Efficacy and Safety of 3 Different Anesthesia Techniques Used in Total Hip Arthroplasty

Chengwei Liang, Jionglin Wei, Xiaoxi Cai, Weilong Lin, Yongqian Fan, Fengjian Yang, Chengwei Liang, Jionglin Wei, Xiaoxi Cai, Weilong Lin, Yongqian Fan, Fengjian Yang

Abstract

BACKGROUND This study compared the efficacy and safety of 3 different anesthesia techniques used in total hip arthroplasty (THA). MATERIAL AND METHODS We allocated 198 patients preparing to undertake THA into 3 groups: general anesthesia group (GA group, n=66), caudal epidural anesthesia group (CEA group, n=66), and spinal-epidural anesthesia group (SEA group, n=66). We compared postoperative adverse effects occurring in patients of the 3 anesthesia groups. The Visual Analog Scale (VAS) score, Minimum Mental State Examination (MMSE) score, and β-amyloid (Aβ) expression were calculated to determine the effects of different anesthesia on the postoperative pain and cognitive dysfunction of patients. RESULTS The CEA and SEA groups had lower rates of perioperative adverse effects than in the GA group. Patients in the GA group required significantly higher administration of analgesics after the surgery than those in CEA and SEA groups. Higher Aβ expression levels and VAS scores, as well as lower MMSE scores, were also seen in the GA group compared with the other 2 groups. CONCLUSIONS CEA and SEA were more effective than GA in THA, and CEA seemed to be a better anesthesia technique than SEA.

Conflict of interest statement

Competing interests

We confirm that we have read BioMed Central’s guidance on competing interests. The authors declare that no competing interests exist.

References

    1. Learmonth ID, Young C, Rorabeck C. The operation of the century: Total hip replacement. Lancet. 2007;370:1508–19.
    1. Atchabahian A, Schwartz G, Hall CB, et al. Regional analgesia for improvement of long-term functional outcome after elective large joint replacement. Cochrane Database Syst Rev. 2015;8:CD010278.
    1. Bozic KJ, Beringer D. Economic considerations in minimally invasive total joint arthroplasty. Clin Orthop Relat Res. 2007;463:20–25.
    1. Kita T, Maki N, Song YS, et al. Caudal epidural anesthesia administered intraoperatively provides for effective postoperative analgesia after total hip arthroplasty. J Clin Anesth. 2007;19:204–8.
    1. Peters CL, Shirley B, Erickson J. The effect of a new multimodal perioperative anesthetic regimen on postoperative pain, side effects, rehabilitation, and length of hospital stay after total joint arthroplasty. J Arthroplasty. 2006;21:132–38.
    1. Jules-Elysee KM, Goon AK, Westrich GH, et al. Patient-controlled epidural analgesia or multimodal pain regimen with periarticular injection after total hip arthroplasty: A randomized, double-blind, placebo-controlled study. J Bone Joint Surg Am. 2015;97:789–98.
    1. Horlocker TT. Pain management in total joint arthroplasty: A historical review. Orthopedics. 2010;33:14–19.
    1. Hu S, Zhang ZY, Hua YQ, et al. A comparison of regional and general anaesthesia for total replacement of the hip or knee: A meta-analysis. J Bone Joint Surg Br. 2009;91:935–42.
    1. Opperer M, Danninger T, Stundner O, Memtsoudis SG. Perioperative outcomes and type of anesthesia in hip surgical patients: An evidence based review. World J Orthop. 2014;5:336–43.
    1. Rodgers A, Walker N, Schug S, et al. Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomised trials. BMJ. 2000;321:1493.
    1. Memtsoudis SG, Rasul R, Suzuki S, et al. Does the impact of the type of anesthesia on outcomes differ by patient age and comorbidity burden? Reg Anesth Pain Med. 2014;39:112–19.
    1. Indelli PF, Grant SA, Nielsen K, Vail TP. Regional anesthesia in hip surgery. Clin Orthop Relat Res. 2005;441:250–55.
    1. Basques BA, Toy JO, Bohl DD, et al. General compared with spinal anesthesia for total hip arthroplasty. J Bone Joint Surg Am. 2015;97:455–61.
    1. Chang CC, Lin HC, Lin HW. Anesthetic management and surgical site infections in total hip or knee replacement: A population-based study. Anesthesiology. 2010;113:279–84.
    1. Simmons SW, Taghizadeh N, Dennis AT, et al. Combined spinal-epidural versus epidural analgesia in labour. Cochrane Database Syst Rev. 2012;10:CD003401.
    1. Wong CA, Ratliff JT, Sullivan JT, et al. A randomized comparison of programmed intermittent epidural bolus with continuous epidural infusion for labor analgesia. Anesth Analg. 2006;102:904–9.
    1. Kulkarni SV, Agarwal P, Nagraj K. To compare the outcome of minor anorectal surgeries under local anesthesia versus spinal anesthesia. Indian J Surg. 2014;76:343–49.
    1. Vernis L, Duale C, Storme B, et al. Perispinal analgesia for labour followed by patient-controlled infusion with bupivacaine and sufentanil: Combined spinal-epidural vs. epidural analgesia alone. Eur J Anaesthesiol. 2004;21:186–92.
    1. Pascual-Ramirez J, Haya J, Perez-Lopez FR, et al. Effect of combined spinal-epidural analgesia versus epidural analgesia on labor and delivery duration. Int J Gynaecol Obstet. 2011;114:246–50.
    1. Yousef AA, Atef AM, Awais WM. Comparison of fentanyl versus meperidine as supplements to epidural clonidine-bupivacaine in patients with lower limb orthopedic surgery under combined spinal epidural anesthesia. BMC Anesthesiol. 2015;15:146.
    1. Neuman MD, Rosenbaum PR, Ludwig JM, et al. Anesthesia technique, mortality, and length of stay after hip fracture surgery. JAMA. 2014;311:2508–17.
    1. Singh RK, Saini AM, Goel N, Bisht D, Seth A. Major laparoscopic surgery under regional anesthesia: A prospective feasibility study. Med J Armed Forces India. 2015;71:126–31.
    1. Mauermann WJ, Shilling AM, Zuo Z. A comparison of neuraxial block versus general anesthesia for elective total hip replacement: A meta-analysis. Anesth Analg. 2006;103:1018–25.
    1. Terrando N, Brzezinski M, Degos V, et al. Perioperative cognitive decline in the aging population. Mayo Clin Proc. 2011;86:885–93.
    1. Steinmetz J, Christensen KB, Lund T, et al. Long-term consequences of postoperative cognitive dysfunction. Anesthesiology. 2009;110:548–55.
    1. Coburn M, Fahlenkamp A, Zoremba N, Schaelte G. Postoperative cognitive dysfunction: Incidence and prophylaxis. Anaesthesist. 2010;59:177–84. quiz 185.
    1. Lanz E, Theiss D, Kellner G, et al. Assessment of motor blockade during epidural anesthesia. Anesth Analg. 1983;62:889–93.
    1. Yousef AA, Amr YM. The effect of adding magnesium sulphate to epidural bupivacaine and fentanyl in elective caesarean section using combined spinal-epidural anaesthesia: A prospective double blind randomised study. Int J Obstet Anesth. 2010;19:401–4.
    1. Loper KA, Ready LB, Downey M, et al. Epidural and intravenous fentanyl infusions are clinically equivalent after knee surgery. Anesth Analg. 1990;70:72–75.
    1. Sizer SC, Cherian JJ, Elmallah RD, et al. Predicting blood loss in total knee and hip arthroplasty. Orthop Clin North Am. 2015;46:445–59.
    1. Modig J. Beneficial effects on intraoperative and postoperative blood loss in total hip replacement when performed under lumbar epidural anesthesia. An explanatory study. Acta Chir Scand Suppl. 1989;550:95–100. discussion 100–3.
    1. Wakamatsu M, Ono K, Katoh H, et al. [Effect of combined spinal and epidural anesthesia on blood loss during total hip replacement]. Masui. 1993;42:56–59. [in Japanese]
    1. Macfarlane AJ, Prasad GA, Chan VW, Brull R. Does regional anaesthesia improve outcome after total hip arthroplasty? A systematic review. Br J Anaesth. 2009;103:335–45.
    1. Barnett SL, Peters DJ, Hamilton WG, et al. Is the anterior approach safe? Early complication rate associated with 5090 consecutive primary total hip arthroplasty procedures performed using the anterior approach. J Arthroplasty. 2016;31(10):2291–94.
    1. Gabriel RA, Kaye AD, Jones MR, et al. Practice variations in anesthetic care and its effect on clinical outcomes for primary total hip arthroplasties. J Arthroplasty. 2016;31(4):918–22.
    1. Yang C, Zhu B, Ding J, Wang ZG. Isoflurane anesthesia aggravates cognitive impairment in streptozotocin-induced diabetic rats. Int J Clin Exp Med. 2014;7:903–10.
    1. Wulf H, Biscoping J, Beland B, et al. Ropivacaine epidural anesthesia and analgesia versus general anesthesia and intravenous patient-controlled analgesia with morphine in the perioperative management of hip replacement. Ropivacaine Hip Replacement Multicenter Study Group. Anesth Analg. 1999;89:111–16.
    1. Shi HJ, Xue XH, Wang YL, et al. Effects of different anesthesia methods on cognitive dysfunction after hip replacement operation in elder patients. Int J Clin Exp Med. 2015;8:3883–88.
    1. Williams-Russo P, Sharrock NE, Mattis S, et al. Cognitive effects after epidural vs. general anesthesia in older adults. A randomized trial. JAMA. 1995;274:44–50.
    1. Iversen LL, Mortishire-Smith RJ, Pollack SJ, Shearman MS. The toxicity in vitro of beta-amyloid protein. Biochem J. 1995;311(Pt 1):1–16.
    1. Manukhina EB, Goryacheva AV, Barskov IV, et al. Prevention of neurodegenerative damage to the brain in rats in experimental Alzheimer’s disease by adaption to hypoxia. Neurosci Behav Physiol. 2010;40(7):737–43.
    1. Strassels SA, Chen C, Carr DB. Postoperative analgesia: Economics, resource use, and patient satisfaction in an urban teaching hospital. Anesth Analg. 2002;94:130–7. table of contents.
    1. Frater RA, Moores MA, Parry P, Hanning CD. Analgesia-induced respiratory depression: Comparison of meptazinol and morphine in the postoperative period. Br J Anaesth. 1989;63:260–65.

Source: PubMed

Sponsoren und Mitarbeiter

Krankheiten

Drogeninterventionen

3
Abonnieren