Effects of Different Concentrations of Ropivacaine Lumbar Plexus-Sciatic Nerve Block on Recovery from Anesthesia, Postoperative Pain and Cognitive Function in Elderly Patients with Femoral Neck Fracture.

Objective: To investigate the effects of lumbar plexus-sciatic nerve block with different concentrations of ropivacaine on recovery from anesthesia, postoperative pain, and cognitive function in elderly patients with femoral neck fracture.

Method: A total of 110 elderly patients with femoral neck fractures who were treated in our hospital from January 2020 to January 2022 were selected as the research objects. According to the concentration of ropivacaine, they were divided into low-, medium-, and high-concentration groups (concentrations of ropivacaine were 0.15%, 0.25%, and 0.40%, respectively), with 36, 37, and 37 cases, respectively. Extubation time, anesthesia recovery time, and hospitalization time were recorded. Cognitive symptoms were assessed by the spatial cognitive ability, working memory ability, simple computing ability, and picture recognition ability test. The pain degree of patients was assessed by visual analogue scale (VAS). The occurrence of adverse reactions in patients was recorded.

Result: There was no significant difference in extubation time, anesthesia recovery time, and hospitalization time among the three groups ( > 0.05). The PCA time of the patients in the high-concentration group was significantly longer than that in the low- and medium-concentration groups. The dosage of sufentanil within 24 hours and total sufentanil in the high-concentration group were significantly lower than those in the low- and medium-concentration groups, and the dosage of sufentanil within 24 hours and total sufentanil in the medium-concentration group was significantly less than that in the low-concentration group ( < 0.05). The cognitive function score for each entry of the three groups 1 d after surgery was lower than that before surgery ( < 0.05); On the 1 day after operation, the cognitive function score for each entry of the patients in the low-concentration group was significantly higher than that in the middle- and high-concentration groups, and the cognitive function score for each entry in the middle-concentration group was significantly higher than that in the high-concentration group ( < 0.05). There was no significant difference in VAS scores between the three groups at 2 h and 8 h after surgery ( > 0.05); 16 h and 24 h after operation, the VAS score of patients in the high-concentration group was significantly lower than that in the low- and medium-concentration groups, and the VAS score in the medium-concentration group was significantly lower than that in the low-concentration ropivacaine group ( < 0.05). The incidence of adverse reactions in the high-concentration ropivacaine group was significantly higher than that in the low- and medium-concentration groups ( < 0.05).

Conclusion: The middle concentration of ropivacaine has good analgesic and nerve block effects and has less influence on cognitive function and less adverse reactions in elderly patients.