关键词: 关节成形术,置换,髋, 神经传导阻滞, 麻醉,静脉

Abstract: Objective  To investigate the effects of lumbar paraspinal nerve block combined with total intravenous anesthesia on hemodynamics, stress response and postoperative awakening in patients undergoing hip replacement. 
Methods  A total of 115 patients undergoing hip replacement were selected and divided into observation group(n=60) and control group(n=55) according to different anesthesia methods. The observation group was given lumbar paraspinal nerve block combined with total intravenous general anesthesia, and the control group was given total intravenous general anesthesia alone. Before anesthesia(T0), at 10 min after anesthesia(T1), at 30 min after anesthesia(T2) and at the end of operation(T3), the mean arterial pressure(MAP), heart rate(HR), norepinephrine and epinephrine levels of the two groups were compared; The postoperative awakening time, conscious sedation effect and adverse reactions during operation of the two groups were compared. 
Results  The changes of MAP and HR in the observation group were not obvious, while the MAP and HR in the control group were increased initially and then decreased, and there were significant differences in the interaction between groups, time points and time points between groups(P＜0.05). The levels of norepinephrine and epinephrine were increased in both groups, and the changes in the levels were smaller in the observation group than in the control group. There were significant differences in the interaction between groups, time points and time points between groups(P＜0.05). The postoperative awakening time of the observation group was significantly shorter than that of the control group, and the postoperative vigilance/sedation score at wake-up was lower in the observation group than in the control group(P＜0.01). There was no significant difference in the incidence of adverse reactions between two groups(P＞0.05). 
Conclusion  Compared with total intravenous general anesthesia alone, lumbar paraspinal nerve block combined with total intravenous general anesthesia for hip replacement can effectively prevent the fluctuation of hemodynamic indexes, and reduce the degree of surgical stress response, with short awakening time and good quality of postoperative recovery and without increasing the incidence of adverse reactions during the operation.

Key words: arthroplasty, replacement,hip, nerve block, anesthesia, intravenous