The Effect Of Anesthesia Styles On The Prognosis Of Orthopaedic Elderly Patients

With the aging of the population and improvement in anesthetic and surgicalmethods, the elderly population undergoing surgical procedure are increasing in theworld. However, the increasing incidence of perioperative complications in the elderlypatients make the great challenges to our clinicians.Whether anesthesia styles can influence the prognosis is inconclusive.This topicwill focus on the effect of anesthesia styles on the prognosis of elderly orthopaedicpatients with two aspects of retrospective analysis and prospective trial.Part one: Comparative outcomes of peripheral nerve blocks vs general anesthesiafor hip fractures in geriatric patientsBackground: We compared genaral anesthesia (GA) and peripheral nerve blocks(PNBs) on postoperative complications and mortality in elderly patients. Materials andMethods:217patients underwent hemiarthroplasty for femoral neck fractures betweenJanuary,2008and December,2012, in PLA General Hospital. Data on preoperativecomorbidities, waiting time to operation; blood loss and transfusion, duration ofoperative time, postoperative hospital length of stay, complications, mortality withinin-hospital,30-day and1-year and charge were collected and analyzed. Univariate andmultivariate cox regression analysis of all variables were used for30-day and1-yearmortality. Results:72patients received GA and145received PNBs are eventuallysubmitted and analyzed. Preoperative comorbidities and intraoperative parameters arenot statistically differences except patients received GA have more dementia (P＜0.001). Mortality is6.9%,14.7%and23.5%at in-hospital,30-day, and1-yearpostoperatively, while mortality and complications do not differ between the two groups.The most common complications are acute cardiovascular events, electrolytedisturbances, delirium. Postoperative acute respiratory events and hypoxemia both arealso common, but no differences are found between groups (P=0.410; P=0.065). Key factors negatively influencing mortality include: age, male gender, ASA status,dementia, perioperative cardiovascular events and respiratory events, postoperativestroke and hypoxia. Conclusions: To the aged patients given hemiarthroplasty forfemoral neck fractures, the mortality and postoperative complications are not significantdifference between peripheral nerve blocks and general anesthesia.Part two: Peripheral nerve blocks vs general anesthesia for total knee replacementin elderly patients on the postoperative quality of recoveryBackground: We compared peripheral nerve blocks with sedation and generalanesthesia on the postoperative quality of recovery in elderly patients. Materials andmethods:213patients who were≥65years old and having undergone total kneereplacement were randomized to peripheral nerve blocks (PNBs), or general anesthesia.All patients received postoperative multimodal analgesia. Postoperative recovery wereassessed at15min,40min,1day,3day, and7day after surgery with the PostoperativeQuality of Recovery Scale. Results: Intraoperative blood pressure and heart rate weremore stable with PNBs (P＜0.001). The recovery was better with PNBs inphysiological (P＜0.001), emotive (P＜0.001), nociceptive (P＜0.001), modifiedcognitive (P＜0.001), and all domains recovery (P＜0.001), but not in activities of dailyliving (P=0.181). Intraoperative drugs and the postoperative sulfentanil requirement ofthe PNBs group were lower (all P＜0.001). Differences were greatest early after surgerywith equivalence by1week. Satisfaction was high and not different between groups (P=0.059). Conclusions: Lumbar plexus and sciatic blocks with sedation facilitates fasterpostoperative recovery than general anesthesia after total knee replacement in patientswho were65years or older.