Continuous central block in geriatric total hip prosthesis operations: An old friend spinal catheter
Gülay Eren, Oya Hergünsel, Yasemin Tekdoş Şeker
Bakırköy Dr. Sadi Konuk Eğitim ve Araştırma Hastanesi, Anestezi ve Reanimasyon Kliniği, İstanbul, Türkiye
Keywords: Bradycardia/etiology; hemodynamics; spinal-epidural anesthesia; total hip prosthesis
Objectives: This study aims to compare continuous spinal anesthesia and combined spinal-epidural anesthesia, which are two central block methods, in patients aged >65 years who were in the American Society of Anesthesiologists (ASA) Class ≥III and were scheduled for total hip prosthesis due to femoral fractures.
Patients and methods: A total of 40 consecutive patients were included in the study. The patients were divided into two groups as the continuous spinal anesthesia group (Group 1; n=20) and combined spinal-epidural anesthesia group (Group 2; n=20). The access route for the central block was L3-4 interspace. Group 1 received 2.5 μg 0.5% isobaric bupivacaine via a spinal catheter. Group 2 received 7.5 μg 0.5% isobaric bupivacaine through spinal anesthesia and an epidural catheter was inserted. The block efficacy was evaluated using the Bromage and pinprick tests and peak times were recorded. Vital signs and motor and sensory levels were measured and the Visual Analog Scale (VAS) and Ramsey Sedation Scale (RSS) scores were recorded during and after operation.
Results: There was no statistically significant difference in the demographic characteristics between the patient groups. There was a statistically significant difference in the pre- and postoperative heart rates in Group 2. A statistically significant difference was also observed in the motor and sensory block peak times, sensory block levels, and motor block degree between the groups. There was a statistically significant difference in the intra- and postoperative VAS and RSS scores between the groups.
Conclusion: Continuous spinal anesthesia is a safe anesthesia technique in geriatric patients to decrease high sympathetic block-induced hemodynamic instabilities with shorter recovery period and fewer complications.