The Comparison Between General Anesthesia And Isobaric Spinal Anesthesia For Total Hip Arthroplasty In Elderly Patients

Objective To compare the influence of general anesthesia and isobaric spinalanesthesia on perioperative hemodynamic changes and postoperative complications in elderlypatients with the total hip arthroplasty, To provide a theoretical basis for anesthesia of elderlypatients with the total hip arthroplasty.Methods Eighty old patients (age:65-90) undergoing to primary and unilateral totalhip arthroplasty were randomly assigned to2groups: isobaric spinal anesthesia group(groupA,n=40, subarachnoid block with15mg of0.5%bupivacaine and50ug of fentanyl), generalanesthesia group(group B,n=40).Heart rate(HR),mean arterial pressure(MAP), central venouspressure(CVP),pulse oxygen saturation(SpO2) were monitored and recorded beforeanesthesia(TO),5minutes after anesthesia (T1),10minutes after anesthesia(T2),At the momentwhen infusing the cement(T3) At3minutes after infusing the cement (T4),At5minutes afterinfusing the cement(T5), At10minutes after infusing the cement(T6),the end ofsurgery(T7),30minutes after the surgery (T8), right after they entered PACU (Post-anesthesiaCare Unit)(T9),30minutes after they entered PACU (T10); records the duration ofsurgery;assesses peak sensory level reached of isobaric spinal anesthesia group (assessed withpinprick);assesses and record the time for sensory block to recede to T12level; PACU andpostoperative pain severity was evaluated using a numerical rating scale(NRS) ranging from0(no pain) to10(worst possible pain), Records supplemental doses of analgesics duringPACU and two days after surgery; Record incidence of nausea,vomiting,pruritus andrespiratory depression; Record doses of phenylephrine,urapidil,nitroglycerin,atropine duringintraoperative and after surgery3days.(5) Records pulmonary complications,cardiovascularcomplications and the changes of cognitive function after surgery3days.Results (1)There was no significant difference in characteristics between two groups.(2)comparison internal group: MAP was significantly decreased at T3,T4,T5compared with T0in group A (P<0.05), MAP was significantly decreased at T2,T3,T4,T5, but significantly increased at T1,T8,T9compared with T0in group B (P<0.05); HR was significantly increasedat T3,T4,T5compared with T0in group A (P<0.05), HR was significantly increased atT1,T3,T4,T5,T8,T9,but decreased at T2compared with T0in group B; CVP was significantlyincreased at T4compared with T0in group A (P>0.05), CVP was significantly increased atT4,T8compared with T0in group B (P<0.05). comparison between the two groups: MAPwas significantly lower at T2in group B than in group A, but higher at T1,T8,T9in group Bthan in group A (P<0.05); HR was significantly lower at T2in group B than in group A, butsignificantly higher at T1,T8,T9in group B than in group A (P<0.05); CVP was significantlylower at T2in group B than in group A (P<0.05),but significantly higher at T8in group B thanin group A (P<0.05).(3) The peak sensory level reached of isobaric spinal anesthesia can meetthe surgical requirements.(4) Pain severity (NRS) and supplemental doses of analgesics inPACU significantly higher in group B than in group A (P<0.05), There were no significantdifference in pain severity (NRS) in the first day after surgery between two groups (P>0.05).But the supplemental doses of analgesics significantly higher in group B than in group A(P<0.05). There were no significant difference in pain severity (NRS) and the supplementaldoses of analgesics in the second day after surgery between two groups (P>0.05).(5) Theincidence of respiratory depression during intraoperative and3days after surgerysignificantly higher in group B than in group A (P<0.05), The incidence of pruritus duringintraoperative and3days after surgery significantly higher in group A than in group B(P<0.05),but the incidence of nausea、vomiting during intraoperative and3days after surgerywere no significant difference between two groups (P>0.05).(6) The doses of phenylephrine、urapidil、 nitroglycerin、atropine during intraoperative and3days after surgery significantlyhigher in group B than in group A (P<0.05).(7) Pulmonary complications, cardiovascularcomplications and the changes of cognitive function after surgery3days significantly higherin group B than in group A.Conclusion The isobaric spinal anesthesia(15mg of0.5%bupivacaine and50ug offentanyl) for elderly patients undergoing total hip arthroplasty is a safer and better option,both in terms of maintaining hemodynamic stability and lower incidence of complicationswithout compromising the surgical conditions compare with general anesthesia.