Key result
Combined spinal and epidural anesthesia resulted in a significantly higher fluctuation of mean arterial pressure compared to combined lumbar plexus and sciatic nerve block (β 6.88) in elderly patients.
Why the study?
Multiple comorbidities in elderly patients make them vulnerable to hemodynamic changes after anesthesia, but post-anesthetic hemodynamic changes between CLPSB and CSEA in femoral head replacement had not been compared.
Does combined lumbar plexus and sciatic nerve block (CLPSB) improve hemodynamic stability compared to combined spinal and epidural anesthesia (CSEA) in elderly patients undergoing unilateral artificial femoral head replacement?
Cohort (n=477)
No
Does combined lumbar plexus and sciatic nerve block (CLPSB) improve hemodynamic stability compared to combined spinal and epidural anesthesia (CSEA) in elderly patients undergoing unilateral artificial femoral head replacement?
Combined lumbar plexus and sciatic nerve block provides better hemodynamic stability and reduces the need for intraoperative vasopressors compared to combined spinal and epidural anesthesia in elderly patients undergoing artificial femoral head replacement.
CLPSB was associated with better hemodynamic stability than CSEA; leaves open whether randomized trials will confirm benefit in elderly hip replacement.
Background: Artificial femoral head replacement is one of the most effective methods for treatment of severe diseases of femoral joint in the elderly. The ideal anesthetic effect is one of the key elements for the success of the operation because it brings fast recovery. However, the multiple comorbidities of the elder patients make them too weak to tolerate the hemodynamic changes after anesthesia. Objective: To compare the post-anesthetic hemodynamic changes between combined lumbar plexus and sciatic nerve block(CLPSB) and combined spinal and epidural anesthesia(CSEA) in elderly patients undergoing unilateral artificial femoral head replacement. Methods: We reviewed records of the patients who aged over 60 years old (age 62-103 years) and received unilateral artificial femoral head replacement. 477 patients were included and divided into CLPSB group (n=90) and CSEA group (n=387). The primary outcome was comparison of the hemodynamic changes after anesthesia, including the SBP, diastolic blood pressure DBP, MAP and (HR). The second outcome was the comparison of the vasopressor used during the surgery. Results: We established three models to compare the two anesthesia methods on hemodynamic changes.All three models exhibit that changes of MAP (∆MAP) after CSEA were higher than that after CLPSB(β= 6.88, 95% CI: 4.33 - 9.42, P < 0.0001), with significant difference, which indicated that CSEA causes higher fluctuation of MAP. Concurrently, the use of vasopressors increased by 137% (OR=2.37, 95%CI: 1.24-4.53, P=0.0091) in the CSEA group, which is statistically significant. However, the changes of HR (∆HR) between the CLPSB and CSEA was not significant(β= 0.50, 95% CI: 1.62 - 2.62, P = 0.6427). Conclusions: Both CLPSB and CSEA are ideal anesthesia methods for patients receiving femoral head eplacement, though CLPSB is more suitable for elderly patients with advanced hemodynamic stability.
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Ke et al. (2022) conducted a cohort in Artificial femoral head replacement (n=477). Combined spinal and epidural anesthesia (CSEA) vs. Combined lumbar plexus and sciatic nerve block (CLPSB) was evaluated on Change in mean arterial pressure (ΔMAP) 10 minutes after anesthesia (β 6.88, 95% CI 4.33-9.42, p=<0.0001). Combined spinal and epidural anesthesia resulted in a significantly higher fluctuation of mean arterial pressure compared to combined lumbar plexus and sciatic nerve block (β 6.88) in elderly patients.
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