Impacts of Ultrasound-Guided Nerve Block Combined with General Anesthesia with Laryngeal Mask on the Patients with Lower Extremity Fractures

Abstract

Objective. Surgical reduction is the leading approach to patients with lower extremity fractures. The options of anesthetic drugs during surgery are of great significance to postoperative recovery of patients. There is no consensus on the optimum anesthesia method for patients undergoing lower extremity fracture surgery. Our study is aimed at investigating the impacts of nerve block combined with general anesthesia on perioperative outcomes of the patients. Methods. In this retrospective study, 48 patients experienced general anesthesia only, and 42 patients received never block combined with general anesthesia. The perioperative hemodynamics was recorded, including mean arterial pressure (MAP), oxygen saturation of blood (SpO2), and heart rate (HR). Visual analogue scale (VAS) and Montreal Cognitive Assessment (MoCA) were carried out to evaluate postoperative pain and cognitive status. Furthermore, adverse reactions and recovery condition were observed between the patients receiving different anesthesia methods. Results. At 15 minutes and 30 minutes after anesthesia, as well as 5 minutes after surgery, significant lower MAP was observed in the patients treated with general anesthesia ( $83.04\pm 8.661$ , $79.17\pm 9.427$ , $86.58\pm 8.913$ ) compared to those receiving never block combined with general anesthesia ( $90.43\pm 4.618$ , $88.74\pm 6.224$ , $92.21\pm 4.015$ ) ( $P<0.05$ ), and compared with general anesthesia group ( $68.5\pm 7.05$ , $69.63\pm 7.956$ , $72.75\pm 8.446$ ), the combined anesthesia group ( $73.52\pm 9.451$ , $74.17\pm 10.13$ , $77.62\pm 9.768$ ) showed obvious higher HR ( $P<0.05$ ). No significant difference in SpO2 was found between the two groups at multiple time points ( $P>0.05$ ). As for the score of VAS and MoCA, remarkably lower VAS and higher MoCA at 6 h, 12 h and 24 h after surgery were presented in the combined anesthesia group compared to general anesthesia group ( $P<0.05$ ). At 24 h after surgery, the two groups showed normal cognitive function ( $26.33\pm 0.7244$ vs. $28.55\pm 0.7392$ ). Incidence of nausea and vomiting in the combined anesthesia group was lower than that of the general anesthesia group ( $P<0.05$ ). The time to out-of-bed activity and hospital stay were shorter in the combined anesthesia group compared with general anesthesia ( $P<0.05$ ). Conclusion. The application of never block combined with general anesthesia contributed to the stability of hemodynamics, alleviation of postoperative pain and cognitive impairment, along with decrease in adverse reactions and hospital stay in the patients with lower extremity fractures.