Safety of Different Anesthesia Methods Combined with Intravenous Fast Channel Anesthesia in Lower Extremity Orthopedic Surgery of the Elderly

Abstract

Objective. To compare the safety of different anesthesia methods combined with intravenous fast channel anesthesia in elderly lower extremity surgery and the effect on postoperative outcome. Methods. A total of 106 elderly patients who underwent lower extremity orthopedic surgery in our hospital from February 2018 to February 2021 were selected and randomly divided into the control group (n = 53) and the observation group (n = 53) according to random number table. All patients received intravenous fast-track anesthesia. On this basis, the control group received spinal-epidural anesthesia, and the observation group received iliac fascial space block on the affected side combined with sciatic nerve block. The operation conditions, blood pressure and heart rate changes, awakening time, postoperative ICU admission rate, and complications were compared between the two groups. Results. There was no statistical difference in the success rate of one-time operation between the two groups ( P > 0.05 ). The times of using analgesics and vasoactive drugs and the dosage of propofol in the observation group during the operation were lower than those in the control group, and the difference was statistically significant ( P < 0.05 ). At T2, T3, and T4, the levels of HR, DBP, and SBP in the observation group were lower than those in the control group, and the difference was statistically significant ( P < 0.05 ). After operation, the time of awakening, spontaneous breathing recovery, and extubation in the observation group were lower than those in the control group, and the difference were statistically significant ( P < 0.05 ). The incidence of complications in the observation group was lower than that in the control group, the cognitive impairment was the most significant one in the incidence of single complication, and the difference was statistically significant ( P < 0.05 ). Conclusion. Based on the combined intravenous fast channel anesthesia, the operation difficulty of the affected side iliac fascial space block combined with sciatic nerve block is the same as that of spinal-epidural anesthesia. It has a higher success rate of one operation, better analgesic and anesthetic effects during the operation, and little effect on blood flow of patients. It can maintain relatively stable heart rate and blood pressure and does not easily cause postoperative complications. Its safety is higher than that of spinal-epidural anesthesia.

The Effect of Peripheral Nerve Block on Postoperative Delirium in Older Adults Undergoing Hip Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

“…A fascia iliaca compartment block and femoral nerve block were performed in seven studies [ 16 , 17 , 18 , 19 , 28 , 29 , 30 ] and five studies [ 31 , 32 , 33 , 34 , 35 ], respectively. The following types of nerve blocks were performed in the remaining studies: lumbosacral plexus block [ 36 , 37 ], lumbar plexus block [ 38 ], a combination of psoas compartment block and sciatic nerve block [ 39 ], femoral and lateral cutaneous block [ 40 ], a combination of fascia iliaca compartment block and sciatic nerve block [ 41 ], and a combination of fascia iliaca compartment block, sacral plexus block, and superior cluneal nerve block [ 42 ]. In six studies, the local anesthetic was continuously administered through a catheter [ 17 , 19 , 31 , 32 , 38 , 39 ].…”

“…Three studies [ 32 , 36 , 37 ] were classified as “low risk”, twelve studies [ 16 , 18 , 19 , 28 , 29 , 30 , 31 , 35 , 38 , 39 , 41 , 42 ] as “some concerns”, and four studies [ 17 , 33 , 34 , 40 ] as “high risk” in the overall bias ( Figure 2 ). For bias arising from the randomization process, 12 studies [ 17 , 18 , 19 , 28 , 30 , 31 , 32 , 33 , 36 , 37 , 39 , 42 ] were rated as “low risk”, while 7 studies [ 16 , 29 , 34 , 35 , 38 , 40 , 41 ] were classified as “some concerns.” For bias due to deviations from the intended interventions, all but one study [ 40 ] with “high risk” due to lack of information, and another study [ 38 ], with “some concerns”, were assessed as “low risk.” For the bias caused by missing outcome data, two studies [ 31 , 42 ] were classified as “some concerns”, and four studies [ 17 , 33 , 34 , 40 ] were rated as “high risk” for the following reasons: insufficient information [ 17 , 40 ], and large population of ex...…”

“…For bias arising from the randomization process, 12 studies [ 17 , 18 , 19 , 28 , 30 , 31 , 32 , 33 , 36 , 37 , 39 , 42 ] were rated as “low risk”, while 7 studies [ 16 , 29 , 34 , 35 , 38 , 40 , 41 ] were classified as “some concerns.” For bias due to deviations from the intended interventions, all but one study [ 40 ] with “high risk” due to lack of information, and another study [ 38 ], with “some concerns”, were assessed as “low risk.” For the bias caused by missing outcome data, two studies [ 31 , 42 ] were classified as “some concerns”, and four studies [ 17 , 33 , 34 , 40 ] were rated as “high risk” for the following reasons: insufficient information [ 17 , 40 ], and large population of exclusion after enrollment [ 33 , 34 ]. Two studies [ 28 , 41 ] were assessed as “some concerns”, while all other studies were assessed as “low risk” for bias in the measurement of the outcome. Meanwhile, all but four studies [ 32 , 36 , 37 , 42 ] evaluated as “low risk” were assessed as “some concerns” for bias in the selection of the reported result.…”

Clinical Effect of Application of Interventional Treatment Models for Improvement of Quality of Postoperative Recovery in Elderly Patients with Total Hip Arthroplasty

“…(1) With contraindications for THA; (2) had a previous history of central nervous system disease, mental illness, or family history of mental illness; (3) a long-term use of drugs affecting the nervous or psychiatric system; (4) long-term alcohol addiction; (5) with severe cardiopulmonary dysfunction or other systemic diseases; (6) patients with severe trauma, need emergency surgery, multi-site surgery, or are critically ill in need of resuscitation; (7) with craniocerebral trauma and coma could not cooperate with treatment workers. Fifty patients were randomly divided into the control group (n=25) and the experimental group (n=25) according to the random number table method.…”

“… 6 However, due to the poor physical function and many basic diseases of elderly patients, the incidence of complications during the perioperative period is significantly higher, which has seriously affected the postoperative rehabilitation of patients. 7 Therefore, it is urgent to improve perioperative management to promote rapid recovery after THA and increase the quality of life of patients.…”