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| The Anesthetic Effects of CSEA and LPSB in Elderly Patients Undergoing Hip Fracture Surgery and their Impact on Cognitive Function |
| YAN Gongyu, YIN Tianying |
| Department of Anesthesiology, Hanzhong Central Hospital, Hanzhong Shaanxi 723000 |
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Abstract 【Objective】To observe the anesthetic effects of combined spinal-epidural anesthesia (CSEA) and lumbar plexus-sciatic nerve block (LPSB) in elderly patients undergoing hip fracture surgery and their impact on cognitive function.【Methods】Eighty elderly patients undergoing internal fixation surgery for hip fractures were randomly divided into an observation group and a control group, with 40 patients in each group. The control group received CSEA anesthesia, while the observation group received LPSB anesthesia. The surgical conditions, hemodynamic parameters at various time points [heart rate (HR), mean arterial pressure (MAP), oxygen saturation (SpO2)], stress response indicators [glucose (GLU), interleukin-6 (IL-6), cortisol (COR)], pain levels before and after surgery, cognitive function changes, and adverse events were compared between the two groups.【Results】There were no statistically significant differences in surgery time and blood loss between the two groups (P>0.05). However, the observation group had lower infusion volumes, longer anesthesia onset times, and longer block duration compared to the control group (P<0.05). At 30 minutes intraoperatively, both groups showed lower HR and MAP than preoperatively and at 1 hour postoperatively (P<0.05), with the observation group having higher HR and MAP than the control group (P<0.05). The GLU, IL-6, and COR levels at 30 min intraoperatively and 1 hour postoperatively were higher than those before operation in both groups, which showed a continuous increase (P<0.05). However, the observation group had lower GLU, IL-6, and COR levels than the control group at these time points (P<0.05). Postoperatively, both groups had lower visual analog scale (VAS) pain scores and higher Montreal Cognitive Assessment (MoCA) scores than preoperatively (P<0.05), with the observation group showing lower VAS and higher MoCA scores than the control group (P<0.05). There was no statistically significant difference in the overall incidence of adverse events between the two groups (P>0.05).【Conclusion】LPSB offers better anesthetic effects than CSEA for elderly patients undergoing hip fracture surgery. It helps stabilize blood circulation, reduces stress responses, has a smaller impact on cognitive function, and does not result in significant adverse events, which makes it suitable for clinical use.
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Received: 24 October 2023
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2024, Vol. 41 
