A Comparison between Diltiazem and Nitroglycerine for Hypotensive Anaesthesia in Total Hip Arthroplasty.

ABSTRACT

Background: To compare controlled induced hypotension for facilitating surgical exposure and reducing intraoperative blood loss, using diltiazem and nitroglycerin in total hip arthroplasty under general anesthesia. Methods: 60 adults of American Society of Anesthesiologists (ASA) grade I and II posted for total hip arthroplasty in the department of orthopaedics were selected for prospective, randomized study and allocated randomly into three groups Group A (control group), group B (diltiazem-controlled hypotension), and group C (nitroglycerin-controlled hypotension).Statistical analysis done using SPSS 20 software. Analysis of variance (ANOVA) test was used to compare the demographic data. Intergroup comparison between A and B,B and C,A and C of the heart rate (HR) and mean arterial pressure (MAP)were done using student t test. A P value <0.05 was considered significant. Results: The mean HR of group B showed a statistically significant decrement which continued 30 min after stoppage of infusion compared to group A (p=0.001)and C(p=0.001).The mean HR of group C showed a statistically significant increase upto the stoppage of infusion compared to group A(P=0.001) and group B(P=0.001). MAP of group C (59.9+4.28)is decreased to the target MAP between 15 and 45min after starting infusion whereas group B (71.2+4.65)remained above target MAP even after 45min. Group B showed a significant decrease in mean MAP (64.43+4.34)continuing upto 30 min after stoppage of infusion(p=0.001) compared to group A(105.8+3.86) and group C(106.4+4.9). Conclusion: Diltiazem is a poor agent for the management of controlled hypotension.