The postoperative period in older age groups after hip or knee arthroplasty

At present, there are many postoperative techniques and protocols recommended, but little data exist on the effectiveness of these methods depending on patient age, which may also influence the postoperative course. Objective: to compare analgesic methods — multimodal analgesia versus continuous (prolonged) epidural analgesia — with respect to their effects on the early postoperative period after hip or knee arthroplasty in patients of different age groups. Materials and methods. The prospective study included 90 operated trauma patients of middle, advanced and very old age who underwent hip or knee arthroplasty. There were two groups: the 1st group (n=45) underwent surgery under spinal anaesthesia (SA), the 2nd group (n=45) underwent combined spinal-epidural anaesthesia (SA+EA). Each group was divided into three age categories: 45–65; 65–75, and older than 75 years. Results. Postoperative pain levels by VAS in both groups were recorded at 1–3 points, although the SA group required more intensive multimodal analgesia. In the SA+EA group, motor block measured by the Bromage scale averaged 0.79±0.08, indicating minimal block manifestations. On the 1st postoperative day, patients receiving continuous EA reported absence of pain based on VAS and other assessments. Hemodynamic differences between groups were not statistically significant, but considering the effects of continuous EA and its minimal impact on patients’ mobility (Bromage scale), it can be concluded that continuous EA is more effective than multimodal analgesia. This conclusion is also supported by measurements of glycemia and cortisol. Conclusion. Regional analgesic techniques are effective and superior for postoperative analgesia. Continuous EA in the postoperative period is more effective than multimodal analgesia. Continuous EA for postoperative pain control is safe across all age groups.