The clinical application of lumbar plexus-the first posterior sacral foramina block for hip arthroplasty in elderly patients

Abstract

Objective: To evaluate the clinical efficacy of lumbar plexus-the first posterior sacral foramina block as an anesthesia technique for hip arthroplasty in elderly patients. Methods: Forty-four patients, aged 60-91 years, weighing 37-100 kg, American Society of Anesthesiologists (ASA) Ⅰ-Ⅲ, underwent elective hip arthroplasty in Tongji Hospital from February 2015 to January 2016.All patients received lumbar plexus and the first posterior sacral foramina block.The first posterior sacral foramina puncture point of 23 cases were located by traditional positioning method, the others were orientated via ultrasonic method.Measurements included effect of sensory blockade after 30 min of completed injection, hemodynamic parameters, quality of surgery blockade, and postoperative adverse reactions related to nerve block. Results: The success rates of the sensory blockade of pinprick for the dermatomes L1-S3 were from 73% to 100%, with 93% success rates of surgical analgesia.Compared with baseline (T0) , the systolic blood pressure (SBP) decreased at 10 min after incision (T5) and 20 min after incision (T6) [T0 vs T5: (137±23) mmHg vs (119±20) mmHg, t=3.825, P<0.05; T0 vs T6: (137±23) mmHg vs (118±18) mmHg, t=4.403, P<0.05]. Heart rate (HR) and diastolic blood pressure (DBP) had no significant changes at different time points (F=0.877, 1.439, P>0.05). One patient suffered urinary incontinence. Conclusion: Lumbar plexus-the first posterior sacral foramina block is one of safe and effective anesthetic techniques for hip arthroplasty in aged patients.