group (P<0.05),there were significant differences in VAS scores at all time points in the rest state in the general anesthesia group (P<0.05),and there was no significant difference in VAS scores at all time points in the exercise state (P>0.05).VAS scores in the combined group at 6h,12h and 24h after surgery were lower than those in the general anesthesia group (P<0.05),and VAS scores in the combined group at 12h after surgery at exercise were lower than those in the general anesthesia group (P<0.05).There was no significant difference in the time of anal exhaust between the two groups (P>0.05),and the time of passive exercise in bed in the combined group was (3.36±0.32) h,which was earlier than that in the general anesthesia group (4.02±0.33) h (P<0.05). Conclusion: The presacral-retro-psoas major space block-selective nerve root block combined with general anesthesia has stable hemodynamics in patients with below-knee osteoporotic fracture surgery,which can effectively reduce the amount of perioperative anaesthetic drugs and improve the analgesic effect,which is of specific clinical significance in promoting the postoperative recovery of patients.
|
|
|
|
|
[1] 胡衍,王栋梁,陈雁西,等.下肢关节周围骨质疏松性骨折诊疗与康复专家共识[J].中国临床医学,2020,27(4):704-712. [2] 李长洲,高天虎,于利,等.下肢骨折术后骨密度变化的相关性研究[J].中国骨质疏松杂志,2018,24(9):1201-1208. [3] 林华,包丽华.骨质疏松性骨折的骨损害[J].中华医学杂志,2022,13(13):903-907. [4] 程康耀,莫文,刘冬梅,吕伟波等.不同麻醉方式用于骨质疏松性椎体压缩性骨折患者椎体后凸成形术效果的Meta分析[J].中国当代医药,2018,25(7):13-16. [5] Zhaofei Z,Feng J,Yonghui F,et al.Evaluation of the analgesic effect of vertebral cancellous bone infiltration anaesthesia during vertebro plasty[J].OrthoP Surg Res,2020,15(1):342. [6] 马岳,李慧莉,吴泽昊,等.L_3椎旁神经阻滞联合骶前-腰大肌后间隙阻滞对全膝关节置换术后患者自控静脉镇痛的影响[J].国际麻醉学与复苏杂志,2019(12):1117-1121. [7] 严广斌.视觉模拟评分法[J].中华关节外科杂志(电子版),2014,8(2):273. [8] 王维,刘玉林,张滢莹.超声引导下竖脊肌平面阻滞对腰椎后路手术全麻效果及术后恢复的影[J].临床麻醉学杂志,2018,34(12):1172-1175. [9] 李永刚.超声引导下竖脊肌平面阻滞辅助全麻在老年腰椎压缩性骨折手术中的应用价值分析[J].现代诊断与治疗,2021,32(20):3313-3314. [10] 陈丽琼,徐超锋,翟子昕,等.超声引导下腰段竖脊肌平面阻滞范围的确定及在腰椎手术中的应用[J].中华医学杂志,2021,101(37):2993-2998. [11] 高建东,李慧莉,王云,等.骶前-腰大肌后间隙阻滞联合选择性腰神经根阻滞用于全麻膝下骨折手术患者的改良效果[J].中华麻醉学杂志,2020,40(11):1371-1374. |
|
|
|