Application of ultrasound-guided nerve block combined with laryngeal mask anesthesia in artificial femoral head replacement for elder patients

Abstract

Objective To investigate the effects of ultrasound-guided nerve block combined with laryngeal mask anesthesia on elderly patients in artificial femoral head replacement. Methods A total of 116 elderly patients with unstable femoral neck fracture admitted in Datong Tongmei Group General Hospital from July 2014 to November 2017 were selected and were divided into study group and control group, with 58 cases in each group, according to random number table method. The patients in the two groups all underwent artificial femoral head replacement, while patients in study group were given ultrasound-guided femoral nerve block compound with laryngeal mask anesthesia, and patients in control group were given general laryngeal mask anesthesia. The incidence of postoperative delirium (POD) and cognitive impairment (POCD) in the two groups were statistically analyzed. The heart rate (HR), mean arterial pressure (MAP) before anesthesia (T1) and at the time of laryngeal mask insertion (T2), skin incision (T3), prosthesis implantation (T4), incision closure (T5) and laryngeal mask extraction (T6) were compared between the two groups, and postoperative visual analogue scale (VAS) scores at different time points (2 hours, 4 hours, 12 hours, 24 hours and 48 hours after treatment) were compared between the two groups. Results There was insignificant difference in the MAP and HR levels between the study group and control group at T1 and T5 time point(P>0.05). At the time of T2, T3, T4 and T6, the levels of HR and MAP in study group were lower than those in control group, and the amplitude of HR and MAP in study group were smaller than those in control group (P<0.05). At 2 hours, 4 hours, 12 hours, 24 hours and 48 hours after operation, the VAS scores of study group group were lower than those of control group (P<0.05). The incidence of POD and POCD in study group were 3.45% and 6.90%, respectively, which were lower than those of control group (15.52% and 22.41%), P<0.05. Conclusions Ultrasound-guided nerve block combined with laryngeal mask anesthesia in artificial femoral head replacement for elderly patients with unstable femoral neck fracture can get more stable hemodynamics, by which the postoperative analgesia is more effective. And it can reduce the occurrence of POD and POCD to a certain extent. Key words: Artificial femoral head replacement; Unstable femoral neck fractures; Ultrasound-guided femoral nerve block; Laryngeal mask anesthesia