Anesthesia For Hip Surgery Research Articles

Triple-block for surgical anesthesia in hip surgery: PENG block with combination of lumbar plexus and erector spinae plane blocks.

Triple-block for surgical anesthesia in hip surgery: PENG block with combination of lumbar plexus and erector spinae plane blocks.

Системна запальна відповідь після операцій на кульшовому суглобі: порівняння спінальної анестезії та комбінації спінальної анестезії з паравертебральною блокадою

Актуальність. C-реактивний білок (CRP) як біохімічний маркер неспецифічного запалення є об’єктивною мірою інвазивності при протезуванні кульшового суглоба. Мета дослідження. Порівняння рівнів CRP після операцій на кульшовому суглобі в умовах або комбінації спінальної анестезії з паравертебральною блокадою, або однієї лише спінальної анестезії. Матеріали та методи. 22 пацієнти, які мали однобічні операції на кульшовому суглобі, були випадковим чином розподілені на дві групи. У контрольній групі (n = 11) проводилась одноразова спінальна анестезія. У дослідній групі (n = 11) під час операції застосовувалась така сама спінальна анестезія, а після операції — однобічна пролонгована паравертебральна блокада. Результати. У 1, 3 і 7-й післяопераційні дні рівні CRP були статистично значуще (p < 0,05) нижчими у дослідній групі, ніж у контрольній. Висновки. Післяопераційне знеболювання пролонгованою паравертебральною блокадою після інтраопераційної спінальної анестезії для операцій на кульшовому суглобі супроводжується меншим зростанням рівня CRP, ніж після однієї лише спінальної анестезії.

Влияние антиконвульсантов на безопасность регионарной анестезии у детей с ДЦП и сопутствующей эпилепсией при операциях на тазобедренном суставе

Влияние антиконвульсантов на безопасность регионарной анестезии у детей с ДЦП и сопутствующей эпилепсией при операциях на тазобедренном суставе

The distribution of anesthetic in the case of psoas-compartment block according to the data of radiography

Anesthesia in hip surgery faces many problems due to age and comorbidity, the necessity of reliable intra- and perioperative anesthesia, thromboprophylaxis. That is why spinal and epidural anesthesia are so popular. However, a lot of potential risks are associated with these types of anesthesia: bradycardia, arterial hypertension, respiratory depression, postpuncture headache, epidural hematoma or abscess and so on. Peripheral nerves block both single application and prolong (via catheter) that include lumbar plexus and sciatic nerve, have some advantages comparing with spinal and epidural anesthesia. Several approaches are proposed to block effectively lumbar plexus in psoas-compartment. The goal: to assess the spreading of local anesthetic after the blockade in psoas-compartment via Capdevila approach. Methods: prolong blockades of psoas-compartment via catheter in lumbar plexus was used as a component of intra- and postoperative analgesia in case of total hip replacement in 21 adult patient. 10 ml of 1 % Lidocaine and 10 ml of contrast agent (iohexol) were injected in catheter at the end of operative procedure. Then standard AP radiography was performed with following assessment of contrast agent spreading along the vertebral bodies. Results: spreading of contrast agent along spinal segments LIII and LIV were found in all (100 %) patients, LV — 7 (33 %), LII — 5 (24 %), and along all, including LI–SI , — 2 (10 %) only. Moreover, two radiographic patterns were distinguished: 8 (38 %) patients had equal distribution of contrast agent along spine, but in 13 (62 %) patients contrast agent was predominantly concentrated near LIII and LIV bodies. Conclusion: 20 ml of solution always envelope LIII and LIV spinal segments, other segments may require additional blockade.

Our Experiences of Anesthesia in Hip Surgery

Our Experiences of Anesthesia in Hip Surgery

Erratum: Regional Anesthesia in Hip Surgery

Indelli PF, Grant SA, Nielsen K, Vail TP. Regional Anesthesia in Hip Surgery. Clin Orthop Relat Res. 2005;441:250-255 One of the authors of the aforementioned article published in the December 2005 issue of the journal requests that her name be correctly listed as Karen C. Nielsen.

Laryngospasm After Autologous Blood Transfusion

Although perioperative autologous blood transfusions are associated with few side effects, transfusion reactions can occur and can be life-threatening. We report the occurrence of postoperative laryngospasm in a patient who underwent spinal anesthesia for hip surgery. The laryngospasm could not be attributed to any cause other than the autologous blood transfusion and recurred when the transfusion was restarted. Laryngospasm was successfully treated both times with positive pressure ventilation. Autologous transfusions can trigger febrile nonhemolytic transfusion reactions, which may result in airway compromise.

Regional Anesthesia in Hip Surgery

Historically, general anesthesia has been the "gold standard" for surgeons and patients when major hip surgery is being done. The recent introductions of improved techniques and catheters for continuous peripheral nerve blocks have made regional anesthesia more attractive to patients and surgeons. We focus on current trends and future directions in perioperative pain management for major orthopaedic procedures done on the hip. The use of epidural or spinal anesthesia during major hip surgery has been linked to a reduced risk of perioperative complications like deep venous thrombosis, less deterioration of cerebral and pulmonary functions in patients who are at high risk for complications, and overall reduced blood loss. In addition, continuous peripheral nerve blocks showed effective and safe postoperative pain control, allowing for lower opioids consumption, improved and earlier rehabilitation, and high patient satisfaction. Accurate patient selection and patient education are fundamental for the success of any regional anesthesia technique. Modern regional anesthesia for major hip surgery includes the use of a single shot and continuous epidural injections, single-shot and continuous spinal injection, continuous lumbar plexus blockade, and continuous peripheral blockade of the femoral and sciatic nerves. Continuous peripheral nerve blocks represent an adjunctive, effective, and safe technique for postoperative pain control after total hip arthroplasty. Future directions in postoperative pain control include the creation of a comprehensive system that supervises the use of continuous peripheral nerve blocks outside the acute inpatient setting for few days following the surgical procedure. Therapeutic study, Level V (expert opinion). See the Guidelines for Authors for a complete description of levels of evidence.

Anaesthesia for hip surgery in the elderly

Surgical repair of hip fracture and total hip arthroplasty are primarily performed on elderly patients. Patients presenting for hip fracture surgery have a high prevalence of preoperative medical problems and may require medical stabilization before surgery. Regional anaesthesia for hip fracture repair may be contraindicated due to perioperative pharmacologic prophylaxis for deep venous thrombosis. The use of regional anaesthesia increases the magnitude and frequency of hypotensive episodes when compared with general anaesthesia. Intraoperative blood losses, averaging 250-300 ml, are not affected by anaesthetic technique. Following hip fracture surgery under spinal anaesthesia, patients exhibit better oxygenation in the early postoperative period than those after general anaesthesia. The frequency of postoperative confusion is unrelated to anaesthetic technique. The incidence of deep venous thrombosis is reduced following spinal anaesthesia as compared with general anaesthesia. The one-month mortality rate, approximately eight per cent, is unrelated to anaesthetic technique. Spinal, epidural and general anaesthesia have been used successfully for total hip arthroplasty. Intraoperative blood loss of 0.5-1.5 litres is reduced with regional anaesthesia. General anaesthesia with controlled hypotension also significantly reduces blood loss. Intraoperative instability with hypoxaemia, hypotension and cardiac arrest may follow impaction of the femoral prosthesis and are related to absorption of acrylic cement monomers and pulmonary embolism of fat, air, and platelet-fibrin aggregates. Postoperative deep venous thrombosis is common and the incidence may be reduced with epidural anaesthesia. Operative mortality is less than one per cent and pulmonary embolism is the commonest cause of death.(ABSTRACT TRUNCATED AT 250 WORDS)

Propofol ou kétamine pour l'anesthésie du grand vieillard. Etude des effets hémodynamiques à l'induction

The haemodynamic changes following anaesthesia for hip surgery in 16 very old ASA II or III patients (mean age 85.8±5 years) were studied. Patients were randomly assigned to two groups : group I 1 mg · kg −1 propofol, group II 1.5 mg · kg −1 ketamine. After injection, the patients were left spontaneously breathing oxygen, and were assisted when apneic. Haemodynamic measures with a Swan-Ganz catheter and thermodilution cardiac output calculator were made before and 1, 3, 5, 10 and 15 min after anaesthetic induction. The two groups were similar in age, weight and mean arterial pressure, but statistically different for some haemodynamic parameters (Ppa, Ppw, CI). In groupe I, arterial pressure fell significantly (−17%) in the first minute and continued to fall (−15%) until the 15 th min. Heart rate remained unchanged : right atrial and pulmonary pressures were not changed; cardiac index fell slightly and MV̇o 2 estimated by the triple product fell (−27%) as soon as propofol was infused. There was no clinical sign of cardiac failure. In group II, arterial pressure increased significantly, and heart rate decreased; pulmonary capillary wedge pressure increased (+93% after the 3 rd min) and cardiac index was unchanged. The ventricular function curve was shifted to the right, suggesting a decrease in inotropism. Systemic vascular resistances were steady. MV̇o 2 increased twofold, mainly due to the rise in pulmonary capillary wedge pressure. In conclusion, the cardiovascular state was maintained in the two groups, however with two opposite patterns : MV̇o 2 decreased with propofol, whilst its increase was important and long lasting with ketamine. Propofol appeared to be a valuable anaesthetic agent for old people when MV̇o 2 elevation may be dangerous.

Comparative Results with General and Peridural Anesthesia for Hip Surgery in the Very Old Patient

Comparative Results with General and Peridural Anesthesia for Hip Surgery in the Very Old Patient