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Peripheral Nerve Block as a Supplement to Light or Deep General Anesthesia in Elderly Patients Receiving Total Hip Arthroplasty: A Prospective Randomized Study

Mei, Bin MD; Zha, Hanning MD; Lu, Xiaolong MBBS; Cheng, Xinqi MD; Chen, Shishou MD; Liu, Xuesheng PhD; Li, Yuanhai PhD; Gu, Erwei MD, FRCPA

doi: 10.1097/AJP.0000000000000502
Original Articles

Background: Peripheral nerve block combined with general anesthesia is a preferable anesthesia method for elderly patients receiving hip arthroplasty. The depth of sedation may influence patient recovery. Therefore, we investigated the influence of peripheral nerve blockade and different intraoperative sedation levels on the short-term recovery of elderly patients receiving total hip arthroplasty.

Methods: Patients aged 65 years and older undergoing total hip arthroplasty were randomized into 3 groups: a general anesthesia without lumbosacral plexus block group, and 2 general anesthesia plus lumbosacral plexus block groups, each with a different level of sedation (light or deep). The extubation time and intraoperative consumption of propofol, sufentanil, and vasoactive agent were recorded. Postoperative delirium and early postoperative cognitive dysfunction were assessed using the Confusion Assessment Method and Mini-Mental State Examination, respectively. Postoperative analgesia was assessed by the consumption of patient-controlled analgesics and visual analog scale scores. Discharge time and complications over a 30-day period were also recorded.

Results: Lumbosacral plexus block reduced opioid intake. With lumbosacral plexus block, intraoperative deep sedation was associated with greater intake of propofol and vasoactive agent. In contrast, patients with lumbosacral plexus block and intraoperative light sedation had lower incidences of postoperative delirium and postoperative cognitive decline, and earlier discharge readiness times. The 3 groups showed no difference in complications within 30 days of surgery.

Conclusions: 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).

Department of Anesthesiology, First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, China

Supported by the National Natural Science Foundation of China, Peking, China. (81171031, 81571039) and the Science and Technology Project of Anhui Province, Hefei city, Anhui province, China (grant number: 1301042204). The authors declare no conflict of interest.

Reprints: Erwei Gu, MD, FRCPA, Department of Anesthesiology, First Affiliated Hospital of Anhui Medical University, No. 218 Jixi Road, Hefei 230022, Anhui Province, China (e-mail: ay_mz_902@163.com).

Received November 11, 2016

Received in revised form January 20, 2017

Accepted March 22, 2017

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.