RESUMO
BACKGROUND/PURPOSE: General Anesthesia (GA) and conscious sedation (CS) are anesthetics for transfemoral transcatheter aortic valve replacement (TF-TAVR). We compared TF-TAVR outcomes using a novel anesthetic approach with fascia iliaca block (FIB) plus minimal CS (MCS) versus GA. METHODS: This retrospective propensity-matched study included consecutive TF-TAVR patients from January 2013 to December 2017 and dichotomized into FIB-MCS vs. GA. Data were collected from electronic records, Society of Thoracic Surgery (STS) database, and the Transcatheter Valve Therapies (TVT) Registry. Primary endpoints were operating room (OR) time, intensive care unit (ICU) and hospital length of stay (LOS). Secondary endpoints were 30-day, 1-year mortality, quality of life, 30-day re-hospitalization rate, failure of FIB-MCS, and hospital safety outcomes. RESULTS: A total of 304 TF-TAVR patients; FIB-MCS (nâ¯=â¯219) vs. GA (nâ¯=â¯85). Propensity matched 162 patients; FIB-MCS (nâ¯=â¯108) vs. GA (nâ¯=â¯54). FIB-MCS had shorter OR time (197.6⯱â¯56.3 vs. 248.2⯱â¯46.3â¯min, pâ¯<â¯0.001), ICU (67.8⯱â¯71.7 vs. 84.9⯱â¯72.1â¯h, pâ¯=â¯0.004) and hospital LOS (3.2⯱â¯3.7 vs. 5.9⯱â¯3.5 d, pâ¯<â¯0.001). FIB-MCS had lower rate of blood transfusion. FIB-MCA vs. GA 30-day and 1-year mortality were similar in the entire (2.3 vs. 2.4%, pâ¯=â¯1.0; and 8.2 vs. 5.9%, pâ¯=â¯0.49) and matched cohorts (0 vs. 3.7%, pâ¯=â¯0.11 and 7.4 vs. 5.6%, pâ¯=â¯0.75). FIB-MCS were less likely to be re-hospitalized [Odd Ratio: 0.32, CI:0.13-0.76] and 2% to 3% higher KCCQ-12 score. CONCLUSION: TF-TAVR using FIB-MCS is feasible and safe with shorter OR time, ICU and hospital LOS, lower risk of 30-day re-hospitalization, similar 30-day and 1-year mortality with better quality of life at 1-year follow-up.
Assuntos
Anestesia Geral , Estenose da Valva Aórtica/cirurgia , Cateterismo Periférico , Sedação Consciente , Artéria Femoral , Bloqueio Nervoso , Substituição da Valva Aórtica Transcateter , Idoso , Idoso de 80 Anos ou mais , Anestesia Geral/efeitos adversos , Anestesia Geral/mortalidade , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/mortalidade , Cateterismo Periférico/efeitos adversos , Cateterismo Periférico/mortalidade , Sedação Consciente/efeitos adversos , Sedação Consciente/mortalidade , Bases de Dados Factuais , Registros Eletrônicos de Saúde , Feminino , Humanos , Tempo de Internação , Masculino , Bloqueio Nervoso/efeitos adversos , Bloqueio Nervoso/mortalidade , Duração da Cirurgia , Readmissão do Paciente , Punções , Qualidade de Vida , Sistema de Registros , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Substituição da Valva Aórtica Transcateter/efeitos adversos , Substituição da Valva Aórtica Transcateter/mortalidade , Resultado do TratamentoRESUMO
BACKGROUND: Modern joint arthroplasty protocols place an emphasis on minimizing patient-reported postoperative pain while minimizing opioid consumption. The use of multimodal pain management protocols has been reported to improve patient outcomes and satisfaction after total hip arthroplasty. METHODS: In a prospective, single-surgeon trial, 50 patients undergoing primary direct anterior approach total hip arthroplasty were randomized to receive a preoperative fascia iliaca compartment block (FICB) or an intraoperative surgeon-delivered psoas compartment block (PCB). Patient-reported pain was recorded in the postanesthesia care unit, recovery floor and 3 weeks postoperatively. Opioid use was recorded during the hospital stay. RESULTS: Average visual analog scale pain scores in the postanesthesia care unit were 38.7 ± 8.7 vs 35.6 ± 8.3 (P = .502) for the preoperative FICB and intraoperative PCB groups, respectively. No significant difference was found between groups at the 3-week visit for postoperative pain (FICB: 2.9 ± 1.4; PCB: 3.2 ± 2.0; P = .970) and patient-reported pain satisfaction (FICB: 8.8 ± 2.2; PCB: 9.7 ± 0.6; P = .110). CONCLUSION: During the direct anterior approach for total hip arthroplasty, PCB is an effective and efficient regional anesthesia technique. It may be used to obtain satisfactory postoperative pain control and patient satisfaction while decreasing hospital resources.