Comparison of combined spinal-epidural anesthesia versus lumbar plexus-sciatic nerve block in elderly patients undergoing internal fixation of hip fractures

Objective To compare combined spinal-epidural anesthesia(CSEA)versus lumbar plexus-sciatic nerve block(LPSB)in elderly patients undergoing internal fixation of hip fractures. Methods Sixty American Society of Anesthesiologists physical status Ⅱ or Ⅲ elderly patients, aged 66-94 yr, with body mass index of 15.2-28.0 kg/m2, scheduled for internal fixation of hip fractures, were randomly assigned into CSEA group and LPSB group using SPSS 18.0 software, with 30 patients in each group.In CSEA group, intrathecal catheter was successfully placed at L3, 4 interspace, 0.5% hyperbaric bupivacaine 8-10 mg was injected into the subarachnoid space and then an epidural catheter was placed.In LPSB group, posterior lumbar plexus block was performed with 0.4% ropivacaine 25-30 ml and parasacral sciatic nerve block with 0.4% ropivacaine 15-20 ml.Dexmedetomidine 0.4-0.6 μg·kg-1·h-1 was infused during the procedure to maintain the Observer′s Assessment of Alertness/Sedation Scale score of 3 or 4 in two groups.Patient-controlled intravenous analgesia was performed with sufentanil and lasted for 48 h. The anesthesia time, volume of intraoperative fluid infused, blood loss, consumption of dexmedetomidine, requirement for vasoactive agents, cardiovascular events, consumption of sufentanil within 24 and 48 h after surgery, rescue analgesia and postoperative adverse reactions were recorded. Results Compared with CSEA group, the anesthesia time was significantly prolonged, the volume of intraoperative fluid infused and consumption of ephedrine were reduced, the consumption of dexmedetomidine was increased, the incidence of bradycardia was decreased, the postoperative consumption of sufentanil was reduced, the rescue analgesia rate was decreased, and no significant change was found in the incidence of postoperative adverse events in LPSB group(P>0.05). Conclusion LPSB can maintain hemodynamics stable and provide postoperative analgesic effect, with better anesthetic efficacy than CSEA when used for internal fixation of hip fractures in elderly patients. Key words: Anesthesia, spinal; Anesthesia, epidural; Nerve block; Hip fracture; Aged