关键词: 关节成形术, 置换, 麻醉, 传导, 老年人

Abstract: Objective To compare the efficacy of lumbar plexus/sciatic nerve block using peripheral nerve stimulator with epidural anesthesia in the unilateral femoral head replacement surgery of elderly patients.Methods Forty patients,ASA physical status ofⅡ - Ⅲ,undergoing the unilateral femoral head replacement surgery were randomly divided into two groups:group N (lumbar plexus/sciatic nerve block group,n = 20);group E(epidural anesthesia group,n = 20). The patients in group N received lumbar plexus/sciatic nerve block using peripheral nerve stimulator.The local anesthetic drug was the mixed solution of 0.3% ropivacaine and 0.3%lidocaine,and the amount of drug for lumber plexus block was 30- 35 mL and 25- 30 mL for sciatic plexus block.The patients in group E received epidural anestheisa and epidural catheter headward.The local anesthetic drug was the mixed solution of 1% lidocaine and 0.5% ropivicaine, 6-8 mL would be given through epidural catheter after test dose.The blood pressure and heart rate were measured before anesthesia,5,10 min after anesthesia,operations beginning and 30 min later(T0 - T4 ).Anesthesia procedure time,adverse reactions and postoperative complications of two groups were recorded.Results The mean artery pressure (MAP) of T2 (10 min after anesthesia)and T3 (operation beginning)in group E were decreased than those of baseline(P <0.01);compared with group N,MAP of T2 and T3 in group E were lower.The heart rates were stable in both groups.Anaesthesia effect of two groups had no significant difference(P >0.05). The complications of group N were less than those of group E (P < 0.01 ).Conclusion The anesthetic strategy of lumbar plexus/sciatic nerve block using peripheral nerve stimulator will lead to precise anesthesia effect.Compared with epidural anesthesia,nerve block had stable hemodynamics and a few complications.

Key words: arthroplasty, replacement, anesthesia, conduction, aged