Evaluation of advantages of sevoflurane inhalation anesthesia combined with lumbosacral plexus block for hip replacement in elderly patients

Abstract

Objective To evaluate the advantages of sevoflurane inhalation anesthesia combined with lumbosacral plexus block for hip replacement in elderly patients. Methods Sixty patients of both sexes, aged 65-85 yr, with body mass index of 18-25 kg/m2, of American Society of Anesthesiologists physical statusⅠ-Ⅲ, scheduled for elective unilateral hip replacement, were divided into 2 groups(n=30 each)using a random number table: total intravenous anesthesia group(TIVA group)and GasMan software-guided sevoflurane inhalation anesthesia combined with lumbosacral plexus block group(SEV-B group). After the laryngeal mask airway was inserted, the patients were mechanically ventilated in both groups.Heart rate and mean arterial pressure(MAP)were recorded before anesthesia(T0), immediately after insertion of laryngeal mask airway(T1), immediately after skin incision(T2), immediately after intramedullary reaming(T3), immediately after prosthesis implanting(T4), at the end of surgery(T5)and at 5 min after removal of the laryngeal mask airway(T6). The end-tidal concentration of sevoflurane at T2-5 was also recorded in group SEV-B.The time for removal of the laryngeal mask airway, duration of stay in post-anesthesia care unit and first ambulation time were recorded.The consumption of anesthetics used during patient-controlled intravenous analgesia(PCIA), effective pressing times of PCIA, requirement for rescue analgesic and adverse reactions were also recorded at 24 h after surgery.The patient′s cognitive function was assessed using Mini-Mental State Examination at 1 day before surgery and 1 and 3 days after surgery, and the occurrence of postoperative cognitive dysfunction was recorded. Results Compared with group TIVA, heart rate at T1-6 and MAP at T2-6 were significantly decreased, and MAP at T1 was increased in group SEV-B, and the time for removal of the laryngeal mask airway, duration of stay in post-anesthesia care unit and first ambulation time were significantly shortened, the consumption of anesthetics used during PCIA, effective pressing times of PCIA, requirement for rescue analgesic and incidence of adverse reactions were reduced at 24 h after surgery, the Mini-Mental State Examination scores were increased at 1 day after surgery, and the incidence of postoperative cognitive dysfunction was decreased at 1 day after surgery in group SEV-B(P<0.05). Conclusion GasMan software-guided sevoflurane inhalation anesthesia combined with lumbosacral plexus block can provide more accurate anesthesia management for hip replacement and promote rapid rehabilitation after surgery in elderly patients. Key words: Anesthesia, inhalation; Nerve block; Aged; Arthroplasty, replacement, hip; Cognition disorders