Comparison of general anesthesia with and without lumbar epidural for total hip arthroplasty: Effects of epidural block on hip arthroplasty

Dauphin, A.; Raymer, Karen; Stanton, Eric; Fuller, Hugh D.

doi:10.1016/s0952-8180(97)00035-4

Cited by 47 publications

(24 citation statements)

References 13 publications

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“…Duration of surgery and body temperature were identified as possible factors influencing blood loss. As already described in previous studies [6][7][8][14][15][16], we also found a reduced blood loss in patients under regional anesthesia compared to general anesthesia.…”

Section: Discussionsupporting

confidence: 89%

Causes of Higher Blood Loss during General Anesthesia Compared to Spinal Anesthesia in Total Hip Replacement – a Retrospective Analysis of Data Collected Online

Benson¹,

Hartmann²,

Jünger³

et al. 2000

Transfus Med Hemother

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Objective: The purpose of this study was to evaluate indicators of intraoperative blood loss in patients undergoing total hip replacement under general or spinal anesthesia using data collected by an anesthesia information management system (AIMS). Furthermore, we wanted to investigate whether data collected with an AIMS are suitable for other comparable clinical investigations. Material and Methods: From January 1, 1997 until July 31, 1999, parameters of 681 elective hip replacements were collected with the AIMS NarkoData and stored in a relational database. The effects of possible influences on blood loss were analyzed for the entire collective. These influential factors were then studied for differences between both methods of anesthesia. Results: The duration of surgery (r = +0.50) and the mean body temperature (r = –0.36) correlated with blood loss. There was a significant difference in blood loss between the 478 hip replacements under spinal anesthesia (604 ??404 ml) and the 203 under general anesthesia (751 ??552 ml). Differences in duration of surgery, transfusion of packed red cells and fluid infusion were noticed. Mean arterial blood pressure was lower in the regional-anesthesia group than in the general-anesthesia group (82.8 ??10.8 vs. 88.1 ??11.4 mm Hg). However, an influential effect was not observed. Conclusions: In this study, duration of surgical procedure under general anesthesia as compared to spinal anesthesia was evaluated as being a cause for increased blood loss. The effects of differences in blood pressure, as described by other authors, could not be verified. The role of body temperature has yet to be investigated. Although retrospective analysis of routinely gathered online data is less comprehensive and coherent when compared to prospective data gathering, it is still useful in forming hypotheses for prospective studies.

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Section: Discussionsupporting

confidence: 89%

Causes of Higher Blood Loss during General Anesthesia Compared to Spinal Anesthesia in Total Hip Replacement – a Retrospective Analysis of Data Collected Online

Benson¹,

Hartmann²,

Jünger³

et al. 2000

Transfus Med Hemother

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“…None of these patients suffered any adverse morbidity during surgery or the immediate postoperative period. Although two different types of anaesthesia were used in these patients, previous studies by us and others have shown no influence of anaesthetic on the incidence of SMI or arrhythmias, and hence the data have been pooled together for analysis [5,16].…”

Section: Resultsmentioning

confidence: 99%

“…Moreover, the introduction of more complex procedures for revision of these arthroplasties in an increasingly ageing population results in the anaesthetist being asked to care for patients with a high incidence of ischaemic heart disease, myocardial infarction, hypertension and diabetes mellitus, who undergo prolonged surgery with high concomitant blood loss. These are all factors that may predispose to SMI [4,14], which may in turn predict postoperative morbidity [15,16]. Studies to date have suggested that the type of anaesthesia used (general or regional) has no effect on the peri-operative rate of SMI [5,15].…”

mentioning

confidence: 99%

Peri‐operative silent myocardial ischaemia in patients undergoing lower limb joint replacement surgery: an indicator of postoperative morbidity or mortality?

et al. 1999

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SummaryOne hundred and twenty-seven patients undergoing major lower limb joint replacement surgery were studied to determine the incidence of silent myocardial ischaemia and to ascertain any link between pre-operative cardiac risk factors, silent myocardial ischaemia and postoperative morbidity. Patients underwent ambulatory ECG monitoring for 4 days (on the pre-operative night and for 3 days postoperatively). Postoperative cardiorespiratory symptomatology and morbidity was assessed by questionnaire at 3 months. Eighty-seven patients had risk factors for silent myocardial ischaemia; 42 patients (30 with risk factors) had peri-operative silent myocardial ischaemia. The median ischaemic loads (range) were 1.04 (0.32-13.31) min.h ¹1 pre-operatively and 5.53 (0.26-56.39), 6.69 (0.04-42.71) and 1.23 (0.1-53.74) min.h ¹1 on postoperative days 1-3, respectively. Risk factors did not predict the occurrence of silent myocardial ischaemia or an increased ischaemic load pre-operatively or overall postoperatively. New symptoms (chest pain, palpitations, breathlessness or fatigue) were associated with both silent myocardial ischaemia and ischaemic load (p < 0.05). Thus cardiac risk factors do not predict the occurrence of silent myocardial ischaemia or adverse outcome. Peri-operative silent myocardial ischaemia was associated with increased postoperative fatigue.

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“…Fifteen of these were subsequently excl uded. 13,14,17,19,20,21,24,26,28,[31][32][33]36,40,43 The reasons for their exclusion can be seen in Figure 1. Thus, 17 articles with the potential to answer our research question were identified.…”

Section: Study Selectionmentioning

confidence: 99%

Neuraxial anesthesia for orthopedic surgery: systematic review and meta-analysis of randomized clinical trials

2013

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CONTEXT AND OBJECTIVE: Taking the outcome of mortality into consideration, there is controversy about the beneficial effects of neuraxial anesthesia for orthopedic surgery. SciELO, EMBASE (1974 to November 2012 and reference lists of the studies included. Only randomized controlled trials were included. RESULTS: Out of 5,032 titles and abstracts, 17 studies were included. There were no statistically significant differences in mortality (risk difference, RD: -0.01; 95% confidence interval, CI: -0.04 to 0.01; n = 1903), stroke (RD: 0.02; 95% CI: -0.04 to 0.08; n = 259), myocardial infarction (RD: -0.01; 95% CI: -0.04 to 0.02; n = 291), length of hospitalization (mean difference, -0.05; 95% CI: -0.69 to 0.58; n = 870), postoperative cognitive dysfunction (RD: 0.00; 95% CI: -0.04 to 0.05; n = 479) or pneumonia (odds ratio, 0.61; 95% CI: 0.25 to 1.49; n = 167). CONCLUSION: So far, the evidence available from the studies included is insufficient to prove that neuraxial anesthesia is more effective and safer than general anesthesia for orthopedic surgery. However, this systematic review does not rule out clinically important differences with regard to mortality, stroke, myocardial infarction, length of hospitalization, postoperative cognitive dysfunction or pneumonia. CONCLUSÃO: Até o momento, as evidências são insuficientes nos estudos incluídos para provar que AN é mais efetiva e segura do que AG para cirurgias ortopédicas. Esta revisão sistemática não descartou diferenças clínicas importantes para mortalidade, acidente vascular encefálico, infarto miocárdico, tempo de internação, disfunção cognitiva pós-operatória e pneumonia. RESUMO IMSc. Professor,

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Comparison of general anesthesia with and without lumbar epidural for total hip arthroplasty: Effects of epidural block on hip arthroplasty

Cited by 47 publications

References 13 publications

Causes of Higher Blood Loss during General Anesthesia Compared to Spinal Anesthesia in Total Hip Replacement – a Retrospective Analysis of Data Collected Online

Causes of Higher Blood Loss during General Anesthesia Compared to Spinal Anesthesia in Total Hip Replacement – a Retrospective Analysis of Data Collected Online

Peri‐operative silent myocardial ischaemia in patients undergoing lower limb joint replacement surgery: an indicator of postoperative morbidity or mortality?

Neuraxial anesthesia for orthopedic surgery: systematic review and meta-analysis of randomized clinical trials

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