Abstract
Background
We hypothesized that the incidence of hypotension during total knee replacement (TKR) surgery is lower in patients given combined spinal-epidural (CSE) anesthesia vs those receiving epidural anesthesia alone.
Methods
In a prospective study, 80 American Society of Anesthesiologists I–II patients (aged 40–80 yr), undergoing elective TKR surgery were randomly assigned to either CSE anesthesia (CSE,n = 40) or epidural anesthesia alone (Epidural,n = 40). Hemodynamic measurements included oscillometric mean arterial blood pressure (MAP), heart rate (HR), and cardiac index (CI) as determined by thoracic bioimpedance; systemic vascular resistance (SVR) was calculated. Our primary endpoint (outcome) was the number of hypotension episodes (defined as MAP < 70 mmHg).
Results
Using univariate analysis, we found no differences between the groups in regards to MAP, HR, CI, or SVR during the perioperative period. The incidence of hypotension was similar in both groups (two patients in each group), as was the incidence of bradycardia (12 patients in CSE, 7 in Epidural;P = 0.2). There were no differences between groups in other hemodynamic measurements including CI and calculated SVR. Analgesia supplementation with fentanyl was more frequently required in the Epidural group (20 vs 6 patients —P = 0.03).
Conclusion
Combined spinal-epidural anesthesia and epidural anesthesia alone during TKR surgery are associated with the same incidence of hypotension with statistically and clinically similar hemodynamic responses.
Résumé
Objectif
Nous avons émis ľhypothèse que ľincidence ďhypotension pendant ľarthroplastie totale du genou (ATG) serait plus faible avec ľanesthésie rachidienne et péridurale combinée (RPC) qu’avec ľanesthésie péridurale seule.
Méthode
Lors ďune étude prospective, 80 patients ďétat physique ASA I–II, de 40 à 80 ans, subissant une ATG réglée, ont été répartis aléatoirement pour recevoir une anesthésie RPC (groupe RPC, n = 40) ou péridurale seule (groupe péridural,n = 40). Les mesures hémodynamiques comprenaient la tension artérielle moyenne (TAM) oscillométrique, la fréquence cardiaque (FC) et ľindex cardiaque (IC) déterminé par la bio-impédance thoracique; la résistance vasculaire générale (RVG) a été calculée. Notre principal paramètre était le nombre ďépisodes ďhypotension définie par une TAM < 70 mmHg).
Résultats
Selon une analyse univariée, il n’y avait aucune différence intergroupe quant à la TAM, la FC, ľIC ou la RVG périopératoires. Ľincidence ďhypotension était similaire dans les deux groupes (deux dans chaque groupe), aussi ľincidence de bradycardie (12 avec ľanesthésie RPC et 7 avec la péridurale; P = 0,2). Les autres mesures hémodynamiques ne présentaient pas de différence intergroupe, y compris ĽIC et la RVG calculée. Un supplément ďanalgésie avec du fentanyl a été plus souvent requis dans le groupe péridural (20 vs 6 patients — P = 0,03).
Conclusion
Ľanesthésie rachidienne et péridurale combinée et ľanesthésie péridurale seule, utilisées pendant ľATG, sont associées à la même incidence ďhypotension et à des réactions hémodynamiques similaires au plan statistique et clinique.
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Ezri, T., Zahalka, I., Zabeeda, D. et al. Similar incidence of hypotension with combined spinal-epidural or epidural alone for knee arthroplasty. Can J Anesth 53, 139–145 (2006). https://doi.org/10.1007/BF03021818
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DOI: https://doi.org/10.1007/BF03021818