Abstract
Background: Peripheral block techniques for total hip arthroplasty have been used as an analgesic strategy, only a few studies described it as an anesthetic technique, so the perioperative performance and safety are poorly studied. Methods: 78 total hip arthroplasties were prospectively observed in our hospital. Divided into 2 groups: 1) General anesthesia; and 2) Lumbar sacral plexus block anesthesia. Variables measured in both groups were: demographics, conversion to general anesthesia, total opioid doses, surgical time, blood loss, postoperative pain, use and total dose of vasopressors drugs, transfusion and ICU transfer needs, postoperative ambulation time, and length of hospital stay. T student and chi-square tests were used upon the case. A significant difference was considered when a value of p Results: 3 patients (7.3%) anesthetized with combined lumbar sacral plexus block were converted to general anesthesia. When comparing peripheral nerve block and general anesthesia, less intraoperative (p = 0.000) and postoperative (p = 0.002) opioid consumption were noted, less postoperative pain in PACU (p = 0.002) and in the first 24 hours (p = 0.005), as well as earlier onset of ambulation (p = 0.008) and shorter hospital stay (p = 0.031). Conclusions: In our study, the lumbar and sacral plexus block anesthesia technique provided anesthetic conditions to perform hip joint arthroplasty and it was proved to be advantageous in comparison to general anesthesia.
Highlights
Anesthetic techniques used for total hip arthroplasty are general anesthesia in 71% of cases, neuraxial anesthesia in 21.4%, or a combination of the above with peripheral nerve blocks in 7.6% [1].Anesthesia alters perioperative outcomes [1] [2] [3]
Peripheral block techniques for total hip arthroplasty have been used as an analgesic strategy, only a few studies described it as an anesthetic technique, so the perioperative performance and safety are poorly studied
We include all adult patients who underwent for total hip arthroplasty in our hospital, since January of 2018 to December of 2019, the study period was based on the patient’s hospital admission and discharge dates, and divided in two groups: 1) Group 1—Combination of lumbar and sacral plexus block plus sedation 41 patients; 2) Group 2—Balanced general anesthesia (GA) 37 patients. 16 of 94 patients were excluded since they received neuraxial anesthesia
Summary
Anesthetic techniques used for total hip arthroplasty are general anesthesia in 71% of cases, neuraxial anesthesia in 21.4%, or a combination of the above with peripheral nerve blocks in 7.6% [1].Anesthesia alters perioperative outcomes [1] [2] [3]. Anesthetic techniques used for total hip arthroplasty are general anesthesia in 71% of cases, neuraxial anesthesia in 21.4%, or a combination of the above with peripheral nerve blocks in 7.6% [1]. Peripheral nerve block techniques have been associated with adverse effects such as muscle weakness and the risk of falls in the postoperative period [7] This statement has been refuted by Liu, who observed that there was no significant difference in muscle weakness during the first postoperative day in patients who received peripheral block compared to those who did not receive it (p > 0.05) [5]. Conclusions: In our study, the lumbar and sacral plexus block anesthesia technique provided anesthetic conditions to perform hip joint arthroplasty and it was proved to be advantageous in comparison to general anesthesia
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