Abstract
Objective To compare the safety of different anesthesia methods combined with intravenous fast channel anesthesia in elderly lower extremity surgery and the effect on postoperative outcome. Methods A total of 106 elderly patients who underwent lower extremity orthopedic surgery in our hospital from February 2018 to February 2021 were selected and randomly divided into the control group (n = 53) and the observation group (n = 53) according to random number table. All patients received intravenous fast-track anesthesia. On this basis, the control group received spinal-epidural anesthesia, and the observation group received iliac fascial space block on the affected side combined with sciatic nerve block. The operation conditions, blood pressure and heart rate changes, awakening time, postoperative ICU admission rate, and complications were compared between the two groups. Results There was no statistical difference in the success rate of one-time operation between the two groups (P > 0.05). The times of using analgesics and vasoactive drugs and the dosage of propofol in the observation group during the operation were lower than those in the control group, and the difference was statistically significant (P < 0.05). At T2, T3, and T4, the levels of HR, DBP, and SBP in the observation group were lower than those in the control group, and the difference was statistically significant (P < 0.05). After operation, the time of awakening, spontaneous breathing recovery, and extubation in the observation group were lower than those in the control group, and the difference were statistically significant (P < 0.05). The incidence of complications in the observation group was lower than that in the control group, the cognitive impairment was the most significant one in the incidence of single complication, and the difference was statistically significant (P < 0.05). Conclusion Based on the combined intravenous fast channel anesthesia, the operation difficulty of the affected side iliac fascial space block combined with sciatic nerve block is the same as that of spinal-epidural anesthesia. It has a higher success rate of one operation, better analgesic and anesthetic effects during the operation, and little effect on blood flow of patients. It can maintain relatively stable heart rate and blood pressure and does not easily cause postoperative complications. Its safety is higher than that of spinal-epidural anesthesia.
Highlights
Due to the aggravation of population aging, the number of elderly patients undergoing lower limb orthopedic surgery is increasing
Inclusion criteria: age ≥65 years; American Society of Anesthesiologists (ASA) rank II ∼ III (ASA classification was limited to a small range in order to minimize the impact of individual patient differences on this study); and cognitive function and mental state were normal before operation
E observation group: ultrasound-guided iliac fascial space block and sciatic nerve block were performed with 0.5% ropivacaine at a dose of 0.2 ml/kg
Summary
Due to the aggravation of population aging, the number of elderly patients undergoing lower limb orthopedic surgery is increasing. Many of these patients have many basic diseases, such as weak physical function, poor surgical tolerance, and high surgical risk [1, 2]. On the basis of applying intravenous fast-track anesthesia, combining with other anesthesia methods can significantly improve the operation effect, which has been widely recognized in clinic [5, 6]. Erefore, this study explored the safety differences of different anesthesia methods combined with intravenous fast track in elderly lower limb orthopedic surgery.
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