Continuous Lumbar Plexus Block under the Guidance of the "Shamrock Method" Ultrasound: Analgesic Effects and Hemodynamic Effects after Total Knee Arthroplasty in Elderly Patients.

Jinpei Xue,Xiang Fu,Zurong Hu

doi:10.1155/2021/3531236

Abstract

Objective To explore the effect of continuous lumbar plexus block guided by the “Shamrock method” on postoperative analgesia and hemodynamics in elderly patients after total knee arthroplasty (TKA). Methods From January 2020 to December 2020 in our hospital, 98 patients who underwent TKA were selected. Using the random number table method, the patients were divided into two groups: a continuous lumbar plexus block group (group L), with 49 patients, and a continuous femoral nerve block group (group F), with 49 patients. The onset time and maintenance time of motor and sensory nerve blocks in patients were recorded. A visual analogue scale (VAS) was applied to assess the pain severity at 6, 12, 24, and 48 h after the operation. The VAS score (FVAS) was applied to evaluate the pain severity of the patients during 24 and 48 h after the operation and knee joint functional exercise. The levels of hemodynamic indexes such as heart rate, mean arterial pressure, and oxyhemoglobin saturation and the levels of hemorheological indexes such as plasma viscosity, high and low whole blood shear viscosity, fibrinogen, and hematocrit were detected and compared between the two groups immediately after the operation and at 12 h and 48 h after the operation, respectively. The incidence of adverse reactions induced by anesthesia was counted. Results The onset time of motor and sensory nerve blocks in group L was lower than that in group F, and the maintenance time was higher than that in group F (P < 0.05). The VAS scores of 6, 12, 24, and 48 h after operation in group L were significantly lower than those in group F (P < 0.05). The FVAS scores of group L at 24 and 48 h after operation were significantly lower than those of group F (P < 0.05). The heart rates of the patients in the two groups were higher at 12 h and 48 h after operation than those immediately after operation (P < 0.05). The heart rates at 12 h and 48 h after operation in group L were lower than those in group F (P < 0.05). The plasma viscosity, high whole blood shear viscosity, and low whole blood shear viscosity in the group L at 12 h and 48 h after operation were lower than those in group F (P < 0.05). There was no significant difference in the incidence of local anesthetic poisoning, nausea, vomiting, urinary retention, pruritus, and other adverse reactions between the two groups (P > 0.05). Conclusion The “Shamrock method” ultrasound-guided continuous lumbar plexus block in elderly patients after TKA has good analgesic effect, stable hemodynamics, little influence on hemorheology, and good safety. It is of great value to enhance the surgical effect and promote postoperative rehabilitation.

Highlights

With the aging of the population, degenerative diseases of joints are increasing
Due to incomplete obturator nerve block and incomplete puncture in the ultrasound image, it is difficult to control the depth of the needle insertion and often difficult to achieve a satisfactory analgesic effect [4, 5]. e “Shamrock method” is a new ultrasonic-guided lumbar plexus nerve block method with in-plane needle insertion, in which a low-frequency probe is placed at the head side of the iliac crest of a patient to obtain ultrasound cross-sectional images of the lumbar spine and paravertebral structure, including ultrasound images of the lumbar plexus nerve
Using the random number table method, the patients were divided into two groups: a continuous lumbar plexus block group, with 49 patients, and a continuous femoral nerve block group, with 49 patients. is study was reviewed and approved by the Hospital Ethics Committee, and all patients provided informed consent

Summary

Introduction

With the aging of the population, degenerative diseases of joints are increasing. Ultrasound-guided continuous femoral nerve block for postoperative analgesia is widely used in clinical practice. Due to incomplete obturator nerve block and incomplete puncture in the ultrasound image, it is difficult to control the depth of the needle insertion and often difficult to achieve a satisfactory analgesic effect [4, 5]. The relationship between the needle and nerves as well as the surrounding vascular tissues can be directly observed and the success rate of block is improved, reducing the occurrence of complications such as kidney and nerve damage [6, 7]. The “Shamrock method” was used to guide continuous lumbar plexus block and continuous femoral nerve block and to compare the analgesic effects and hemodynamic effects of the two ways on elderly patients after TKA

Methods

Results

Conclusion