Effects of ultrasound-guided lumbar plexus and sacral plexus block combined with general anesthesia on the anesthetic efficacy and surgical outcomes in elderly patients undergoing intertrochanteric fracture surgery: a randomized controlled trial

Abstract

Background Surgery for intertrochanteric fractures in elderly patients is challenging due to the risk of severe pain and significant stress responses. We investigated the effects of a combined approach of ultrasound-guided lumbar plexus and sacral plexus block with general anesthesia on anesthetic efficacy and surgical outcomes in these patients. Methods A randomized controlled trial was conducted involving 150 elderly patients, divided into two groups: the combined anesthesia group (receiving ultrasound-guided lumbar plexus and sacral plexus block along with general anesthesia) and the general anesthesia alone group. Outcome measures included hemodynamic parameters, postoperative pain levels (VAS scores), postoperative recovery times, and incidence of adverse reactions. Results In the combined anesthesia group, the patients had more stable intraoperative hemodynamics, lower postoperative VAS scores at 1, 3, and 6 h, and faster recovery times (eye-opening upon command and return of respiratory function) compared to the general anesthesia group. Furthermore, the incidence of adverse reactions was significantly lower in the combined anesthesia group. Conclusions Ultrasound-guided lumbar plexus and sacral plexus block combined with general anesthesia enhanced the anesthetic efficacy and improved surgical outcomes in elderly patients undergoing intertrochanteric fracture surgery.

Peripheral Nerve Blocks for Hip Fractures

“…In comparing a single-shot lumbar plexus block as the primary anesthetic to a subarachnoid block, one study showed the lumbar plexus blockade to provide more stable intraoperative hemodynamics and a longer duration of postoperative analgesia in patients undergoing intertrochanteric hip fracture repair [ 35 ]. Even if not used as the primary anesthetic, a lumbar plexus block as an adjunct to general anesthesia compared to general anesthesia alone for hip fracture repair has been shown to improve intraoperative hemodynamics in addition to facilitating lower postoperative pain scores (1, 3, and 6 h), faster recovery times, and the decreased incidence of adverse events [ 36 ]. Although the lumbar plexus block is a great block, due to its level of difficulty and higher complication risks, its utilization has significantly dropped due to the availability of safer alternatives such as the FICB and FNB.…”