[Epidural vs general anaesthesia]. / Anestesia epidurale vs generale.

BACKGROUND: Aim of this study is to determine if and how the anaesthesia technique can significantly influence the outcome in patients after major orthopaedic surgery in terms of: patrimony of red blood cells (blood loss and erythropoiesis), incidence of intra and postoperative complications, postoperative pain control and hospital stay. METHODS: 210 patients, ASA physical status I-III, undergoing elective primary total hip replacement were randomly allocated in three groups of 70 patients to receive either epidural anaesthesia (Group EA), general anaesthesia (GA), or epidural anaesthesia integrated with mild general anaesthesia (IA). RESULTS: Data show a significant difference between the amount of pain measured by VRS immediately after surgery: prevalently absent in groups IA (84.3%) and EA (85.7%) and prevalently severe and moderate in group AG (34.3%). The measurement of the basic circulating erythrocyte mass in the first, third and fifth postoperative day, calculated by the Mercuriali formula, which considers blood loss, autologous and homologous transfusions and erythropoiesis, showed that general anaesthesia leads to a significant delay in the resumption of haemopoiesis. This result was attenuated by its combination with epidural anaesthesia. CONCLUSIONS: On the basis of the literature and the results of our study, epidural anaesthesia seems to be the most appropriate technique for patients scheduled for total hip replacement: due to its simpler analgesic cover, its tendency to be associated with a lower incidence of complications in the first 24 hours after surgery. The incidence of relevant hypotension is minor compared to integrated anaesthesia. General anaesthesia produced a significant decrease in postoperative erythropoiesis.

[Prosthesis and emergency surgery of hernia]. / Prothèse et chirurgie herniaire en urgence.

Use of prostheses in emergency surgery is a controversial issue due to the risk of infection. We report our experience with a series of 31 strangled hernias treated in emergency situations with a polypropylene (n = 29) or a vinyl (n = 2) sheath placed in a pre-peritoneal or retro-muscular position. There were three small bowel resections and 13 resections of the omentum for necrosis. There were no cases of infectious complications during the post-operative period. There were no recurrent hernias during the follow-up. The absence of any supplementary morbidity after emergency prosthesis is in agreement with the data in the literature. These results suggest that a prosthesis can be proposed for strangled hernias when the weakness of the parietal wall would compromise a conventional procedure. Excluded are cases with severe infection, including peritonitis by gangrenous perforation of an incarcerated loop and associated colonic resections.