Effects of ultrasound-guided lumbar-sciatic nerve block and epidural anesthesia on the levels of IL-6, IL-8, TNF-α and coagulation factors in peripheral blood of elderly patients after hip arthroplasty.

Abstract

Background: To investigate the effects of ultrasound-guided lumbar-sciatic nerve block and epidural anesthesia on the levels of inflammatory factors such as Interleukin-6 (IL6), Interleukin-8 (IL-8), Tumor necrosis factor-a (TNF-α) and coagulation factors in peripheral blood of elderly patients after hip arthroplasty to provides reference value for the choice of intraoperative anesthesia.

Methods: 96 elderly patients underwent hip arthroplasty in our hospital from March 2018 to December 2019 were selected and divided into ultrasound-guided lumbar-sciatic nerve block group (group A) and epidural anesthesia group (group B) randomly , there were 48 cases in each group. The onset time of intraoperative anesthesia, postoperative hemodynamic indexes, pain score, inflammatory factors and blood coagulation factor levels were compared between group A and group B.

Results: It was proved that: (1) The onset time of sensory block and motor block in group B were shorter compared with group A, and the maintenance time of anesthesia was prolonged (P<0.05); (2) Compared with group A, visual analogue scale (VAS) score of group B patients after operation was lower (P<0.05); (3) The systolic blood pressure (SBP) and diastolic blood pressure (DBP) of group B were higher than group A (P<0.05) ) at T1 and T2, while the comparison of SBP and DBP between groups was not statistical difference at T3 and T4 (P>0.05); (3) Compared with group A, the levels of TNF, IL-8and IL-6 in peripheral blood of group B decreased after T2, T3 and T4 (P<0.05); (4) Statistical difference in plasma factor V activity (FV:C), coagulation factor VIII activity (FVIII:C) and fibrinogen (FIB) levels were showed between groups A and B at T2, T3 and T4 (P<0.05) with significantly lower values in group B compared to group A(P<0.05). (5) The half-year mortality rates of patients in two group were 5.56% and 8.33% respectively. There was no significant difference between group A and group B (P>0.05).

Conclusions: Compared with epidural anesthesia, lumbarsciatic nerve block is showed significantly lower values in concentration of peripheral blood coagulation factors and inflammatory factors after surgery, thereby alleviating postoperative hypercoagulability and inflammation.