Reduced Concentrations of NSE, S100β, Aβ, and Proinflammatory Cytokines in Elderly Patients Receiving Ultrasound-Guided Combined Lumbar Plexus-Sciatic Nerve Block during Hip Replacement

Abstract

Objective. The increase of hip fractures is related to the aging of the population, which has caused a huge medical burden in many countries. Hip replacement has been approved as a highly successful surgical intervention for the patients with hip fractures. Different anesthesia choices in the surgical intervention are associated with the prognosis of patients. This study focused on investigating the application of ultrasound-guided combined lumbar plexus-sciatic nerve block in elderly patients with hip fractures. Methods. In this retrospective study, 62 elderly patients received combined spinal-epidural anesthesia and 58 elderly patients underwent ultrasound-guided combined lumbar plexus-sciatic nerve block during the surgery. Hemodynamic monitoring including pulse oxygen saturation (SpO2), heart rate and blood pressure, the assessment of pain intensity using Visual Analogue Scale (VAS), cognitive function assessment through Montreal Cognitive Assessment (MoCA) and biomarkers consisting of serum levels of neuron specific-enolase (NSE), S100 beta protein (S100-β), and amyloid beta protein (Aβ), as well as immune function by interleukin-6 (IL-6), interleukin-1β (IL-1β), tumor necrosis factor-α (TNF-α), and high sensitivity C-reactive protein (hs-CRP) were detected in this study. Furthermore, length of hospital stay (LOS) and adverse reactions including hematoma, hypotension, nausea, and vomit were analyzed. Results. The findings indicated that comparing with the patients receiving combined spinal-epidural anesthesia, those undergoing ultrasound-guided combined lumbar plexus-sciatic nerve block showed significantly lower level of heart rate, higher level of SpO2, and lower level of diastolic pressure and systolic pressure at 5 minutes and 30 minutes after anesthesia and after surgery ( P < 0.05 ), indicated obviously lower VAS score at 12, 24, and 48 hours after surgery ( P < 0.05 ), and revealed higher MoCA score at 12 days after surgery ( P < 0.05 ). A significantly higher level of NSE, S100β, Aβ, IL-6, IL-1β, TNF-α, and hs-CRP was revealed in the two groups receiving different anesthesia methods at 10 days after surgery compared with that before surgery ( P < 0.05 ). However, the patients receiving ultrasound-guided combined lumbar plexus-sciatic nerve block had obviously lower expression of NSE, S100β, Aβ, IL-6, IL-1β, TNF-α, and hs-CRP compared with the group accepting combined spinal-epidural anesthesia ( P < 0.05 ). The two groups indicated no significant difference in incidence of hypotension and vomit, etc. ( P < 0.05 ), but showed remarkable difference referring to total incidence of adverse reactions and LOS ( P < 0.05 ). Conclusion. The application of ultrasound-guided combined lumbar plexus-sciatic nerve block in hip replacement contributes to the stability of hemodynamics and alleviation of postoperative pain intensity. It can reduce cognitive and immune impairment of the elderly patients with hip fractures.

Analysis of Efficacy, Complications, and Inflammatory Reactions of Bridge Combined Internal Fixation System for Periarticular Fractures of the Shoulder

“…Wang et al [ 17 ] applied BCFS to treat femoral fractures, and no postoperative implant fracture, wound infection, or other serious complications occurred, similar to our research results. Finally, we detected three serum proinflammatory markers, namely, TNF- α , IL-1 β , and IL-6; the three are highly correlated with patients' immune response, and their increased concentrations will reduce patients' immune function [ 22 ]. The results showed that postoperatively, the three indexes in OG were significantly lower than those before treatment and CG, which suggested that BCFS had an inhibitory effect on the inflammatory response of patients with periarticular fractures of the shoulder.…”

Effect of peripheral nerve block versus general anesthesia on the hemodynamics and prognosis of diabetic patients undergoing diabetic foot Surgery

“…Using ultrasound equipment during nerve block, anesthesia may have contributed to this outcome by allowing for accurate localization and minimizing the risk of nerve damage, thereby promoting the reduction of postoperative pain; this may also mitigate the likelihood of chronic pain development [ 24 ]. Effective postoperative pain management improves patient recovery and reduces persistent pain [ 15 , 18 , 25 ]. Conversely, the GEA group’s use of the short-acting opioid Remifentanil may have contributed to the observed nociceptive hypersensitivity, potentially exacerbating postoperative pain [ 26 – 29 ].…”

“…PNB with ultrasound guidance have garnered increased acceptance stemming from their heightened efficacy and capacity to ameliorate systemic complications associated with GEA. In contrast to the adverse impact of the latter on cardiopulmonary function, ultrasound-guided PNB have proved instrumental in not only impeding the activation of inflammatory factors [ 14 , 15 ] but also in restraining the physiological reaction engendered by surgical trauma, thereby curtailing the accompanying injury. In this retrospective study, we examined the impact of GEA and PNB anesthetic techniques on intraoperative hemodynamics, postoperative analgesia, and treatment results for DFUs.…”

Peripheral Nerve Blocks in Geriatric Orthopedic Anesthesia for Hip Fractures: Unveiling Economic and Clinical Dimensions

“…Regional anesthesia techniques offer benefits compared to general or spinal anesthesia. Peripheral nerve blocks (PNBs) have emerged as innovative alternatives, exhibiting benefits in hemodynamic stability, reduced complications, and shorter hospital stays [30] [48]. In the elderly, where hip fractures often present significant risks, research also demonstrates the success of peripheral nerve blocks, even in highrisk patients.…”

“…Nerve blocks, by minimizing complications have the potential to reduce healthcare costs associated with prolonged hospital stays. Utilizing peripheral regional anesthesia in hip surgeries is linked to enhanced hemodynamic stability and a decreased incidence of complications, presenting a favorable alternative to general or spinal anesthesia [30]. Within this patient population, localized anesthesia, specifically peripheral and neuraxial nerve blocks, is associated with a reduced risk of pulmonary complications, postoperative cognitive dysfunction, and shorter intensive care unit stays [31].…”