Epidural Versus General Anaesthesia for Total Hip Arthroplasty in Elderly Patients

Abstract

Sixty elderly patients were given at random either epidural analgesia with bupivacaine 0.75% or general anaesthesia with thiopentone, fentanyl, pancuronium, N2O/O2 for total hip replacement. Preoperatively the patients were of equal physical status with normal and similar laboratory values. All patients were mentally normal for their age. On the 1st postoperative day, the general anaesthesia group had a significantly lower than PaO2 than the epidural group (P less than 0.025). PaO2 in the general anaesthesia group was significantly lower than the preoperative value on the 1st and 3rd days (P less than 0.001 and P less than 0.01, respectively). None of the 29 patients in the epidural group but seven of 31 patients in the general anaesthesia group has significant mental changes postoperatively (P less than 0.01). Five of these patients still had mental changes which reduced the quality of life several months later. In the general anaesthesia group one patient died from acute myocardial infarction. Low postoperative PaO2 might have contributed to this death. Two patients in the epidural group had symptoms of pulmonary embolism postoperatively. Thus elderly patients appear to do better after hip replacement with less deterioration of cerebral and pulmonary functions when given epidural analgesia than when surgery is performed under general anaesthesia. These patients should therefore be offered epidural analgesia whenever possible.

Cerebral Microembolization during Primary Total Hip Arthroplasty and Neuropsychologic Outcome: A Pilot Study

“…The incidence is reportedly between 0% and 26%. Hole et al [37] reported patients receiving general anesthesia showed poorer NP outcome when compared with those receiving epidural anesthesia for THA, but the NP testing in this study was not robust. Only the study by Williams-Russo et al [74] used thorough NP testing and no major differences were seen when comparing the two methods of anesthesia for patients undergoing TKA.…”

“…During the past 40 years, many studies have assessed the incidence of these features and attempted to analyze the relationship to the type of anesthesia [6,11,12,37,38,40,51,57,60,64,74]. The incidence is reportedly between 0% and 26%.…”

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

“…The method used by the authors to conceal the allocation sequence was described correctly in four of the studies included. 18,25,27,29 The other studies did not report any details regarding allocation concealment that would make it possible to determine whether this process had been free of bias.…”

“…Thus, 17 articles with the potential to answer our research question were identified. 15,16,18,22,23,25,27,29,30,34,35,[37][38][39]41,42,44 We also analyzed 441 titles from the reference lists of these 17 studies included, but did not find any additional studies (Figure 1). …”

“…23 In the study by Hole et al, patients of different ages received different premedication, and the surgical technique may not have been the same because thirteen surgeons participated in this study. 27 In the study by McKenzie et al, statistical tests and significance level were not described. 34 In the study by Valentin et al, there were more ill patients in one group.…”