Spinal and General Anaesthesia in Total Hip Replacement: Frequency of Deep Vein Thrombosis

Thorburn, J.; Louden, J.R.; Vallance, R.

doi:10.1093/bja/52.11.1117

Cited by 154 publications

(37 citation statements)

References 5 publications

(5 reference statements)

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“…This relationship has been repeatedly described in the hip arthroplasty literature 4,5,7,[21][22][23][24][25][26][27][28][29] . Blood loss during total hip arthroplasty performed under general anesthesia is often a function of how well a low blood pressure is maintained during the procedure 28 .…”

Section: Discussionmentioning

confidence: 86%

General Compared with Spinal Anesthesia for Total Hip Arthroplasty

Basques

Toy

Bohl

et al. 2015

The Journal of Bone and Joint Surgery

179

120

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Section: Discussionmentioning

confidence: 86%

General Compared with Spinal Anesthesia for Total Hip Arthroplasty

Basques

Toy

Bohl

et al. 2015

The Journal of Bone and Joint Surgery

179

120

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“…Furthermore, hip replacement is followed by a high incidence of postoperative deep venous thrombosis unless prophylactic measures are taken (Modig et al 1981, Thorburn et al 1980). …”

Section: Introductionmentioning

confidence: 99%

Activation of cascade systems by hip arthroplasty: No difference between fixation with and without cement

Bredbacka¹,

Andreen

Blombäck³

et al. 1987

Acta Orthopaedica Scandinavica

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No difference between fixation with and without cementThe acrylic bone cement has been regarded as a very potent activator of the hemostatic mechanisms. A battery of coagulation, fibrinolytic. and kallikrein variables were studied perioperatively in 21 patients undergoing hip arthroplasty with fixation of the prosthesis either with (Charnley) or without (HP-Garches) cement. Epidural analgesia was used and dextran 6 per cent as thromboprophylaxis. The HP-Garches procedure was shorter and caused less blood loss. No differences were found between the two surgical procedures regarding the activation of the cascade systems. The coagulation and fibrinolytic systems were activated early, but a week postoperatively the latter seems to predominate. A marked activation of the kallikrein system was apparent.Our study shows that despite thromboprophylaxis a marked activation of the coagulation, fibrinolytic, and kallikrein systems occurs in relation to hip arthroplasty irrespective of the use or nonuse of cement and irrespective of the volume of blood loss during surgery. It may be the reaming of the bone marrow that initiates the activation of the cascade systems.

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“…They concluded that SA can consider as an effective alternative to GA for lumbar spine surgery as it had lower incidence of minor complications. (7) As previous studies showed, SA reduced blood loss for lower limb orthopedic and vascular surgeries compared to GA. (8)(9)(10)(11) The decreased blood loss during spinal anesthesia likely contributed to the lower surgical time, and less bleeding would facilitate dissection and result in less time needed to effect hemostasis prior to surgical closure. Reduced rate of bleeding within the wound has been suggested as one factor that may contribute to a shorter surgical time in spinal anesthesia In addition, although surgeons are interested in spinal anesthesia as a more reliable method, experience shows the prolonged operation performed in the prone position under spinal anesthesia increases the surgeon's stress and anxiety.…”

Section: Discussionmentioning

confidence: 99%

Spinal Anesthesia a Better and Effective Alternative to General Aneasthesia in Spine Surgeries : A Prospective Open Label Single Arm Study

S¹,

Ravindran²,

Chaithanya³

et al. 2014

jemds

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INTRODUCTION:In all practical purposes various thoraco lumbar and lumbar surgeries like discectomy, laminectomy and spinal fusion procedures are usually performed under general anesthesia (GA). Our aim of this study is to assess whether spinal anesthesia is a better and effective alternative to general anesthesia in terms of economic advantage and functional recovery with both intra and post-operative heamodynamic stability. METHODS: In our study hundred patients with age group 25-45 yrs within the ASA criteria of class I-III were enrolled. All patients were randomly selected based on age, sex, ASS criteria, duration of surgery, heart rate (HR), mean arterial pressure (MAP), blood loss, previous history of risk factors and co morbidities. The severity of postoperative pain based on visual analogue scale (VAS) and use of analgesics post operatively, were recorded. RESULTS: There were 41 males and 59 females. The mean age of the patient was 39.28±9.27 yrs. Six patients had hypertension, 11 with diabetes. Patients with ASA Grade I and II and III were 60, 34 and 6 respectively. There were no episodes of air way compromises, 2 patients had spinal aneasthesia failures, no incidence of post dural puncture headache, 3 patients had mean blood pressure fluctuations among them, one patient had post-operative paraperesis due to hematoma treated by immediate decompression, and 13 patients had usage of propofol sedation in terms of comfort. The duration of surgery (range) was 77.25±22.44 min (40-120) Severity of postoperative pain after four hours of surgery on VAS was 3.24±0.46. Twenty two patients (22%) required analgesics. Two patients had post-operative vomiting. CONCLUSIONS: In our study we have considered that spinal anesthesia for advantages such as less blood loss, intra operative blood pressure and heart rate changes, postoperative pain, quick functional recovery and lower incidence of pulmonary complications. Additionally, during spinal anesthesia patient extremities and chest can be reposition as needed, to avoid nerve injury, brachial plexus palsy or pressure necrosis to either the face or chest wall and finally the most important being an economical advantage and patient and surgeons satisfaction. We showed that spinal aneasthesia is better and effective alternative to GA in providing postoperative analgesia and decreasing blood loss with both intra and post-operative hemodynamic stability without increasing adverse side effects.

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Spinal and General Anaesthesia in Total Hip Replacement: Frequency of Deep Vein Thrombosis

Cited by 154 publications

References 5 publications

General Compared with Spinal Anesthesia for Total Hip Arthroplasty

General Compared with Spinal Anesthesia for Total Hip Arthroplasty

Activation of cascade systems by hip arthroplasty: No difference between fixation with and without cement

Spinal Anesthesia a Better and Effective Alternative to General Aneasthesia in Spine Surgeries : A Prospective Open Label Single Arm Study

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