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Online ISSN 1827-1596
SMART 2002 Milan, May 29-31, 2002
PROBLEMS IN ORTHOPEDIC ANESTHESIA
Borghi B. 1, Laici C. 2, Iuorio S. 3, Casati A. 4, Fanelli G. 4, Celleno D. 5, Michael M. 6, Serafini P. L. 7, Pusceddu A. 8 per conto del Gruppo di Studio Siaarti sull’Anestesia in Ortopedia
1 Modulo Dipartimentale per il coordinamento della Ricerca in Anestesia IRCCS Istituti Ortopedici Rizzoli (Bologna) N. Montone, H. van Oven, F. Mazzanti Servizio di Anestesia e Rianimazione, IRCCS Istituti Ortopedici Rizzoli (Bologna) U. Righi, S. Bugamelli, A. Ricci, M. L. Nepoti
2 Scuola di Specializzazione in Anestesia e Rianimazione, Università degli Studi - Bologna
3 Istituto Emergenze Medico Chirurgiche Università degli Studi - Ancona: A. Luzi, L. Sinkovets, G. Mercuri
4 IRCCS H. San Raffaele (Milano): A. Albertin
5 Ospedale FBF, Isola Tiberina (Roma): P. Costantino
6 Casa di cura S. Maria Castellanza (VA): M. Morandini, A. Solmi, M. Caldi
7 Ospedale S. Agostino, Modena: A. Menegon, M. P. Rambaldi
8 Ospedale di Desio: M. H. Rusconi, E. Storti G. Arosio Analisi statistica: E. Pignotti
Background. Aim of this study is to determine if and how the anaesthesia technique can significantly influence the outcome in patients after major orthopaedic surgery in terms of: patrimony of red blood cells (blood loss and erythropoiesis), incidence of intra and postoperative complications, postoperative pain control and hospital stay.
Methods. 210 patients, ASA physical status I-III, undergoing elective primary total hip replacement were randomly allocated in three groups of 70 patients to receive either epidural anaesthesia (Group EA), general anaesthesia (GA), or epidural anaesthesia integrated with mild general anaesthesia (IA).
Results. Data show a significant difference between the amount of pain measured by VRS immediately after surgery: prevalently absent in groups IA (84.3%) and EA (85.7%) and prevalently severe and moderate in group AG (34.3%). The measurement of the basic circulating erythrocyte mass in the first, third and fifth postoperative day, calculated by the Mercuriali formula, which considers blood loss, autologous and homologous transfusions and erythropoiesis, showed that general anaesthesia leads to a significant delay in the resumption of haemopoiesis. This result was attenuated by its combination with epidural anaesthesia.
Conclusions. On the basis of the literature and the results of our study, epidural anaesthesia seems to be the most appropriate technique for patients scheduled for total hip replacement: due to its simpler analgesic cover, its tendency to be associated with a lower incidence of complications in the first 24 hours after surgery. The incidence of relevant hypotension is minor compared to integrated anaesthesia. General anaesthesia produced a significant decrease in postoperative erythropoiesis.