Project description:BACKGROUND:Intravertebral and general anesthesia (GA) are two main anesthesia approaches but both have defects. This study was aimed to evaluate the effect of subarachnoid anesthesia combined with propofol target-controlled infusion (TCI) on blood loss and transfusion for total hip arthroplasty (THA) in elderly patients in comparison with combined spinal-epidural anesthesia (CSEA) or GA. METHODS:Totally, 240 patients (aged ?65 years, American Society of Anesthesiologists [ASA] I-III) scheduled for posterior THA were enrolled from September 1st, 2017 to March 1st, 2018. All cases were randomly divided into three groups to receive CSEA (group C, n?=?80), GA (group G, n?=?80), or subarachnoid anesthesia and propofol TCI (group T, n?=?80), respectively. Primary outcomes measured were intra-operative blood loss, autologous and allogeneic blood transfusion, mean arterial pressure at different time points, length of stay in post-anesthesia care unit (PACU), length of hospital stay, and patient satisfaction degree. Furthermore, post-operative pain scores and complications were also observed. The difference of quantitative index between groups were analyzed by one-way analysis of variance, repeated measurement generalized linear model, Student-Newman-Keuls test or rank-sum test, while ratio index was analyzed by Chi-square test or Fisher exact test. RESULTS:Basic characteristics were comparable among the three groups. Intra-operative blood loss in group T (331.53?±?64.33?mL) and group G (308.03?±?64.90?mL) were significantly less than group C (455.40?±?120.48?mL, F?=?65.80, P?<?0.001). Similarly, the autologous transfusion of group T (130.99?±?30.36?mL) and group G (124.09?±?24.34?mL) were also markedly less than group C (178.31?±?48.68?mL, F?=?52.99, P?<?0.001). The allogenetic blood transfusion of group C (0 [0, 100.00]) was also significantly larger than group T (0) and group G (0) (Z?=?2.47, P?=?0.047). Except for the baseline, there were significant differences in mean arterial blood pressures before operation (F?=?496.84, P?<?0.001), 10-min after the beginning of operation (F?=?351.43, P?<?0.001), 30-min after the beginning of operation (F?=?559.89, P?<?0.001), 50-min after the beginning of operation (F?=?374.74, P?<?0.001), and at the end of operation (F?=?26.14, P?<?0.001) among the three groups. Length of stay in PACU of group T (9.41?±?1.19?min) was comparable with group C (8.83?±?1.26?min), and both were significantly shorter than group G (16.55?±?3.10?min, F?=?352.50, P?<?0.001). There were no significant differences among the three groups in terms of length of hospitalization and post-operative visual analog scale scores. Patient satisfaction degree of group T (77/80) was significantly higher than group C (66/80, ??=?7.96, P?=?0.004) and G (69/80, ??=?5.01, P?=?0.025). One patient complained of post-dural puncture headache and two complained of low back pain in group C, while none in group T. Incidence of post-operative nausea and vomiting in group G (10/80) was significantly higher than group T (3/80, ??=?4.10, P?=?0.043) and group C (2/80, ??=?5.76, P?=?0.016). No deep vein thrombosis or delayed post-operative functional exercise was detected. CONCLUSIONS:Single subarachnoid anesthesia combined with propofol TCI seems to perform better than CSEA and GA for posterior THA in elderly patients, with less blood loss and peri-operative transfusion, higher patient satisfaction degree and fewer complications. TRIAL REGISTRATION:chictr.org.cn: ChiCTR-IPR-17013461; http://www.chictr.org.cn/showproj.aspx?proj=23024.
| S-EPMC7190232 | biostudies-literature