Effects of lumbar quadratus block combined with general anesthesia in elderly patients with percutaneous nephrolithotomy

Objective To investigate the effects of ultrasound-guided lumbar quadratus block combined with general anesthesia on inflammatory stress and early postoperative cognitive function in elderly patients undergoing percutaneous nephrolithotomy.

Methods A total of 86 elderly patients who underwent percutaneous nephrolithotomy were selected as study objects, and were divided into observation group (n=43) and control group (n=43) by random number table method. The patients in the control group were anesthetized generally, and the patients in the observation group were anesthetized with ultrasound-guided lumbar quadratus muscle block combined with general anesthesia. The operation conditions, heart rate, mean arterial pressure and Visual Analogue Scale(VAS) scores at different time points of the two groups were compared, and the changes of cognitive function and serum inflammatory indicatorsinterleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), and C-reactive protein (CRP) of the two groups were compared.

Results The dosage of remifentanil and propofol in the observation group were significantly less than those in the control group (P < 0.05), but there was no significant difference in the operation time and heart rate, mean arterial pressure, MMSE score and serum inflammatory indicators before anesthesia (P>0.05). At the beginning of lithotripsis and the end of operation, the heart rate and mean arterial pressure of the observation group were lower than those of control group (P < 0.05). At 2, 6, 12, 24 h after surgery, VAS scores of two groups were decreased gradually, and VAS scores of the observation group were lower than those in the control group (P < 0.05). At 1 day after surgery, MMSE score of the control group was lower than that before anesthesia and the observation group (P < 0.05), but there was no statistically significant difference in MMSE score of the observation group compared to before anesthesia (P>0.05). At 3 days after operation, the levels of IL-6, TNF-α and CRP in the observation group were higher than before anesthesia, but were lower than those in the control group (P < 0.05).

Conclusion Ultrasound-guided lumbar quadratus block combined with general anesthesia can be used in elderly patients undergoing percutaneous nephrolithotomy. It is conductive to reduce the amount of anesthetic drugs, stabilize the patient's heart rate and average arterial pressure, relieve postoperative pain and inflammatory stress response, and improve postoperative cognitive function.