A variant of anesthesia for total arthroplasty of the lower extremity joints

Abstract

In this study we sought to optimize analgesia in total joint arthroplasty of the lower extremity and reduce the risk of arterial hypotension in patients with various degrees of obesity. The optimization contributed to the development of a new technique of spinal anesthesia. The technique leads to the epidural volume extension, as well as the decrease of local anesthetic doses administered into the subarachnoid space and saving the level of sensory block. The aim of the study was to study the effect of the spinal anesthesia with the epidural volume extension technique on the level of sensory block and hemodynamics in patients with various degrees of obesity during total arthroplasty of the lower extremity joints for III stage osteoarthritis. The prospective single-center study included 103 patients (79 men (76.7%), mean age 59±11 years, range from 33 to 74 years) who were treated in the Department of Traumatology and Orthopedics from September 2019 to May 2020. Anthropometric parameters, levels of sensory and motor blocks, level of pain syndrome, sympathetic block, duration of surgery and anesthesia were analyzed. To assess the impact of all factors on the outcome, methods of one-dimensional analysis with the calculation of relative risk (RR) were used. All patients were divided into two groups: the control group (combined spinal-epidural anesthesia was used) and the main group (spinal anesthesia with epidural volume extension was used). The average upper level of the sensor block (Th-segment) at 15 minutes after spinal anesthesia did not significantly differ in the groups (p=0.95). Differences in the frequency of hypotension in the groups were not statistically significant (p˃0.05). RR: 1.17 [95% CI: 0.794; 1.726]. Reducing the dose of a local anesthetic by 25% to provide adequate spinal anesthesia with the epidural volume extension in patients with a high body mass index achieves the same result when assessing sensory, motor and sympathetic blockages when compared with the traditional method of anesthesia.