[COMBINED SPINAL-PARAVERTEBRAL ANESTHESIA IN TOTAL HIP ARTHROPLASTY.]

Abstract

Background: Optimizing analgesia in total hip arthroplasty contributed to the idea of combined use of spinal and paravertebral anesthesia.

The aim: the clinical evaluation of combined spinal-paravertebral anesthesia in patients undergoing total hip ar- throplasty.

Materials and methods: 67 patients were divided into groups: at the first a combined spinal-paravertebral anesthesia (KSPA) was used, the second - a combined spinal-epidural anesthesia (CSEA). The location of the lumbar plexus was determined by ultrasound scan. Spinal component was provided 0.5% ropivacaine solution. In the perioperative period propofol infusionfor sedation was used. After operation infusion of 0.2% ropivacaine solution at a rate of5-6 ml/hour was started through the catheter for 48 hours. The postoperative period was assessed pain intensity on a 10-point visual analog scale (VAS), the needfor analgesics, incidence of complications and patient satisfaction with the quality of anesthesia.

Results: The lumbar plexus at the L2-3 level was in 29,9%- immediately after the release ofthe intervertebral holes, in 67.2%- in the psoas major muscle at L4-5 level of 80.1% in the psoas major muscle. In both groups postoperative pain intensity within 48 hours does not exceed 3, VAS scores. The frequency of complications in the postoperative period was against the background of paravertebral blockade of 18.2%, against the backdrop of epidural analgesia - 26 5%. 90.1% ofpatients in the first group and 82.4% ofpatients in the second group were fully satisfied with the chosen method of anesthesia (p> 0.05).

Conclusions: Combined spinal-paravertebral block for total hip arthroplasty is an effective and safe method of pain relief.