Ultrasound-guided iliofascial block combined with general anaesthesia in elderly hip replacements

doi:10.3877/ cma.j.issn.1674-134X.2025.01.016

Abstract

Abstract:

Objective

To explore the application effect of ultrasound-guided iliofascial space block combined with general anesthesia in elderly patients with total hip replacement.

Methods

A total of 98 elderly patients undergoing hip arthroplasty admitted to Jianyang City Hospital of Traditional Chinese Medicine from January 2019 to December 2022 were prospectively selected.The enrolled patients were randomly divided into the experimental group and the control group by blocked randomization, 49 cases each.The surgical indices (awake time, autonomous breathing time, extubation time, time to get out of bed and activity time, 48 h self-controlled intravenous analgesia sufentanil dosage), analgesic effect ［visual analogue scale (VAS)］, stress indices ［lactic acid lactate (LAC), glucose (GLU), cortisol (Cor)］, and incidence of postoperative cognitive dysfunction (POCD) ,as well as total incidence of adverse effects were compared between the two groups by chi square test and t test.

Results

The experimental group’s time to wakefulness, time to voluntary breathing, time to extubation, time to get out of bed, and 48-h self-controlled intravenous analgesia sufentanil dosage were all smaller than those of the control group (t=4.916, 6.316, 8.134, 14.147, 22.537, all P<0.05).The differences in VAS scores at the comparisons of time point, between-group and interaction were statistically significant (F=107.483, 46.779,65.498, all P<0.05); the postoperative VAS scores at 4 (t=9.139, 4.239), 12 (t= 20.791, 13.736), and 24 h(t=19.031, 17.982) were lower than the data before surgery in both groups (all P<0.05); the experimental group’s postoperative 4, 12, and 24 h VAS scores were lower than the control group’s (t=7.542, 12.092, 4.864,all P<0.05).The differences at time points, between groups, and in interaction between the two groups in LAC(F=1125.988, 26.250, 47.356), GLU (F=62.906, 22.722, 13.733), and Cor (F=146.894, 12.875, 46.328)data were statistically significant (all P<0.05).LAC, GLU, and Cor were higher than preoperative data in the control group at 4 h (t=21.634, 9.724, 3.923) and 24 h after surgery (t=22.919, 6.015, 8.402）, the differences were statistically significant (all P<0.05); in the study group, LAC was higher than preoperative data at 4 h and 24 h after surgery (t=21.649, 16.227, both P<0.05), and data of GLU and Cor at 24 h after surgery were higher than the preoperative data (t=2.331, 2.651, both P<0.05).The LAC, GLU, and Cor in the experimental group were lower than those in the control group at 4 h (t=3.470, 7.464, 2.684) and 24 h after surgery (t=7.084,3.327, 5.652) (all P<0.05).The incidence of POCD in the experimental group at two weeks, three weeks and one month after surgery were lower than that in the control group (χ²=7.184, 7.900, 10.261, all P<0.05).There was no statistically significant difference in the incidence of urinary tract infection, pulmonary infection, nausea and vomiting, cardiac arrhythmia, hypotension, or somnolence between the two groups (all P>0.05).The total incidence of adverse reactions in the experimental group was 10.2% lower than 26.5% in the control group(χ²=4.356, P<0.05).

Conclusion

The application of ultrasound-guided iliofascial space block in elderly patients with total hip replacement can effectively relieve pain, improve stress level, reduce the incidence of POCD, and promote early recovery.

Key words: Arthroplasty, replacement, hip, Aged, Ultrasonic waves, Ilium, Fascia, Anesthesia, conduction

Xun Liu, Qinglin Yan, Fubin Li, Jun Guo. Ultrasound-guided iliofascial block combined with general anaesthesia in elderly hip replacements[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2025, 19(01): 109-115.

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Figures/Tables 6

Table 1 General information of two groups

组别Groups	例数Case number	性别（男/女）Gender (male/female)	年龄［岁，（ $\overset{ˉ}{x}$ ±s）］Age (year)	BMI［kg/m²，（ $\overset{ˉ}{x}$ ±s）］	ASA分级［例（%）］
组别Groups	例数Case number	性别（男/女）Gender (male/female)	年龄［岁，（ $\overset{ˉ}{x}$ ±s）］Age (year)	BMI［kg/m²，（ $\overset{ˉ}{x}$ ±s）］	Ⅰ～Ⅱ	Ⅲ
对照组Control group	49	25/24	69. 8±6. 1	24. 2±2. 3	28（57. 1）	21（42. 9）
实验组Experimental group	49	29/20	68. 6±6. 1	25. 0±2. 2	27（55. 1）	22（44. 9）
统计值Statistical values		χ ²=0. 660	t=0. 807	t=1. 579	χ ²=0. 041
P值		>0. 05	>0. 05	>0. 05	>0. 05
组别Groups	例数Case number	麻醉时间［min，（ $\overset{ˉ}{x}$ ±s）］Anaesthesia time	手术时间［min，（ $\overset{ˉ}{x}$ ±s）］Surgery time	出血量［ml，（x±s）］Blood loss	术毕心率［次/min，（ $\overset{ˉ}{x}$ ±s）］HR at the end ofsurgery	术毕平均动脉压［mmHg，（ $\overset{ˉ}{x}$ ±s）］Mean arterial pressure atthe end of surgery
对照组Control group	49	150. 0±20. 3	120. 3±23. 5	108. 5±25. 4	116. 3±3. 3	76. 4±8. 4
实验组Experimental group	49	153. 0±21. 3	118. 6±21. 4	103. 3±24. 3	117. 3±3. 6	76. 4±8. 3
统计值Statistical values		0. 586	0. 368	1. 045	1. 429	0. 006
P值		>0. 05	>0. 05	>0. 05	>0. 05	>0. 05

Table 1 General information of two groups

组别Groups	例数Case number	性别（男/女）Gender (male/female)	年龄［岁，（ $\overset{ˉ}{x}$ ±s）］Age (year)	BMI［kg/m²，（ $\overset{ˉ}{x}$ ±s）］	ASA分级［例（%）］
组别Groups	例数Case number	性别（男/女）Gender (male/female)	年龄［岁，（ $\overset{ˉ}{x}$ ±s）］Age (year)	BMI［kg/m²，（ $\overset{ˉ}{x}$ ±s）］	Ⅰ～Ⅱ	Ⅲ
对照组Control group	49	25/24	69. 8±6. 1	24. 2±2. 3	28（57. 1）	21（42. 9）
实验组Experimental group	49	29/20	68. 6±6. 1	25. 0±2. 2	27（55. 1）	22（44. 9）
统计值Statistical values		χ ²=0. 660	t=0. 807	t=1. 579	χ ²=0. 041
P值		>0. 05	>0. 05	>0. 05	>0. 05
组别Groups	例数Case number	麻醉时间［min，（ $\overset{ˉ}{x}$ ±s）］Anaesthesia time	手术时间［min，（ $\overset{ˉ}{x}$ ±s）］Surgery time	出血量［ml，（x±s）］Blood loss	术毕心率［次/min，（ $\overset{ˉ}{x}$ ±s）］HR at the end ofsurgery	术毕平均动脉压［mmHg，（ $\overset{ˉ}{x}$ ±s）］Mean arterial pressure atthe end of surgery
对照组Control group	49	150. 0±20. 3	120. 3±23. 5	108. 5±25. 4	116. 3±3. 3	76. 4±8. 4
实验组Experimental group	49	153. 0±21. 3	118. 6±21. 4	103. 3±24. 3	117. 3±3. 6	76. 4±8. 3
统计值Statistical values		0. 586	0. 368	1. 045	1. 429	0. 006
P值		>0. 05	>0. 05	>0. 05	>0. 05	>0. 05

Table 2 Surgical indicators of the two groups

组别Groups	例数Case number	清醒时间［min,（ $\overset{ˉ}{x}$ ±s）］Awake time	自主呼吸时间［min,（ $\overset{ˉ}{x}$ ±s）］Time to spontaneousrespiration	拔管时间［min,（ x±s）］Time toextubation	下床活动时间［d,（ $\overset{ˉ}{x}$ ±s）］Time to out-of-bedactivity	术中低血压发生率［例（%）］Incidence ofintraoperativehypotension	48 h自控静脉镇痛舒芬太尼［μg,（ $\overset{ˉ}{x}$ ±s）］48 h Self-controlledintravenous analgesiasufentanil
对照组Control group	49	6. 21±0. 84	10. 32±1. 16	13. 32±1. 27	4. 10±0. 33	3（6. 12）	138. 81±7. 64
实验组Experimental group	49	5. 36±0. 58	8. 29±1. 44	10. 65±1. 41	3. 22±0. 17	4（8. 16）	92. 11±12. 33
统计值Statistical value		t=4. 916	t=6. 316	t=8. 134	t=14. 147	χ ²=0. 154	t=22. 537
P值		＜0. 001	＜0. 001	＜0. 001	＜0. 001	>0. 05	＜0. 001

Table 2 Surgical indicators of the two groups

组别Groups	例数Case number	清醒时间［min,（ $\overset{ˉ}{x}$ ±s）］Awake time	自主呼吸时间［min,（ $\overset{ˉ}{x}$ ±s）］Time to spontaneousrespiration	拔管时间［min,（ x±s）］Time toextubation	下床活动时间［d,（ $\overset{ˉ}{x}$ ±s）］Time to out-of-bedactivity	术中低血压发生率［例（%）］Incidence ofintraoperativehypotension	48 h自控静脉镇痛舒芬太尼［μg,（ $\overset{ˉ}{x}$ ±s）］48 h Self-controlledintravenous analgesiasufentanil
对照组Control group	49	6. 21±0. 84	10. 32±1. 16	13. 32±1. 27	4. 10±0. 33	3（6. 12）	138. 81±7. 64
实验组Experimental group	49	5. 36±0. 58	8. 29±1. 44	10. 65±1. 41	3. 22±0. 17	4（8. 16）	92. 11±12. 33
统计值Statistical value		t=4. 916	t=6. 316	t=8. 134	t=14. 147	χ ²=0. 154	t=22. 537
P值		＜0. 001	＜0. 001	＜0. 001	＜0. 001	>0. 05	＜0. 001

Table 3 Comparison of VAS between the two groups

组别Groups	例数Case number	术前Before surgery	术后4 hFour hours after surgery	术后12 h12 h after surgery	术后24 h24 h after surgery	F值	P值
对照组Control group	49	6. 22±1. 14	5. 63±0. 62^a	4. 18±0. 39^ab	3. 65±0. 88^abc	时间：107. 483组间：46. 779	时间：＜0. 001组间：＜0. 001
实验组Experimental group	49	6. 2±1. 05	4. 69±0. 40^a	3. 27±0. 22^ab	2. 86±0. 72^abc	交互：65. 498	交互：＜0. 001
统计值Statistical value		0. 075	7. 542	12. 092	4. 864	-	-
P值		>0. 05	＜0. 001	＜0. 001	＜0. 001	-	-

Table 4 Stress indicators of the two groups

组别Groups	例数Case number	LAC（mg/L）			F值	P值
组别Groups	例数Case number	术前Before surgery	术后4 hFour hours after surgery	术后24 h24 h after surgery	F值	P值
对照组Control group	49	0. 57±0. 21	2. 05±0. 43^a	1. 40±0. 29^ab	时点：1125. 988组间：26. 250	时点：＜0. 001组间：0. 001
实验组Experimentalgroup	49	0. 60±0. 16	2. 40±0. 56^a	1. 86±0. 35^ab	交互：47. 356	交互：＜0. 001
t 值		t=0. 795	t=3. 470	t=7. 084
P值		>0. 05	0. 001	＜0. 001
组别Groups	例数Case number	GLU（mmol/L）			F值	P值
组别Groups	例数Case number	术前Before surgery	术后4 hFour hours after surgery	术后24 h24 h after surgery	F值	P值
对照组Control group	49	5. 15±1. 25	5. 63±1. 37^a	5. 79±1. 46^ab	时点：62. 906组间：22. 722	时点：＜0. 001组间：＜0. 001
实验组Experimentalgroup	49	5. 07±1. 24	7. 86±1. 58^a	6. 83±1. 63^ab	交互：13. 733	交互：＜0. 001
t 值		t=0. 318	t=7. 464	t=3. 327
P值		0. 751	＜0. 001	0. 001
组别Groups	例数Case number	Cor（nmol/L）			F值	P值
组别Groups	例数Case number	术前Before surgery	术后4 hFour hours after surgery	术后24 h24 h after surgery	F值	P值
对照组Control group	49	182. 41±23. 68	189. 26±25. 05	196. 90±30. 06	时点：146. 894组间：12. 875	时点：＜0. 001组间：＜0. 001
实验组Experimentalgroup	49	183. 07±23. 73	203. 72±28. 19^a	234. 68±35. 86^ab	交互：46. 328	交互：＜0. 001
t 值		t=0. 138	t=2. 684	t=5. 652
P值		>0. 05	0. 009	＜0. 001

Table 5 Incidence of postoperative POCD of the two groups

组别Groups	例数Case number	术后2周Two weeks after surgery	术后3周Two weeks after surgery	术后1个月One month after surgery
对照组Control group	49	2（4. 08）	4（8. 16）	6（12. 24）
实验组Experimentalgroup	49	11（22. 45）	15（30. 61）	20（40. 82）
χ ² 值		7. 184	7. 900	10. 261
P值		0. 007	0. 005	0. 001

Table 6 Comparison of the occurrence of adverse reactions between the two groups

组别Groups	例数Case number	尿路感染Urinary tractinfection	肺部感染Lunginfections	恶心呕吐Nausea andvomiting	心律失常Arrhythmia	低血压Low bloodpressure	嗜睡Drowsiness	总发生率Overallincidence
对照组Control group	49	0	0	2（4. 1）	1（2. 0）	1（2. 0）	1（2. 0）	5（10. 2）
实验组Experimentalgroup	49	1（2. 0）	1（2. 0）	4（8. 2）	1（2. 0）	3（6. 1）	3（6. 1）	13（26. 5）
χ ²值								4. 356
P值								0. 037

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