摘要
Background:Intravertebral and general anesthesia(GA)are two main anesthesia approaches but both have defects.This study was aimed to evaluate the effect of subarachnoid anesthesia combined with propofol target-controlled infusion(TCI)on blood loss and transfusion for total hip arthroplasty(THA)in elderly patients in comparison with combined spinal-epidural anesthesia(CSEA)or GA.Methods:Totally,240 patients(aged>65 years,American Society of Anesthesiologists[ASA]I-III)scheduled for posterior THA were enrolled from September 1st,2017 to March 1st,2018.All cases were randomly divided into three groups to receive CSEA(group C,w=80),GA(group G,n=80),or subarachnoid anesthesia and propofol TCI(group T,w=80),respectively.Primary outcomes measured were intra-operative blood loss,autologous and allogeneic blood transfusion,mean arterial pressure at different time points,length of stay in post-anesthesia care unit(PACU),length of hospital stay,and patient satisfaction degree.Furthermore,post-operative pain scores and complications were also observed.The difference of quantitative index between groups were analyzed by one-way analysis of variance,repeated measurement generalized linear model,Student-Newman-Keuls test or rank-sum test,while ratio index was analyzed by Chi-square test or Fisher exact test.Results:Basic characteristics were comparable among the three groups.Intra-operative blood loss in group T(331.53±64.33 mL)and group G(308.03±64.90 mL)were significantly less than group C(455.40±120.48 mL,F=65.80,P<0.001).Similarly,the autologous transfusion of group T(130.99±30.36 mL)and group G(124.09±24.34 mL)were also markedly less than group C(178.31±48.68 mL,F=52.99,P<0.001).The allogenetic blood transfusion of group C(0[0,100.00])was also significantly larger than group T(0)and group G(0)(Z=2.47,P=0.047).Except for the baseline,there were significant differences in mean arterial blood pressures before operation(F=496.84,P<0.001),10-min after the beginning of operation(F=351.43,P<0.001),30-min after the beginning of operation(F=559.89,P<0.001),50-min after the beginning of operation(F=374.74,P<0.001),and at the end of operation(F=26.14,P<0.001)among the three groups.Length of stay in PACU of group T(9.41±1.19 min)was comparable with group C(8.83±1.26 min),and both were significantly shorter than group G(16.55±3.10 min,F=352.50,P<0.001).There were no significant differences among the three groups in terms of length of hospitalization and post-operative visual analog scale scores.Patient satisfaction degree of group T(77/80)was significantly higher than group C(66/80,%=7.96,P=0.004)and G(69/80,/2=5.01,P=0.025).One patient complained of post-dural puncture headache and two complained of low back pain in group C,while none in group T.Incidence of post-operative nausea and vomiting in group G(10/80)was significantly higher than group T(3/80,/2=4.10,P=0.043)and group C(2/80,x2=5.76,P=0.016).No deep vein thrombosis or delayed post-operative functional exercise was detected.Conclusions:Single subarachnoid anesthesia combined with propofol TCI seems to perform better than CSEA and GA for posterior THA in elderly patients,with less blood loss and peri-operative transfusion,higher patient satisfaction degree and fewer complications.Trial registration:chictr.org.cn:ChiCTR-IPR-17013461;http://www.chictr.org.cn/showproj.aspx?proj=23024.
