To observe the anesthetic effect of lumbar plexus-sciatic nerve block (LPSB) and combined spinal-epidural anesthesia (CSEA) and their impact on hemodynamics in elderly patients with hip fracture.

A total of 312 elderly patients with hip fracture admitted to Wuhan Central Hospital affiliated to Tongji Medical College, Huazhong University of Science and Technology from January 2019 to January 2020 were selected as the research subjects. The patients were divided into an observation group and a control group by the random number table method, with 156 cases in each group. All patients underwent hip replacement; the observation group underwent LPSB for anesthesia, and the control group underwent CSEA. Indexes related to anesthesia effect were recorded in both groups, including time to effective anesthesia, time to sensory block, time to awakening, time to orientation recovery, time to recovery of motor function, time to extubation, and visual analogue scale (VAS) score. The scores of mini mental state examination (MMSE) before anesthesia and 6 h, 12 h, 24 h, and 48 h after anesthesia were recorded. Hemodynamic indexes [diastolic blood pressure (DBP), systolic blood pressure (SBP), mean arterial pressure (MAP), and heart rate (HR)] were compared between the two groups before anesthesia, 15 min after anesthesia, and 15 min after recovery. The adverse reactions of the two groups were observed and recorded.

Compared with the control group, time to effective anesthesia and time to sensory block were significantly longer, time to awakening, time to orientation recovery, time to motor function recovery, and time to extubation were significantly shorter, and the VAS score was significantly lower in the observation group (P＜0.05 each). At 6 h, 12 h, 24 h, and 48 h after anesthesia, the MMSE scores of the two groups showed a trend of decrease first and then increase; the difference was statistically significant (P＜0.05 each). Compared with the control group, the MMSE scores of the observation group at 6 h, 12 h, and 24 h after anesthesia were significantly higher (P＜0.05 each). The levels of DBP, SBP, MAP, and HR in both groups showed a downward trend from pre-anesthesia to 15 minutes post-anesthesia, and significantly increased from 15 minutes after anesthesia to 15 minutes after awakening (P＜0.05 each). Compared with the control group, the levels of all indicators in the observation group at 15 min after anesthesia and 15 min after awakening were significantly higher (P＜0.05 each). The total incidence of adverse reactions in the observation group was significantly lower than that of the control group (13.46% vs 25.00%, P＜0.05).

LPSB has a better anesthetic effect in elderly hip surgery, less impact on patients' cognitive function and hemodynamics, and lower incidence of adverse reactions, which is worthy of promotion.