Effect of subarachnoid anesthesia combined with propofol target-controlled infusion on blood loss and transfusion for posterior total hip arthroplasty in elderly patients.
Chin Med J (Engl)
; (6): 650-656, 2020 Mar 20.
Article
en En
| MEDLINE
| ID: mdl-32197030
ABSTRACT
BACKGROUND:
Intravertebral and general anesthesia (GA) are two main anesthesia approaches but both have defects. This study was aimed to evaluate the effect of subarachnoid anesthesia combined with propofol target-controlled infusion (TCI) on blood loss and transfusion for total hip arthroplasty (THA) in elderly patients in comparison with combined spinal-epidural anesthesia (CSEA) or GA.METHODS:
Totally, 240 patients (aged ≥65 years, American Society of Anesthesiologists [ASA] I-III) scheduled for posterior THA were enrolled from September 1st, 2017 to March 1st, 2018. All cases were randomly divided into three groups to receive CSEA (group C, nâ=â80), GA (group G, nâ=â80), or subarachnoid anesthesia and propofol TCI (group T, nâ=â80), respectively. Primary outcomes measured were intra-operative blood loss, autologous and allogeneic blood transfusion, mean arterial pressure at different time points, length of stay in post-anesthesia care unit (PACU), length of hospital stay, and patient satisfaction degree. Furthermore, post-operative pain scores and complications were also observed. The difference of quantitative index between groups were analyzed by one-way analysis of variance, repeated measurement generalized linear model, Student-Newman-Keuls test or rank-sum test, while ratio index was analyzed by Chi-square test or Fisher exact test.RESULTS:
Basic characteristics were comparable among the three groups. Intra-operative blood loss in group T (331.53â±â64.33âmL) and group G (308.03â±â64.90âmL) were significantly less than group C (455.40â±â120.48âmL, Fâ=â65.80, Pâ<â0.001). Similarly, the autologous transfusion of group T (130.99â±â30.36âmL) and group G (124.09â±â24.34âmL) were also markedly less than group C (178.31â±â48.68âmL, Fâ=â52.99, Pâ<â0.001). The allogenetic blood transfusion of group C (0 [0, 100.00]) was also significantly larger than group T (0) and group G (0) (Zâ=â2.47, Pâ=â0.047). Except for the baseline, there were significant differences in mean arterial blood pressures before operation (Fâ=â496.84, Pâ<â0.001), 10-min after the beginning of operation (Fâ=â351.43, Pâ<â0.001), 30-min after the beginning of operation (Fâ=â559.89, Pâ<â0.001), 50-min after the beginning of operation (Fâ=â374.74, Pâ<â0.001), and at the end of operation (Fâ=â26.14, Pâ<â0.001) among the three groups. Length of stay in PACU of group T (9.41â±â1.19âmin) was comparable with group C (8.83â±â1.26âmin), and both were significantly shorter than group G (16.55â±â3.10âmin, Fâ=â352.50, Pâ<â0.001). There were no significant differences among the three groups in terms of length of hospitalization and post-operative visual analog scale scores. Patient satisfaction degree of group T (77/80) was significantly higher than group C (66/80, χâ=â7.96, Pâ=â0.004) and G (69/80, χâ=â5.01, Pâ=â0.025). One patient complained of post-dural puncture headache and two complained of low back pain in group C, while none in group T. Incidence of post-operative nausea and vomiting in group G (10/80) was significantly higher than group T (3/80, χâ=â4.10, Pâ=â0.043) and group C (2/80, χâ=â5.76, Pâ=â0.016). No deep vein thrombosis or delayed post-operative functional exercise was detected.CONCLUSIONS:
Single subarachnoid anesthesia combined with propofol TCI seems to perform better than CSEA and GA for posterior THA in elderly patients, with less blood loss and peri-operative transfusion, higher patient satisfaction degree and fewer complications. TRIAL REGISTRATION chictr.org.cn ChiCTR-IPR-17013461; http//www.chictr.org.cn/showproj.aspx?proj=23024.
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Dolor Postoperatorio
/
Propofol
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Artroplastia de Reemplazo de Cadera
/
Anestesia General
Tipo de estudio:
Prognostic_studies
Límite:
Aged
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Aged80
/
Female
/
Humans
/
Male
Idioma:
En
Revista:
Chin Med J (Engl)
Año:
2020
Tipo del documento:
Article
País de afiliación:
China