Peripheral Nerve Block as a Supplement to Light or Deep General Anesthesia in Elderly Patients Receiving Total Hip Arthroplasty

Mei, Bin; Zha, Hanning; Lu, Xiao‐Long; Cheng, Xinqi; Chen, Shishou; Liu, Xuesheng; Li, Yuanhai; Gu, Erwei

doi:10.1097/ajp.0000000000000502

Cited by 25 publications

(32 citation statements)

References 37 publications

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“…All patients in the 3 groups received intubation. 26 Our study as a retrospective evaluation, lumbosacral plexus plus T 12 paravertebral nerve blocks without intubation were evaluated. The first RCT by Junfeng Zhang et al investigating the effect of combined lumbar and sacral plexus block with sedation versus general anesthesia on long-term prognosis indicated that ultrasound-guided combined lumbar and sacral plexus block with sedation could be safely used in hip fracture surgery in elderly patients and can reduce the incidence of perioperative complications and improve long-term prognosis.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Combined Lumbosacral Plexus and T12 Paravertebral Nerve Blocks With General Anesthesia in Older Adults Undergoing Primary Total Hip Arthroplasty: A Retrospective, Propensity Score–Matched Cohort Study

Chen

Yuan

et al. 2020

Geriatr Orthop Surg Rehabil

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Background: Total Hip Arthroplasty(THA) is a surgical treatment for hip disease. A large amount of evidence has been reported on comparing outcomes of neuraxial(spinal or epidural) anesthesia and general anesthesia. However, it is unclear whether nerve blocks(NB) as main anesthesia technique compared with general anesthesia(GA) for THA could reduce perioperative complications. We conducted a retrospective evaluation of NB and GA, using a propensity score-matched analysis(PSMA). Methods: A total of 902 patients older than 60 years old with hip disease undergoing primary THA received combined lumbosacral plexus and T12 paravertebral nerve blocks (n = 143) or GA (n = 759) at our institution from 2012 to 2018.Binary logistic regression was used for comparison of the primary outcomes(the incidence of delirium) and the secondary outcomes(the percentage of postoperative hemoglobin(>10g/dl), transfusion(>2 units), major cardiac events(MACE), postoperative pulmonary complications (PPC) and 30-day mortality) in the matched cohorts.Statistical analysis was performed using SPSS v 23.0. Results: Both cohorts were balanced in all included parameters after PSMA. The incidence of delirium was lower (OR 0.233,95% CI 0.064-0.845, p = 0.030) in NB group in matched cohorts. In the unmatched and matched cohorts, the percentage of Hb(>10g/dl) was higher in GA group but the incidence of transfusion(>2 units) was higher in NB group. No difference was found in the incidence of 30-day mortality in the unmatched and matched cohorts. In the unmatched cohorts, the incidence of PPC was higher and LOS was longer in NB cohort, but no difference was observed in the matched cohorts. Conclusion: In patients older than 60 years old receiving primary THA, NB could be associated with a lower incidence of delirium.

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Section: Discussionmentioning

confidence: 99%

Comparison of Combined Lumbosacral Plexus and T12 Paravertebral Nerve Blocks With General Anesthesia in Older Adults Undergoing Primary Total Hip Arthroplasty: A Retrospective, Propensity Score–Matched Cohort Study

Chen

Yuan

et al. 2020

Geriatr Orthop Surg Rehabil

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“…67 Lumbosacral plexus block in combination with intraoperative light sedation resulted in better postoperative outcomes, reduced the use of opioids, and offered satisfactory postoperative analgesia. 72 Non-pharmaceutical management Acupuncture is an important method for POCD treatment. Liu et al showed that electroacupuncture intervention may improve cognitive function by inhibiting overexpression of the neuroinflammatory reaction and promoting improvement of neurological function.…”

Section: Pharmaceutical Managementmentioning

confidence: 99%

Postoperative cognitive dysfunction in elderly patients undergoing hip arthroplasty

et al. 2020

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Even after successful hip arthroplasty, elderly patients who have undergone this procedure remain subject to cognitive decline and may collectively develop postoperative cognitive dysfunction (POCD). However, no consensus exists as to the risk factors resulting in a higher likelihood that a patient may present with this complication, and the aetiology of POCD is not well understood. We conducted a systematic review of papers concerning the influence of POCD‐related risk factors in patients undergoing hip arthroplasty but limited the literature search to papers in English. A systematic and electronic search for manuscripts in the PubMed database was performed in order to identify all studies in which the risk factors for POCD were investigated. Articles were also obtained from the authors' files. Keywords for the search were postoperative cognitive dysfunction/change/impairment/decline/deficit, elderly/older/aged patients, and hip arthroplasty/replacement surgery. The evidence published to date suggests that POCD is a multifactorial disease, which includes an individual patient's characteristics, surgery, type of anaesthesia, and pain levels. All of these factors can increase the risk of POCD incidence. There are a number of factors that appear to influence the risk of early cognitive dysfunction after hip arthroplasty. Nevertheless, the specific mechanism and explicit risk factors associated with this cognitive dysfunction are not completely understood. Hip arthroplasty has made it possible for older patients to find relief from pain and improve their function, whereas it also increases the risk for suffering POCD that may affect these patients' quality of life and increase their mortality. Therefore, it is worthwhile investigating the mechanism of POCD in future studies in order to prevent and treat this condition.

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“…Both the combined lumbar and sacral plexus block (CLSB) with general anesthesia (BIS 60-80) and the unilateral spinal anesthesia (SA) on the operative side had been reported to be safe and effective as regional anesthesia techniques for hip surgery [9][10][11]. To the authors' knowledge, there were no studies comparing the superiority of these two anesthesia methods in terms of ADL.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Effects between Combined Lumbar-Sacral Plexus Block plus General Anesthesia and Unilateral Spinal Anesthesia in Elderly Patients Undergoing Hip Fracture Surgery: A Pilot Randomized Controlled Trial

Tang

Fang

et al. 2021

Evidence-Based Complementary and Alternative Medicine

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Purpose. Hip fracture is a common injury in geriatric populations, which is associated with poor quality of life. However, the ideal anesthesia technique for this disease is yet to be identified. This study aimed to compare the combined lumbar-sacral plexus block (CLSB) plus general anesthesia (bispectral index (BIS) 60–80) with the unilateral spinal anesthesia (SA) on activity of daily living in elderly patients undergoing hip fracture surgery. Methods. A total of 124 elderly patients undergoing hip fracture surgery were randomly assigned to two groups. Patients in the SA group received light-specific gravity spinal anesthesia, and patients in the CLSB group received lumbar and sacral plexus block with general anesthesia (BIS 60–80). The primary outcomes were 30-day activity of daily living (ADL). The secondary outcomes were postoperative pain scores, postoperative delirium, in-hospital cost, and major complications. Results. The ADL scores of postoperative day 30 (POD30) in the CLSB group are higher than those in the SA group (27.34 ± 7.01 versus 24.70 ± 6.40, P = 0.045 ). Compared to preoperative ADL scores, there were higher increased scores in the CLSB group than in POD30 (CLSB group 8.09 ± 3.39 versus SA group 4.87 ± 3.90, P < 0.001 ). Mild-to-moderate pain did not have differences between the two groups (rest pain: 3 versus 2, P = 0.344 ; motion pain: 5 versus 4, P = 0.073 ). There were no significant differences in incidence of postoperative delirium, PONV, and other complications. Conclusion. The unilateral SA can reduce the deterioration of ADL after hip fracture surgery and provide a better postoperative recovery.

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Peripheral Nerve Block as a Supplement to Light or Deep General Anesthesia in Elderly Patients Receiving Total Hip Arthroplasty

Abstract: Lumbosacral plexus block reduced the need for opioids and offered satisfactory postoperative analgesia. It led to better postoperative outcomes in combination with intraoperative light sedation (high bispectral index).

Cited by 25 publications

References 37 publications

Comparison of Combined Lumbosacral Plexus and T12 Paravertebral Nerve Blocks With General Anesthesia in Older Adults Undergoing Primary Total Hip Arthroplasty: A Retrospective, Propensity Score–Matched Cohort Study

Comparison of Combined Lumbosacral Plexus and T12 Paravertebral Nerve Blocks With General Anesthesia in Older Adults Undergoing Primary Total Hip Arthroplasty: A Retrospective, Propensity Score–Matched Cohort Study

Postoperative cognitive dysfunction in elderly patients undergoing hip arthroplasty

Comparison of Effects between Combined Lumbar-Sacral Plexus Block plus General Anesthesia and Unilateral Spinal Anesthesia in Elderly Patients Undergoing Hip Fracture Surgery: A Pilot Randomized Controlled Trial

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