Clinical application of ultrasound-guided femoral nerve and lateral femoral cutaneous nerve block for patients undergoing hip fracture surgery

Abstract

Objective To observe the application of ultrasound-guided femoral nerve block(FNB) and lateral femoral cutaneous nerve block(LFCNB) for patients undergoing hip fracture surgery. Methods 60 patients scheduled for hip fracture surgery undergoing LMA general anesthesia were randomly divided into 3 groups, 20 cases in each group.Before transfer patients from bed to operating table, A group received dezocine 5mg iv, B group received fascia iliaca compartment block(FICB), C group received FNB combined with LFCNB.40mL of 0.375% ropivacaine was injected guiding by ultrasound in B group and C group.The time of sufficient sensory block and awake, the dosage of propofol and remifentanil, MAP and HR at pre-block(T1), 20min after block(T2), transfer bed(T3), LMA insert(T4), skin incision(T5), LMA remove(T6) and sober(T7) were recorded.Pain was assessed using visual analogue scale(VAS) pre- and post block.The incidence of using vasoactive drugs, agitation, pain and adverse reaction were also recorded. Results The time of sufficient sensory block and awake, the dosage of propofol and remifentanil in A, B and C groups were as following: A group (not measured), (20.3±1.3)min, (835±6.7)mg, (1 285±18)μg; B group (12.2±2.7)min, (13.3±1.4)min, (610±9.9)mg, (835±15)μg; C group (9.7±2.4)min, (12.8±1.5)min, (555±6.5)mg, (785±16)μg.The time of awake, the dosage of propofol and remifentanil in B group and C group were significantly lower than those in A group(F=2.62, 2.41, 2.45, all P<0.05). The time of sufficient sensory block in C group was lower than that in B group(P<0.05). The MAP and HR at T2, T3, T5 and T7 in A, B and C groups were: A group (115±4)mmHg, (90±8)beats/min, (135±6)mmHg, (98±8)beats/min, (104±6)mmHg, (87±4)beats/min, (120±5)mmHg, (88±8)beats/min; B group (102±3)mmHg, (81±6)beats/min, (112±5)mmHg, (82±8)beats/min, (89±6)mmHg, (72±3)beats/min, (100±6)mmHg, (76±8)beats/min; C group (100±3)mmHg, (80±6)beats/min, (109±6)mmHg, (83±5)beats/min, (86±5)mmHg, (70±3)beats/min, (99±5)mmHg, (75±5)beats/min.The levels of MAP and HR in B group and C group were significantly lower than those in A group(F=2.25, 2.85, 2.87, 2.91, all P<0.05). The VAS scores at T2, T3, and T7 in A, B and C groups were: A group (3.9±0.7)points, (8.2±0.3)points, (6.0±0.8)points; B group (2.3±0.4)points, (4.1±0.4)points, (2.2±0.7)points; C group (2.1±0.5)points, (2.4±0.4)points, (1.2±0.4)points.The VAS scores in B group and C group were significantly lower than those in A group(2.36, 2.82, 2.88, all P<0.05). The VAS scores at transfer bed and sober in C group were significantly lower than those in B group(F=2.32, 2.38, all P<0.05). The incidence of using ephedrine/atropine, urapidil/esmolol, PONV, agitation, pain and incision pain in A, B and C groups were: A group 30%, 30%, 25%, 25%, 40%; B group 10%, 10%, 0%, 0%, 10%; C group 10%, 5%, 0%, 0%, 0%.The number of patients who required vasoactive drugs and adverse reaction in B group and C group were significantly lower than those in A group(χ2=7.58, 8.81, 9.11, 9.11, 8.89, all P<0.05). The incidence of incision pain at sober in C group was lower than that in B group(χ2=9.21, P<0.05). Conclusion The ultrasound-guided FNB and LFCNB can obviously shorten the onset time, reduce the dosage of general anaesthetic and maintain the stability of hemodynamics during the perioperative period.It has effective analgesia during transfer of patients from bed to operating table and sober. Key words: Ultrasonography; Nwuromuscular blockade; Hip fracture surgery