Spinal anesthesia vs psoas compartment-sciatic nerve block for hip replacement in elderly .
This report has been verified
by one or more authors of the
original publication.
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2015;3(8):2 BMC Anesthesiol. 2014 Nov 5;14:9970 elderly patients with ASA physical status III or IV and scheduled for elective hip replacement were included in this trial. The purpose of this study was to compare continuous spinal anesthesia with combined psoas compartment-sciatic nerve block with respect to hemodynamic effects in elderly high-risk patients. The results from this trial indicated comparable results, with continuous spinal anesthesia taking significantly shorter time to perform than combined psoas compartment-sciatic nerve block.
Was the allocation sequence adequately generated?
Was allocation adequately concealed?
Blinding Treatment Providers: Was knowledge of the allocated interventions adequately prevented?
Blinding Outcome Assessors: Was knowledge of the allocated interventions adequately prevented?
Blinding Patients: Was knowledge of the allocated interventions adequately prevented?
Was loss to follow-up (missing outcome data) infrequent?
Are reports of the study free of suggestion of selective outcome reporting?
Were outcomes objective, patient-important and assessed in a manner to limit bias (ie. duplicate assessors, Independent assessors)?
Was the sample size sufficiently large to assure a balance of prognosis and sufficiently large number of outcome events?
Was investigator expertise/experience with both treatment and control techniques likely the same (ie.were criteria for surgeon participation/expertise provided)?
Oui = 1
Incertain = 0,5
Non pertinent = 0
Non = 0
L'évaluation des critères de rapport permet d'évaluer la transparence avec laquelle les auteurs rapportent les caractéristiques méthodologiques et les caractéristiques de l'essai dans la publication. L'évaluation est divisée en cinq catégories qui sont présentées ci-dessous.
2/4
Aleatorización
4/4
Medición de resultados
4/4
Inclusión / exclusión
4/4
Descripción de la terapia
4/4
Estadísticas
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
L'indice de fragilité est un outil qui aide à l'interprétation des résultats significatifs, en fournissant une mesure de la force d'un résultat. L'indice de fragilité représente le nombre d'événements consécutifs qui doivent être ajoutés à un résultat dichotomique pour que le résultat ne soit plus significatif. Un petit nombre représente un résultat plus faible et un grand nombre un résultat plus fort.
Pourquoi cette étude était-elle nécessaire maintenant ?
Hip replacements are common in the elderly population. There has been increased interest towards using regional anaesthesia in this patient population, avoiding certain comorbidity-related complications with general anaesthesia that are especially seen in older patients. Two methods of regional anaesthesia that have piqued interest among surgeons are continuous spinal anaesthesia (CSA) and combined psoas compartment-sciatic nerve block (PCSNB). While neither are free of potential complications, its has been suggested that PCSNB may be more advantageous in elderly patients when considering hemodynamic effects. This trial aimed to compare the effectiveness of each anesthesia in elderly patients undergoing hip replacement surgery.
Quelle était la principale question de recherche ?
In high-risk, elderly patients undergoing hip replacement, how do the hemodynamic effects and anesthesia quality of continuous spinal anesthesia compare with combined psoas compartment-sciatic nerve block?
- Mean arterial blood pressure was significantly higher in the PCSNB group than the CSA group at the beginning of surgery (p=0.038), at the 5th (p=0.029), 10th (p=0.012), and 20th (p=0.009) minutes of surgery.
- 13 patients in the CSA group and 4 patients in the PCSNB group experienced arterial hypotension requiring epinephrine treatment (p=0.012).
- The duration of the block procedure was significantly shorter in the CSA group compared with the PCSNB group (18.51 +/- 1.82 min vs. 35.53 +/- 5.51 min; p<0.001).
- Patients in the CSA group loss significantly less intraoperative blood than patients in the PCSNB group (283.14 +/- 68.66 mL vs. 329.57 +/- 53.66 mL; p=0.02).
- There was a significantly lesser amount of patients in the CSA group that required postoperative rescue analgesic than in the PCSNB group (11 vs. 30; p=0.0001).
De quoi dois-je me souvenir en priorité ?
Psoas compartment-sciatic nerve block took longer time to perform, resulted in more intraoperative blood loss, and required more postoperative analgesia, but maintained mean arterial pressure in the first 20 minutes of surgery when compared with continuous spinal anesthesia. Fewer patients in the psoas compartment-sciatic nerve block group experienced arterial hypertension requiring ephedrine treatment compared to the continuous spinal anesthesia group.
Comment cela affectera-t-il les soins prodigués à mes patients ?
This study is one of the first investigations into the comparative effect on hemodynamic effects between a combined psoas compartment-sciatic nerve block and continuous spinal anaesthesia in high-risk elderly patients undergoing hip replacement. Based on the findings of this trial, a combined psoas compartment-sciatic nerve block may have less of an effect on hemodynamics than continuous spinal anaesthesia, though appears more technically demanding as evidenced by the increased length of administration. Important to note is the small number of patients included within this study, necessitating the need for further evaluation of PCSNB and CSA in a larger cohort of patients.
AVIS DE NON-RESPONSABILITÉ
Le contenu de cette page est fourni à titre d'information uniquement et n'est pas destiné à remplacer un avis médical, un diagnostic ou un traitement professionnel. Si vous avez besoin d'un traitement médical, demandez toujours l'avis de votre médecin ou rendez-vous au service des urgences le plus proche. Les opinions, croyances et points de vue exprimés par les individus sur le contenu de cette page ne reflètent pas les opinions, croyances et points de vue d'OrthoEvidence.
0 de 4 articles mensuels GRATUITS débloqués
