Hypotensive epidural anesthesia in patients with preoperative renal dysfunction presenting for hip arthroplasty

Abstract

Objective To investigate the benefits and safety of hypotensive epidural anesthesia (HEA) in comparison with normotensive epidural anesthesia in patients with preoperative renal dysfunction presenting for hip arthroplasty. Background HEA is one of the anesthetic techniques used to reduce perioperative blood loss for total hip replacement. The technique includes a combination of an extensive epidural block and an intravenous infusion of low-dose epinephrine (1–5 μg/min) to adjust and control the mean arterial blood pressure together with preserving central venous pressure and cardiac output. Patients and methods Forty adult patients of both sexes undergoing primary unilateral hip arthroplasty, ranging in age from 60 to 74 years, ASA II–III with mild renal dysfunction were divided into two groups: group I received epidural anesthesia with strict preservation of the mean arterial blood pressure (65–90 mmHg) during surgery using vasopressors, fluids, and/or blood transfusions and group II received epidural anesthesia and hypotension was induced by maintaining the mean arterial blood pressure at 55–60 mmHg during the entire surgery. Results The heart rate and the mean arterial blood pressure showed a significant difference between the two groups at 15, 30, 45, 60, and 90 min intraoperatively (P Conclusion HEA is superior to normotensive epidural anesthesia in patients with renal impairment undergoing hip arthroplasty in the form of decreased blood loss and the need for blood infusion, provides a clear surgical field, and leads to an improvement in cement fixation and decreased incidence of postoperative deep vein thrombosis and blood loss, with no evidence of acute kidney injury postoperatively.