To compare the effects of ultrasound-guided modified lumbosacral plexus block (MLPB) combined with monitor anesthesia care (MAC)and spinal anesthesia (SA) on perioperative prognosis and inflammatory stress response in elderly patients undergoing hip surgery.

From January 2019 to January 2020, 62 patients aged 65-90 years old, ASA grade Ⅱ or Ⅲ, underwent unilateral hip operation in the Department of Orthopedics of Jiaxing First Hospital. All the recruiters were divided into 2 groups, MLPB group and SA group, according to random number table method. The MLPB group underwent ultrasus-guided modified lumbosacral plexus block before surgery, and 0.375% ropivacaine 30 ml was injected into the lumbosacral plexus and sacral plexus respectively on the surgical side, and intraoperative combined MAC. In SA group, 1.5 ml of 0.375% ropivacaine hydrochloride and 1 ml of sterile water was injected into subarachnoid space for spinal anesthesia. The main outcome measures were theplasma concentrations ofIL-1β, IL-6, and TNF-α at 6 h after surgery. Secondary outcome measures included perioperative hemodynamic changes, resting and moving pain scores at 6h, 12 h, 24 h, 36 h, 48h, and perioperative adverse reactions.

Compared with MLPB group, plasma levels of IL-1β, IL-6 and TNF-α in SA group at 6 h after operation were significantly increased (P<0.05). In SA group, systolic blood pressure, diastolic blood pressure and mean arterial pressure were significantly decreased at the end of anesthesia and 15 minutes after anesthesia (P<0.05). In the SA group, 53.33% of patients experienced at least one episode of severe hypotension, while only 6.45% of patients in the MLPB group experienced significant hypotension (P<0.05). In addition, compared with the MLPB group, patients in the SA group had higher pain scores at resting and moving at 6 and 12 hours after surgery, and the difference was statistically significant. At the same time, the incidence of nausea and vomiting in SA group was significantly increased (P<0.05), and the incidence of other complications was not statistically significant between the two groups.

Ultrasound-guided MLPB combined with MAC can reduce postoperative inflammatory stimulation in elderly patients, and the hemodynamics of patients are stable, the postoperative pain stimulation is reduced, the occurrence of adverse reactions is reduced, and there is a better anesthetic effect in elderly hip surgery.