Spinal anesthesia versus combined sciatic nerve/lumbar plexus nerve block in elderly patients undergoing total hip arthroplasty: a retrospective study

Abstract

BACKGROUND: The most important cause of mortality due to long bone fractures in the elderly patients are femoral fractures that require total hip arthroplasty (THA). THA surgeries may cause severe postoperative pain, long hospital stays, a need for transfusion and mortality. OBJECTIVE: Compare outcomes of spinal anesthesia (SA) versus combined sciatic nerve/lumbar plexus block (CSLPB). DESIGN: Retrospective cohort trıal. SETTING: University hospital in Turkey. PATIENTS AND METHODS: We selected patients from the electronic medical records by date of surgery (most recent first) and compared demographic and pre- and postoperative clinical characteristics including the amount of opioid use within the first 48 postoperative hours, 30-day mortality rates, length of hospital stay, intraoperative oxygen saturation (SpO 2 ) and mean arterial pressure (MAP) values, duration of the surgery, and blood transfusion need. MAIN OUTCOME MEASURE: Opioid use within the first 48 postoperative hours. SAMPLE SIZE: 204, 102 patients in each group with overall median (IQR) age of 82 (10.2) years. RESULTS: There was no significant difference between the groups in terms of the amount of opioid use within the postoperative 48 hours, 30-day mortality rates, intensive care need, duration of the surgery, blood transfusion need, and length of hospital stay. While the intraoperative SpO 2 value was lower in the CSLPB group ( P =.03), MAP values were lower in the SA group ( P =.046). Preoperative American Society of Anesthesiology score (ASA) scores ( P =.039) and the number of comorbidities were higher in the CSLPB group. CONCLUSION: We prefer CSLPB used with standardized sedation protocols for anesthesia in THA surgery in elderly patients. LIMITATIONS: Retrospective design and single-centered. CONFLICT OF INTEREST: None.

Combined Lumbar Plexus-Sciatic Nerve Block for Urgent Lower Limb Surgery: A Good Alternative in Patients With High Anesthetic Risk

“…Among various regional anesthesia techniques, the CLP-SNB is the method that appears to be the most versatile in terms of effectiveness regardless of the surgical indication. This is due to the sensitive and motor innervation of the lower limb, which dermatomes, myotomes, and sclerotomes are theoretically all anatomically covered by this combination [8].…”

Peripheral Nerve Blocks for Hip Fractures

“…Another study showed the effect of combining lumbar plexus and sciatic nerve blocks for hip fracture surgery by comparing them to spinal anesthesia, wherein they showed that a combined lumbar plexus–sciatic nerve block was equivalent to spinal anesthesia in terms of adequate anesthesia for surgery. Their study population showed a bias toward using the regional block as the primary block for sicker patients, which is their institutional norm, and providing spinal anesthesia for those deemed healthier [ 47 ].…”

Comparison of the Effects of Combined Femoral and Sciatic Nerves Block versus General Anesthesia on Hemodynamic Stability and Postoperative Complication in Patients with Diabetic Foot: A Prospective, Double-Blind and Randomized Controlled Trial

“…Peripheral nerve block can not only provide a good anesthetic effect as a simple anesthesia method but can also be combined with other anesthesia methods to reduce postoperative pain. [11][12][13] The noninvasive, real-time visualization and reproducibility of ultrasound provide accurate data and abundant means for clinical preanesthesia evaluation, intraoperative monitoring and pain treatment. With ultrasound guidance, the efficacy and safety of nerve block have been greatly improved.…”