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

Abstract

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.

Comparison of Anesthesia Beginning at On-hours Versus Off-hours on Outcomes in Patients Undergoing Hip Surgery: A Retrospective, Propensity Score–matched Cohort Study

“…It is worth noticing that in the off-hours group, the anesthetist was more likely to choose GA (63.8% vs. 18.0%), rather than CSEA (13.8% versus 29.8%) or pure PNB (3.4% versus 18.7%) to nish the hip surgery. Considering that current studies support the superiority of spinal anesthesia (Chen et al, 2019, Neuman et al, 2012 or PNB (Guay et al, 2017, Min et al, 2020 over GA for the prognosis of hip surgery patients, this phenomenon might be an important factor for worse postoperative outcomes of patients in the off-hours group before PSM. It is also explicable a phenomenon that off-hours working might affect the decision and judgment of the anesthetist.…”

“…Anesthesia beginning at off-hours was also associated with higher intraoperative dosage of sufentanil (24.5 vs. 19.3 µg; P = 0.003) (Table 2). [12][13][14][15][16][17][18][19]; P = 0.020) (Table 3).…”

Applicability and Effectiveness of Ultrasound Combined Nerve Stimulator-Guided Lumbosacral Plexus Block in Supine Versus Lateral Position During Surgeries for Lower Limb Fracture-A Prospective Randomized Controlled Trial

“…In contrast to these observations, the patients in the L group received posterior approach lumbar plexus block. Due to the deep position and complex anatomical structures, the puncture was relatively di cult and therefore the procedure time was longer [24].…”

Applicability and effectiveness of ultrasound combined with nerve stimulator-guided lumbosacral plexus block in the supine versus lateral position during surgeries for lower limb fracture-a prospective randomized controlled trial

“…Therefore, ultrasound-guided procedures could easily aid the injection of local anaesthetics to target specific sites, resulting in fewer puncture attempts [ 29 , 30 ]. Due to the deep position and complex anatomical structures of the lumbar plexus, the block was relatively difficult [ 31 ]. As the fascial plane block target is a fascial plane rather than a specific nerve (nerve root), this approach decreases the risk of nerve injury [ 32 ].…”