Goal-directed haemodynamic therapy during elective total hip arthroplasty under regional anaesthesia

Abstract

IntroductionTotal hip replacement is one of the most commonly performed major orthopaedic operations. Goal-directed therapy (GDT) using haemodynamic monitoring has previously demonstrated outcome benefits in high-risk surgical patients under general anaesthesia. GDT has never been formally assessed during regional anaesthesia.MethodsPatients undergoing total hip replacement while under regional anaesthesia were randomised to either the control group (CTRL) or the protocol group (GDT). Patients in the GDT group, in addition to standard monitoring, were connected to the FloTrac sensor/Vigileo monitor haemodynamic monitoring system, and a GDT protocol was used to maximise the stroke volume and target the oxygen delivery index to > 600 mL/minute/m2.ResultsPatients randomised to the GDT group were given a greater volume of intravenous fluids during the intraoperative period (means ± standard deviation (SD): 6,032 ± 1,388 mL vs. 2,635 ± 346 mL; P < 0.0001), and more of the GDT patients received dobutamine (0 of 20 CTRL patients vs. 11 of 20 GDT patients; P < 0.0003). The GDT patients also received more blood transfused during the intraoperative period (means ± SD: 595 ± 316 mL vs. 0 ± 0 mL; P < 0.0001), although the CTRL group received greater volumes of blood replacement postoperatively (CTRL patients 658 ± 68 mL vs. GDT patients 198 ± 292 mL; P < 0.001). Overall blood consumption (intraoperatively and postoperatively) was not different between the two groups. There were an increased number of complications in the CTRL group (20 of 20 CTRL patients (100%) vs. 16 of 20 GDT patients (80%); P = 0.05). These outcomes were predominantly due to a difference in minor complications (20 of 20 CTRL patients (100%) vs. 15 of 20 GDT patients (75%); P = 0.047).ConclusionsGDT applied during regional anaesthesia in patients undergoing elective total hip replacement changes intraoperative fluid management and may improve patient outcomes by decreasing postoperative complications. Larger trials are required to confirm our findings.Trial registrationSRCTN11616985

State-of-the-art fluid management in the operating room

“…Cecconi et al showed improved outcomes in 40 patients receiving regional anesthesia for hip arthroplasty [33]. Kapoor et al showed a decrease in the duration of mechanical ventilation, ICU LOS, and hospital LOS in patients undergoing cardiac surgery [34].…”

Perioperative regional anesthesia complications in geriatric patients: clinical report

“…It has also been observed that crystalloid preloading alone may not be sufficient in elderly to compensate for the decrease in systemic vascular resistance (19) . In recent years, goal directed therapy (GDT), a combination of intravenous fluids and inotropes during surgeries in which spinal anaesthesia is used, has been suggested since this therapy may improve outcomes by decreasing the rate of minor postoperative complications (20) . Therefore one should aggressively apply some preemptive clinical strategies to lower the risks for these patients.…”

Current Approaches in Hip and Knee Arthroplasty Anaesthesia

“…Bu komplikasyonların başında nörolojik hasar yer almaktadır. Ultrasonografik değerlendir-me yapıldıktan sonra veya ultrasonografi eşliğinde bloğun gerçekleştirilmesi uygulama güvenliğini arttırır (36)(37)(38)(39)(40)(41)(42)(43)(44). Postoperatif erken dönemde ortaya çıkan ağrıyı azaltmak için multimodal analjezi tekniğinin bir parçası olarak lokal infiltrasyon analjezisi önerilir.…”