Study of different methods of regional anesthesia during total hip arthroplasty in elderly and senile patients | Ukrainian Medical Journal

Traumatic interventions on the lower extremities in elderly and senile patients are becoming more common with the development of anesthesiology. In geriatric patients, a combination of age-related changes in the body and concomitant diseases is typical, which significantly increases the risk of anesthesia, since most anesthetics suppress the functioning of organs and systems, primarily the cardiovascular system. All patients who underwent arthroplasty of large joints of the lower limb were randomly divided into two groups: 1st group — spinal anesthesia was performed; 2nd group — combined spinal-epidural anesthesia. Each group was divided into subgroups by age: up to 65; 65–75 and over 75 years. Intraoperative sedation was performed with midazolam. In 1st group, postoperative analgesia included intravenous administration of acetaminophen, ketorolac, and with Visual Analogue Scale (VAS) >5 points, intramuscular administration of morphine. In 2nd group, the postoperative analgesia regimen was similar, but when the level of pain on VAS ≥3 points was reached, it was supplemented with epidural boluses of 0.125% bupivacaine solution 10 ml. The established correlation of the study results with the postulates of the multimodal Enhanced Recovery After Surgery (ERAS) strategy confirms the pathophysiological feasibility of using regional techniques as a key component of antinociceptive protection, and the positive clinical trend indicates the advantages of combined regional (spinal-epidural) anesthesia.

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