Effects Of Three Different Anesthesia Methods On Outcomes In Elderly Patients Undergoing Hip Replacement Surgery

Objective As the deline of organs' function and with multiple comorbidities,elderly patients cann't tolerate the anesthesia and surgery.Hip arthroplasty is a familiar surgery among elderly patients.Selecting correct anesthesia method is a disputable issue.Generally,hip replacement operation procedures can be performed with either regional or general anesthesia.Dexmedetomidine can confer the natural sleep to patient without obvious respiratory depression and was reported to have protective effects on the heart,kidney,brain and other organs' function.In this study,we compared three different anesthesia methods : Intraspinal anesthesia plus low dose of dexmedetomidine,Intraspinal anesthesia and general anesthesia,to investigate the effects of three different anesthesia methods on outcomes in elderly patients undergoing hip replacement operation.Methods One hundred and twenty elderly patients(aged 65-80 years old)undergoing hip replacement operation were randomly divided into three groups(40 patients each group): general anesthesia group(group A),Intraspinal anesthesia group(B),Intraspinal anesthesia and plus low-dose of dexmedetomidine group(C).All the operations completed by the same surgeon,all patients received biological-based prosthetic(cementless)implantation.Incision local anesthesia plus patient controlled intravenous analgesia(PCIA)were applied to all patients.Twelve hours after the surgery,patients received subcutaneous injection of low molecular heparin(5000 units).Blood loss and transfusion volume and operating time were recorded.patient comfort levels were investigated,the occurrence of stroke,postoperative delirium,respiratory and cardiovascular complications were also recorded.The level of painful was evaluated by VAS score after operation,early ambulation time,side effects during recovery time,days of hospitalization after operation,length of ICU stay,postoperative 30-day mortality were also recorded.Results There were no difference in the blood loss,transfusion and operating time among three groups.Compared with the group B,patient comfort levels were better in group C and the group A.(P < 0.05),and it has no statistical significance between group C and group A,Delirium occurrence,VAS score and early ambulation time in group A is significantly higher than patients in group C and group B(P < 0.05),There were no differences in the occurrence of stroke,postoperative respiratory complications,cardiovascul complications,side effects during recovery time,days of hospitalization after operation and mortality in 30 days among the three groups.Conclusion The method of intraspinal anesthesia plus low dose of dexmedetomidine is more preferable than general anesthesia and intraspinal anesthesia for elderly patients with hip replacement surgery.With intraspinal anesthesia or intraspinal anesthesia plus low dose of dexmedetomidine,the incidences of postoperative complications reduced in elderly patients received hip replacement surgery.Intraspinal anesthesia plus low dose of dexmedetomidine is more confortable to patients than intraspinal anesthesia.