Caudal block in combination with general anesthesia as the best method of anesthesia for large joint replacement

Abstract

Operations of total hip and knee arthroplasty are currently one of the most frequent surgical interventions performed for functional rehabilitation of patients with osteoarthritis or patients who have received a fracture of the femoral neck. The best method for providing anesthesia and pain relief for total joint replacement has not been determined. Until now, a unified point of view on the choice of the optimal method of anesthesia and analgesia in surgical interventions for arthroplasty has not been formed. Purpose of the study.: To study the effectiveness of caudal anesthesia in hip and knee arthroplasty. Material and research methods: The study was conducted in the surgical clinic of the AMU in 56 patients who underwent surgery for hip and knee arthroplasty. The age of the patients varied from 57 to 99 years. Depending on the chosen anesthesia technique, the patients were divided into 2 groups: in the 1st group (n=28) endotracheal anesthesia was performed, induction of anesthesia with propofol and rocuronium bromide, anesthesia based on sevoflurane 1.0 vol% with caudal administration of ropivacaine 2 mg/kg in combinations with dexamethasone 0.2 mg/kg; group 2 (n=28 patients) underwent multicomponent endotracheal anesthesia (propofol 3 mg/kg, rocuronium bromide 0.6 mg/kg, sevoflurane 1.5–2.5 vol/% with high doses of fentanyl 5–6 µg /kg/hour. Research results: During the traumatic moment of the operation, the average heart rate in group I (general anesthesia + caudal block) was significantly lower than in group II (general anesthesia) (69.4±2.0 versus 89.40±3.0, p=0.010), but there are significant differences in SBP or DBP between the two groups. Conclusion: The inclusion of caudal blockade in the protocol of general anesthesia provides adequate pain relief, both intra- and postoperatively, in patients undergoing arthroplasty of large joints of the lower extremities.