Effects of lumbar sympathetic ganglion block on tourniquet response in lower extremity orthopedic surgery

Abstract

Objective To investigate whether lumbar sympathetic ganglion block（LSGB）can alleviate the hypertensive response induced by tourniquets in lower extremity orthopedic surgery. Methods A total of 60 patients who needed pneumatic tourniquet during elective lower extremity orthopedic surgery in Nanjing First Hospital from March 2022 toAugust 2023 were randomly selected, and they met the age of 18⁃70 years, ASA grade I-II, with tourniquet using time of1⁃2.5 h and the operation time of 60⁃150 min. The randomized number table method was used to divide the participants into control group（group C, 30 cases）and LSGB group（group L, 30 cases）. Before entering the operation room, the ultrasound-guided LSGB was performed in group L , while no treatment was carried out in group C. After entering the operation room, the two groups received a homogeneous general anesthesia plan and management. The following perioperative conditions were recorded and compared between the two groups：（1）the incidence of“tourniquet⁃induced hypertension”（TH）, （2）systolic blood pressure（SBP）, diastolic blood pressure（DBP）, mean arterial pressure（MAP）and heart rate（HR）at 10 time points, including before entering the operating room（T0）, after sedation（baseline, T1）, 15 min（T2）, 30 min（T3）, 45 min（T4）, 60 min（T5）, 75 min（T6）and 90 min（T7）after tourniquet inflation, as well as immediate point（T8）and 5 min after tourniquet deflation（T9）, （3）the dosage of anesthetic drugs, vasoactive drugs and anti- arrhythmic drugs, （4）tracheal extubation time and stay in the post- anaesthesia care unit（PACU）, （5）15-item quality of rehabilitation（QoR-15）scale scores. Results Compared with group C, the incidence of TH in group L was lower（20.00% vs 43.33%, χ2=5.04, P=0.03）, the usages of remifentanil, sufentanil, nicardipine, and esmolol decreased, and the extubation time and PACU stay shortened, with statistically significant differences（P<0.05）. Compared with group C, in group L, SBP was lower at T3-7 and higher at T8-9, DBP was lower at T5-7 and higher atT2, T8, MAP was lower at T5-7 and higher at T8, HR was lower at T5-7, and the differences were statistically significant（P<0.05）. Conclusion LSGB can reduce the incidence of TH in lower extremity orthopedic surgery, reduce the use ofopioids, vasoactive drugs and anti⁃arrhythmic drugs, and provide more stable hemodynamics.

Keywords

• lower extremity surgery
• lumbar sympathetic ganglion
• nerve block
• tourniquets
• hypertension
• anesthetic drug
• vasoactive drug