Anesthesia For Hip Arthroplasty Research Articles

Morbidité et mortalité en anesthésie pour arthroplastie totale de la hanche sur terrain de drépanocytose dans un pays à faible revenu : cas du centre hospitalier Monkole

Background: Anaesthesia for hip arthroplasty in patients with sickle cell disease is considered a high-risk procedure. This study investigated morbidity and mortality in a low-income country using Monkole Hospital as an example.Methods. A cross-sectional study of electrophoretically confirmed sickle cell patients anaesthetised at Monkole for hip arthroplasty during the period October 2018 to April 2024. Peri-anaesthetic data up to hospital discharge were collected prospectively and analysed with SPSS 26.0 for p<0.05. Anaesthetic management at Monkole is multidisciplinary. Transfusion exchange, Hb S assay, and systematic cardiorespiratory investigations are not performed. Simple transfusion was carried out with the aim of achieving a haemoglobin level of 7 and 9 g/dl.Results. Eighty-six patients were enrolled. The mean age was 26.02 years, 88.54% were aged 18 and over, and 66.3% were women. BMI was <18.5 kg/mm2 in 48.8%; 84.9% were polytransfused; only 9.3% were on hydroxyurea and only one had received exchange transfusion; 2.3% were icteric and 97.7% were classified ASA III. The mean Hb level was 8.3g/dl, and less than 7g/dL in 15.1% of cases. Antibiotic prophylaxis was administered in all patients with cefazolin ± gentamycin. Spinal anaesthesia (bupivacaine + morphine) was used alone (95.3%), combined with general anaesthesia (3.48%), and the prosthesis was cemented in 95.35% of cases. Intraoperative complications were: arterial hypotension (18.6%), discomfort (4.6%), the effect of cementing (4.6%), poor quality of spinal block (1.6%), haemorrhage (2.3%). Transfusion was required for 79.1% of patients intraoperatively and 3.2% postoperatively. Postoperative complications accounted for 11.6%: anaemia (5.8%), vaso-occlusive crisis (2.3%), urinary retention (2.3%), and vomiting (1.6%). No deaths or acute chest syndrome were recorded. All patients spent one day in intensive care and the average hospital stay was 5 days. Alcohol consumption and procedures lasting longer than two hours were associated with intraoperative complications. Leanness, previous anaesthesia, platelet count below 1500000/mm3, prolonged activated partial thromboplastin time, and the presence of intraoperative complications were associated with postoperative complications.Conclusion. There was no and morbidity was represented by minor complications. It seems possible to anaesthetise patients with sickle cell disease for hip arthroplasty without measuring haemoglobin S or exchanging transfusions, with a lower risk of morbidity and mortality.

Дексмедетомидин как адъювант к бупивакаину при спинальной анестезии для артропластики тазобедренного сустава

Актуальность. Спинальная анестезия является экономически эффективным методом для хирургии нижних конечностей. Один из ее недостатков — небольшая длительность послеоперационной аналгезии. Цель исследования: ­выявить эффект от добавления 5 или 10 мкг дексмедетомидина к 12 мг бупивакаина на характеристики блока у пациентов, подвергающихся артропластике тазобедренного сустава. Материалы и методы. 45 пациентов были случайным образом разделены на три группы (по 15 в каждой): Б — введение лишь бупивакаина, БД5 — бупивакаин и 5 мкг дексмедетомидина и БД10 — бупивакаин и 10 мкг дексмедетомидина. Перед операцией и после нее оценивался моторный блок по модифицированной шкале Bromage. После операции также регистрировалось время до первой потребности в системной аналгезии. Результаты. Перед операцией время наступления полного моторного блока (Me [25 %; 75 %]) в группе БД10 (6,5 [5,0; 10] минуты) было незначительно меньше, чем в группах БД5 (10,0 [7,0; 15,0] минуты; p = 0,35) и Б (13,5 [10,0; 15,0] минуты; p = 0,08). После операции время частичного исчезновения моторного блока в группе БД10 (540 [360; 660] минут) было значительно (p &lt; 0,001) большим, чем в группах БД5 (330 [300; 420] минут) и Б (200 [190; 240] минут); различие между группами БД10 и БД5 также было большим (p = 0,015). Время до полного исчезновения моторного блока в группе БД10 (630 [420; 720] минут) было значительно (p &lt; 0,001) большим, чем в группах БД5 (380 [340; 460] минут) и Б (255 [210; 280] минут); различие между группами БД10 и БД5 также было большим (p = 0,008). В послеоперационном периоде время до первой потребности в системной аналгезии в группе БД10 было большим (720 [600; 860] минут), чем в группах БД5 (450 [400; 540] минут; p = 0,0014) и Б (285 [230; 300] минут; p &lt; 0,001); в группе БД5 время до первой потребности системной аналгезии было большим, чем в группе Б (p &lt; 0,001). Выводы. Добавление дексмедетомидина удлиняет как моторный блок, так и аналгезию от спинальной анестезии.

Improved analgesia with clonidine when added to local anesthetic during combined spinal‐epidural anesthesia for hip arthroplasty: a double‐blind, randomized and placebo‐controlled study

The perioperative effects of intrathecal and epidural clonidine combined with local anesthetic were evaluated in 60 patients undergoing hip arthroplasty. This was a double-blinded study and the patients were randomized into three groups, with 20 patients in each group. All patients received spinal anesthesia with 17.5 mg of plain bupivacaine with 15 microg of clonidine (Group BC-RC) or without clonidine (Groups B-R and B-RC). Postoperatively, epidural infusion was administered in the following way: Group B-R-ropivacaine 4 mg h(-1); Groups B-RC and BC-RC: ropivacaine 4 mg h(-1) and clonidine 40 microg h(-1). Sensory block was assessed with light touch, pinprick, transcutaneous electrical stimulation at T12 and L2 dermatomes, and perception of thermal stimuli. The maximal upper level of sensory block measured by pin-prick (T6-T7) did not differ between the groups while the partial sensory block for cold and warmth were increased two dermatomes above pin-prick level in the group with intrathecal clonidine compared to the other two groups (P < 0.05). Duration of anesthesia, analgesia and motor block were longer in Group BC-RC compared to Groups B-R and B-RC (P < 0.02). Postoperatively, both VAS score on movement and PCA-morphine consumption were higher in Group B-R than in Groups B-RC and BC-RC (P < 0.01). The arterial pressure and heart rate in Groups B-RC and BC-RC were significantly lower than in Group B-R at 10-24 and 15-24 h, respectively, after spinal injection. Low-dose intrathecal clonidine provided a better quality of anesthesia and longer-lasting analgesia. Epidural clonidine-ropivacaine infusion resulted in improved postoperative analgesia but was associated with a moderate decrease in blood pressure.

A Comparison of Spinal and Epidural Anesthesia for Hip Arthroplasty

A Comparison of Spinal and Epidural Anesthesia for Hip Arthroplasty

Clinical considerations in anaesthesia for hip arthroplasty

Experiences with the anaesthetic management of 248 patients undergoing total hip replacement are presented. Blood loss does not appear to be influenced by hypertension, the method of venting or the type of anaesthetic, with the exception of neurolept-analgesia. The importance of oxygen therapy in the treatment of the pulmonary embolic syndrome is stressed and the prevention of deep venous thrombosis is discussed. Mortality and morbidity figures are given.