The effect of ultrasound–guided dexamethasone compound ropivacaine iliofascia space space block on pain caused by lumbar anesthesia in patients with total hip replacement
Authors: Li Aiguo , Peng Lingyun , Zhang Xu 
Published: December 2024

Abstract:

Objective
To observe the effect of dexamethasone complex ropivacaine on reducing lateral side pain in patients undergoing total hip arthroplasty.

Methods
120 patients aged 45 to 75 years who were proposed to undergo unilateral total hip replacement, ASA ∼grade, and L2-3Gap for puncture. The 120 patients were randomly divided into four groups of 30 each. In group A, 5 μ g sufentanyl injection was injected before lumbar anesthesia; in the other three groups; in group 1, ropivacaine and saline in group B; dexmedetomidine combined with ropivacaine in group C; dexamethasone plus ropivacaine in group D. After entering the operating room, electrocardiogram and pulse oxygen saturation were routinely monitored (SpO2), Invasive mean arterial pressure (MAP), heart rate (HR), and pain visual analogue score (VAS). Monitoring and recorded into the operating room (T0), The iliac fascia lacuna block or vein, 5min after administration (T1), 10min after iliac fascia space block (T2), 15min after iliac fasspace block (T3, When SA changes the body position) of HR, SpO2, MAP, and VAS score values. The operation duration, anesthesia operation duration, intraoperative bleeding volume, patient anesthesia satisfaction, adverse reactions of hypotension, bradycardia, chills and nausea and vomiting, and the number of postoperative intravenous analgesia pump dosage presses were recorded.

Results
Sex, age, height, weight, and bleeding conditions (P&gt; 0.05).(1) Comparison of the hemodynamic changes between the groups: in T2The fluctuations in heart rate and arterial blood pressure in group D (10min after dose) were smaller than those of the other three groups, with statistically significant differences (P &lt;0.05); in T3The arterial blood pressure and heart rate fluctuations in groups B, C and D were smaller than those in group A, with A statistically significant difference (P &lt;0.05).(2) Comparison of VAS scores: change within ①group: four groups of patients, T2, T3Time points with T0 Significant changes in VAS scores were statistically significant (P &lt;0.05); where D group T1Time point VAS score with T0Comparison, statistically significant (P &lt;0.05); change between ②groups: Group D compared to groups A, B and C in T1The changes in VAS scores were statistically different (P &lt;0.05); compared with group A, groups B and C were in T1The difference in VAS score change at time points was not statistically significant (P&gt; 0.05); in T2, T3VAS scores, but in groups B, C and D, were statistically lower (P &lt;0.05); (3) Comparison of intraoperative complications: the incidence of hypotension, bradycardia, nausea and vomiting, and local anesthetic poisoning (P&gt; 0.05). In groups C and D, the number of postoperative analgesic pump dosage presses was significantly less than that in groups A and B, with a significant difference (P &lt;0.05).

Conclusion
Ultrasound-guided dexamethasone compound ropivacaine iliac cia space block can significantly reduce the pain caused by lateral lumbar anesthesia in total hip replacement surgery, and facilitate the hemodynamic stability of patient, better patient comfort and higher satisfaction with anesthesia. Combined dexmedetomidine and dexamethasone had better postoperative analgesia and less opioid use in the analgesic pump. Compared with the dexamethasone compound ropivacaine group, the nerve block was faster and patients were more satisfied with anesthesia, which was conducive to postoperative rehabilitation and worthy of clinical promotion and application.