Effects of combined lumbar plexus and sciatic nerve block on perioperative cardiovascular complications in elderly patients with heart disease undergoing lower limb surgery

AIM:To investigate the feasibility of combined lumbar plexus and sciatic nerve block in elderly patients with heart disease undergoing lower limb surgery and whether this modality of anesthesia could decrease the incidence of perioperative cardiovascular complications. METHODS: Sixty elderly patients undergoing arthroscopic knee surgery were divided randomly into combined lumbar plexus and sciatic nerve block group (PNB group, n=30) and combined spinal and epidural anesthesia group (CSEA group, n=30). Changes of mean arterial blood pressure (MAP) and heart rate (HR) at different time points during operation, onset and recovered time of sensory, motor nerve block, analgesic persistent time and perioperative cardiovascular complications were recorded. RESULTS: There were no significant differences in HR at different time points between groups (P>0.05). MAP in CSEA group was significantly lower at 10- and 15-min timepoints after injection of local anesthetics compared with that in the PNB group (P<0.05). The incidence of perioperative cardiovascular complications in the CSEA group (23%) was significantly higher than in the PNB group (17%) (P<0.05). Sensory and motor nerve onset time in CSEA group ［(1.3±0.9) min and (4.1±2.3) min］ was shorter than in the PNB group ［(7.9±2.4) min and (15.2±4.1) min (P<0.05)］, whereas the sensory nerve maintenance time in the PNB group ［(418±103) min］ was longer than that in CSEA group ［(182±99) min］, and the motor nerve maintenance time in PNB group ［(282±68) min］ was shorter than in the CSEA group ［(305±76) min, P<0.05］. Postoperative 6-h VAS scores in PNB group (1.1±0.2) were significantly lower than those in the CSEA group ［(5.2±1.7), P<0.05］. CONCLUSIONS: Combined lumbar plexus and sciatic nerve block is suitable for elderly patients with heart disease undergoing lower limb procedures by providing a longer analgesia, stable hemodynamics and fewer cardiovascular complications.