Effect of subarachnoid anesthesia combined with propofol target-controlled infusion on blood loss and transfusion for posterior total hip arthroplasty in elderly patients.

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, n = 80), GA (group G, n = 80), or subarachnoid anesthesia and propofol TCI (group T, n = 80), 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 (331.53 ±â€Š64.33 mL) and group G (308.03 ±â€Š64.90 mL) were significantly less than group C (455.40 ±â€Š120.48 mL, F = 65.80, P < 0.001). Similarly, the autologous transfusion of group T (130.99 ±â€Š30.36 mL) and group G (124.09 ±â€Š24.34 mL) were also markedly less than group C (178.31 ±â€Š48.68 mL, F = 52.99, P < 0.001). The allogenetic blood transfusion of group C (0 [0, 100.00]) was also significantly larger than group T (0) and group G (0) (Z = 2.47, P = 0.047). Except for the baseline, there were significant differences in mean arterial blood pressures before operation (F = 496.84, P < 0.001), 10-min after the beginning of operation (F = 351.43, P < 0.001), 30-min after the beginning of operation (F = 559.89, P < 0.001), 50-min after the beginning of operation (F = 374.74, P < 0.001), and at the end of operation (F = 26.14, P < 0.001) among the three groups. Length of stay in PACU of group T (9.41 ±â€Š1.19 min) was comparable with group C (8.83 ±â€Š1.26 min), and both were significantly shorter than group G (16.55 ±â€Š3.10 min, F = 352.50, P < 0.001). 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, χ = 7.96, P = 0.004) and G (69/80, χ = 5.01, P = 0.025). 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, χ = 4.10, P = 0.043) and group C (2/80, χ = 5.76, P = 0.016). 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.

The efficacy of simultaneous bilateral axillary brachial plexus block under the guidance of neurostimulator or ultrasound: a prospective study.

PURPOSE: This study was designed to investigate the risk of local anesthetic toxicity and efficacy of simultaneous bilateral axillary brachial plexus block performed under the guidance of ultrasound or a neurostimulator. METHODS: One hundred and twenty patients who were anesthetized with bilateral axillary plexus block simultaneously between February 2012 and March 2014 were enrolled in the study. The patients were anesthetized under the guidance of a neurostimulator (group N, n = 60) or ultrasound (group U, n = 60). The block performance time, procedure-related pain, adverse events, total and free plasma concentrations of ropivacaine, and other data were recorded. The comparison was analyzed statistically. RESULTS: The block performance time, and onset of the sensory and motor block, of group N was longer than that of group U (p < 0.001). The procedure-related pain of group N was more serious than that of group U (p < 0.05). The patient satisfaction rate of group U was higher than that of group N (p < 0.05). The total plasma concentrations of ropivacaine in group N were comparable to those of group U, except for the value at 50 min after injection (p < 0.05). The free plasma concentrations of ropivacaine of group N at 5 min were significantly higher than that of group U (p < 0.001). No apparent serious adverse events were observed perioperatively in both groups. CONCLUSIONS: Simultaneous bilateral axillary brachial plexus block guided by neurostimulator or ultrasound in bilateral distal upper extremity surgery seems to have a low risk of local anesthetic toxicity and to be effective. The ultrasound-guided block is superior in terms of providing the same degree of anesthesia with shorter duration, less pain, and faster onset of sensory and motor blockades, which is important in clinical practice.

[Comparing the analgesic efficacy of continuous femoral nerve blockade and continuous intravenous analgesia after total knee arthroplasty].

OBJECTIVE: To compare the analgesic efficacy of continuous femoral nerve blockade (CFNB) and continuous intravenous analgesia (CIA) after total knee arthroplasty (TKA). METHODS: 126 patients undergoing TKA under combined epidural-spinal anesthesia were randomized to receive either a femoral infusion of ropivacaine 0.2% (median infusion rate 5 ml/h) (n = 63) or an intravenous infusion of fentanyl 30 µg/kg (2 ml/h) (n = 63). Adjuvant analgesics were oral celebrex or IM pethidine. In the CFNB group, CFNB was established before combined epidural-spinal anesthesia and 20 ml 0.5%ropivacaine was infused through the catheter placed near femoral nerve. Visual analogue scale (VAS) scores were assessed at rest and on passive mobilization by acute pain service blinded to analgesic treatment. Nausea and vomiting, dizziness, satisfaction and other side-effects were assessed postoperatively. RESULTS: There was significantly less VAS scores in the CFNB group comparing the CIA group at rest 4, 8, 12, 16, 24, 36, 48 h after surgery (P < 0.01). A significant difference in VAS scores was found in CFNB group vs CIA group on passive mobilization 24, 36, 48 h after operation (P < 0.01). There was significantly less dizziness, nausea and vomiting in the CFNB group (P < 0.01). Patient satisfaction was higher in the CFNB group (92.1%) than the CIA group (20.6%) (P < 0.01). CONCLUSION: CFNA with ropivacaine 0.2% is more effective in controlling postoperative pain than CIA and CFNB is an effective regional component of a multimodal analgesic strategy after TKA.