A Comparative Randomized Control Study of Continuous Spinal Anaesthesia with Continuous Epidural Anaesthesia in Elderly Patients Undergoing Dynamic Hip Screw Surgeries
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Abstract
Background: Hip fractures in elderly patients is common and occurs with trivial fall. Continuous epidural anesthesia (CEA) and Continuous spinal anesthesia (CSA) are available modalities for lower extremities surgeries. This study was done to compare the effectiveness of CEA and CSA.
Methods: A prospective open-label randomized control trial was carried out in the Department of Anaesthesiology and Critical care at GMC, Kadapa, from January 2019 to July 2020. One hundred patients were enrolled and divided into Group A and B, with 50 participants in each group. Group A received continuous spinal anesthesia, and Group B was given continuous epidural anesthesia. VAS score, Onset of sensory block, the Onset of motor block and no. of rescue analgesia, etc., were considered as the primary outcome variable. coGuide statistical software was used for analysis.
Results: There was a statistically significant difference between the study groups (Group A vs. Group B) in the Onset of sensory block (7.6 ± 1.6 min, 17.5 ± 1.62 min), the start of motor block (10.1 ± 1.11 min,20.28 ± 1.36 min), duration of sensory block (108.7 ± 16.84 min, 147.4 ± 20.39 min), duration of motor block (175.8 ± 12.47 min, 219.4 ± 18.56 min) and analgesia duration (199.2 ± 11.92 min, 327.6 ± 18.8 min) respectively. The Difference in the number of rescue analgesia in 24 hrs between the study group was significant with a P-value of <0.001.
Conclusion: The current study revealed that CSA is more effective than CEA in Hip surgeries.
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[2]Kanters TA, van de Ree CLP, de Jongh MAC, Gosens T, Hakkaart-van Roijen L. Burden of illness of hip fractures in elderly Dutch patients. Arch Osteoporos. 2020; 15(1):11.
[3]Forni C, D’Alessandro F, Gallerani P, Genco R, Bolzon A, Bombino C, et al. Effectiveness of using a new polyurethane foam multi-layer dressing in the sacral area to prevent the onset of pressure ulcer in the elderly with hip fractures: A pragmatic randomised controlled trial. Int Wound J. 2018;15(3):383-390.
[4]Castelli A, Daidone S, Jacobs R, Kasteridis P, Street AD. The determinants of costs and length of stay for hip fracture patients. PLoS One. 2015;10(7):e0133545.
[5]Patel MC, Chandra M, Lo JC. Mortality following hip fracture in Chinese, Japanese, and Filipina women. Am J Manag Care. 2016;22(10):e358-e359.
[6]Lau EM. The epidemiology of osteoporosis in Asia. IBMS Bonekey. 2009;6(5):190-193.
[7]Dhanwal DK, Siwach R, Dixit V, Mithal A, Jameson K, Cooper C. Incidence of hip fracture in Rohtak district, North India. Arch Osteoporos. 2013; 8(1-2):135.
[8]Office of the Registrar General & Census Commissioner, India. Census of India: Age Structure And Marital Status. 2011. [Cited 2021 Jan 28]. Available from: https://censusindia.gov.in/Census_And_You/age_structure_and_marital_status.aspx
[9]Jonnes C, Shishir SM, Najimudeen S. Type II intertrochanteric fractures: Proximal femoral nailing (PFN) versus Dynamic Hip Screw (DHS). Arch Bone Jt Surg. 2016; 4(1):23-28.
[10]Katsoulis M, Benetou V, Karapetyan T, Feskanich D, Grodstein F, Pettersson-Kymmer U, et al. Excess mortality after hip fracture in elderly persons from Europe and the USA: the CHANCES project. J Intern Med. 2017; 281(3):300-310.
[11]O’Neill F, Condon F, McGloughlin T, Lenehan B, Coffey JC, Walsh M. Dynamic hip screw versus DHS blade: A biomechanical comparison of the fixation achieved by each implant in bone. J Bone Jt Surg - Ser B. 2011; 93(5):616-621.
[12]Beh ZY, Yong PSA, Lye S, Eapen SE, Yoong CS, Woon KL, et al. Continuous spinal anaesthesia: A retrospective analysis of 318 cases. Indian J Anaesth. 2018; 62(10):765-772.
[13]Moore JM. Continuous spinal anesthesia. Am J Ther. 2009; 16(4):289-294.
[14]Emyedu A, Kyoheirwe B, Atumanya P. Continuous Spinal Anesthesia following Inadvertent Dural Puncture during Epidural Placement for an Emergency Laparotomy. Case Rep Anesthesiol. 2021; 2021:8819864.
[15]Veličković I, Pujic B, Baysinger CW, Baysinger CL. Continuous spinal anesthesia for obstetric anesthesia and analgesia. Front Med. 2017; 4:133.
[16]De Andrés J, Valía JC, Olivares A, Bellver J. Continuous spinal anesthesia: A comparative study of standard microcatheter and spinocath. Reg Anesth Pain Med. 1999; 24(2):110-116.
[17]Elfeky M, Stohy AS, Sabra M, Mahareak A, Alkumity A. Randomized comparison of continuous spinal anesthesia versus continuous epidural anesthesia in high-risk elderly patients undergoing major orthopedic lower limb surgeries. Res Opin Anesth Intensive Care. 2019; 6(1):72.
[18]Rodgers A, Walker N, Schug S, McKee A, Kehlet H, Van Zundert A, et al. Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: Results from overview of randomised trials. Br Med J. 2000; 321(7275):1493-1497.
[19]Scheinin H, Virtanen T, Kentala E, Uotila P, Laitio T, Hartiala J, et al. Epidural infusion of bupivacaine and fentanyl reduces perioperative myocardial ischaemia in elderly patients with hip fracture - A randomized controlled trial. Acta Anaesthesiol Scand. 2000; 44(9):1061-1070.
[20]López MM, Guasch E, Schiraldi R, Maggi G, Alonso E, Gilsanz F. Continuous spinal anaesthesia with minimally invasive haemodynamic monitoring for surgical hip repair in two patients with severe aortic stenosis. Brazilian J Anesthesiol (English Ed. 2016;66(1):82-85.
[21]Lux EA. Continuous spinal anesthesia for lower limb surgery: A retrospective analysis of 1212 cases. Local Reg Anesth. 2012; 5(1):63-67.
[22]Daniel.WW. Determination of sample size for estimating proportions. Biostatistics A foundation for analysis in the health sciences. 1999; 8:189-90.
[23]BDSS Corp. Released 2020. coGuide Statistics software, Version 1.0, India: BDSS corp. Available from: https://www.coguide.in. [Last accessed on 2021 Jan 26].
[24]Dhanwal DK, Dennison EM, Harvey NC, Cooper C. Epidemiology of hip fracture: Worldwide geographic variation. Indian J Orthop. 2011; 45(1):15-22.
[25]Cheung C-L, Ang S Bin, Chadha M, Chow ES-L, Chung Y-S, Hew FL, et al. An updated hip fracture projection in Asia: The Asian Federation of Osteoporosis Societies study. Osteoporos Sarcopenia. 2018; 4(1):16-21.
[26]Martyr JW, Clark MX. Hypotension in elderly patients undergoing spinal anaesthesia for repair of fractured neck of femur. A comparison of two different spinal solutions. Anaesth Intensive Care. 2001; 29(5):501-505.
[27]Imbelloni LE, Gouveia MA, Cordeiro JA. Continuous spinal anesthesia versus combined spinal epidural block for major orthopedic surgery: Prospective randomized study. Sao Paulo Med J. 2009;127(1):7-11.
[28]Amin SM, Sadek SF. Continuous spinal anesthesia for elderly patients with cardiomyopathy undergoing lower abdominal surgeries. Egypt J Anaesth. 2016; 32(4):535-540.
[29]Eraki K, Abaza K, El Malky A, Medhat M. Continuous Anesthesia: Spinal Versus Epidural For Lower Limb Surgeries. Zagazig Univ Med J. 2020; 0(0):0-0.
[30]Lux EA. Continuous spinal anesthesia for lower limb surgery: A retrospective analysis of 1212 cases. Local Reg Anesth. 2012;5(1):63-67.
[31]Reisli R, Celik J, Tuncer S, Yosunkaya A, Otelcioglu S. Anaesthetic and haemodynamic effects of continuous spinal versus continuous epidural anaesthesia with prilocaine. Eur J Anaesthesiol. 2003;20(1):26-30.
[32]De Andrés J. Continuous spinal anaesthesia. Curr Opin Anaesthesiol. 1997;10(5):341-344..
[2]Kanters TA, van de Ree CLP, de Jongh MAC, Gosens T, Hakkaart-van Roijen L. Burden of illness of hip fractures in elderly Dutch patients. Arch Osteoporos. 2020; 15(1):11.
[3]Forni C, D’Alessandro F, Gallerani P, Genco R, Bolzon A, Bombino C, et al. Effectiveness of using a new polyurethane foam multi-layer dressing in the sacral area to prevent the onset of pressure ulcer in the elderly with hip fractures: A pragmatic randomised controlled trial. Int Wound J. 2018;15(3):383-390.
[4]Castelli A, Daidone S, Jacobs R, Kasteridis P, Street AD. The determinants of costs and length of stay for hip fracture patients. PLoS One. 2015;10(7):e0133545.
[5]Patel MC, Chandra M, Lo JC. Mortality following hip fracture in Chinese, Japanese, and Filipina women. Am J Manag Care. 2016;22(10):e358-e359.
[6]Lau EM. The epidemiology of osteoporosis in Asia. IBMS Bonekey. 2009;6(5):190-193.
[7]Dhanwal DK, Siwach R, Dixit V, Mithal A, Jameson K, Cooper C. Incidence of hip fracture in Rohtak district, North India. Arch Osteoporos. 2013; 8(1-2):135.
[8]Office of the Registrar General & Census Commissioner, India. Census of India: Age Structure And Marital Status. 2011. [Cited 2021 Jan 28]. Available from: https://censusindia.gov.in/Census_And_You/age_structure_and_marital_status.aspx
[9]Jonnes C, Shishir SM, Najimudeen S. Type II intertrochanteric fractures: Proximal femoral nailing (PFN) versus Dynamic Hip Screw (DHS). Arch Bone Jt Surg. 2016; 4(1):23-28.
[10]Katsoulis M, Benetou V, Karapetyan T, Feskanich D, Grodstein F, Pettersson-Kymmer U, et al. Excess mortality after hip fracture in elderly persons from Europe and the USA: the CHANCES project. J Intern Med. 2017; 281(3):300-310.
[11]O’Neill F, Condon F, McGloughlin T, Lenehan B, Coffey JC, Walsh M. Dynamic hip screw versus DHS blade: A biomechanical comparison of the fixation achieved by each implant in bone. J Bone Jt Surg - Ser B. 2011; 93(5):616-621.
[12]Beh ZY, Yong PSA, Lye S, Eapen SE, Yoong CS, Woon KL, et al. Continuous spinal anaesthesia: A retrospective analysis of 318 cases. Indian J Anaesth. 2018; 62(10):765-772.
[13]Moore JM. Continuous spinal anesthesia. Am J Ther. 2009; 16(4):289-294.
[14]Emyedu A, Kyoheirwe B, Atumanya P. Continuous Spinal Anesthesia following Inadvertent Dural Puncture during Epidural Placement for an Emergency Laparotomy. Case Rep Anesthesiol. 2021; 2021:8819864.
[15]Veličković I, Pujic B, Baysinger CW, Baysinger CL. Continuous spinal anesthesia for obstetric anesthesia and analgesia. Front Med. 2017; 4:133.
[16]De Andrés J, Valía JC, Olivares A, Bellver J. Continuous spinal anesthesia: A comparative study of standard microcatheter and spinocath. Reg Anesth Pain Med. 1999; 24(2):110-116.
[17]Elfeky M, Stohy AS, Sabra M, Mahareak A, Alkumity A. Randomized comparison of continuous spinal anesthesia versus continuous epidural anesthesia in high-risk elderly patients undergoing major orthopedic lower limb surgeries. Res Opin Anesth Intensive Care. 2019; 6(1):72.
[18]Rodgers A, Walker N, Schug S, McKee A, Kehlet H, Van Zundert A, et al. Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: Results from overview of randomised trials. Br Med J. 2000; 321(7275):1493-1497.
[19]Scheinin H, Virtanen T, Kentala E, Uotila P, Laitio T, Hartiala J, et al. Epidural infusion of bupivacaine and fentanyl reduces perioperative myocardial ischaemia in elderly patients with hip fracture - A randomized controlled trial. Acta Anaesthesiol Scand. 2000; 44(9):1061-1070.
[20]López MM, Guasch E, Schiraldi R, Maggi G, Alonso E, Gilsanz F. Continuous spinal anaesthesia with minimally invasive haemodynamic monitoring for surgical hip repair in two patients with severe aortic stenosis. Brazilian J Anesthesiol (English Ed. 2016;66(1):82-85.
[21]Lux EA. Continuous spinal anesthesia for lower limb surgery: A retrospective analysis of 1212 cases. Local Reg Anesth. 2012; 5(1):63-67.
[22]Daniel.WW. Determination of sample size for estimating proportions. Biostatistics A foundation for analysis in the health sciences. 1999; 8:189-90.
[23]BDSS Corp. Released 2020. coGuide Statistics software, Version 1.0, India: BDSS corp. Available from: https://www.coguide.in. [Last accessed on 2021 Jan 26].
[24]Dhanwal DK, Dennison EM, Harvey NC, Cooper C. Epidemiology of hip fracture: Worldwide geographic variation. Indian J Orthop. 2011; 45(1):15-22.
[25]Cheung C-L, Ang S Bin, Chadha M, Chow ES-L, Chung Y-S, Hew FL, et al. An updated hip fracture projection in Asia: The Asian Federation of Osteoporosis Societies study. Osteoporos Sarcopenia. 2018; 4(1):16-21.
[26]Martyr JW, Clark MX. Hypotension in elderly patients undergoing spinal anaesthesia for repair of fractured neck of femur. A comparison of two different spinal solutions. Anaesth Intensive Care. 2001; 29(5):501-505.
[27]Imbelloni LE, Gouveia MA, Cordeiro JA. Continuous spinal anesthesia versus combined spinal epidural block for major orthopedic surgery: Prospective randomized study. Sao Paulo Med J. 2009;127(1):7-11.
[28]Amin SM, Sadek SF. Continuous spinal anesthesia for elderly patients with cardiomyopathy undergoing lower abdominal surgeries. Egypt J Anaesth. 2016; 32(4):535-540.
[29]Eraki K, Abaza K, El Malky A, Medhat M. Continuous Anesthesia: Spinal Versus Epidural For Lower Limb Surgeries. Zagazig Univ Med J. 2020; 0(0):0-0.
[30]Lux EA. Continuous spinal anesthesia for lower limb surgery: A retrospective analysis of 1212 cases. Local Reg Anesth. 2012;5(1):63-67.
[31]Reisli R, Celik J, Tuncer S, Yosunkaya A, Otelcioglu S. Anaesthetic and haemodynamic effects of continuous spinal versus continuous epidural anaesthesia with prilocaine. Eur J Anaesthesiol. 2003;20(1):26-30.
[32]De Andrés J. Continuous spinal anaesthesia. Curr Opin Anaesthesiol. 1997;10(5):341-344..
| Files | ||
| Issue | Vol 8 No Supp. 1 (2022): Supplement 1 |
|
| Section | Research Article(s) | |
| Keywords | ||
| Continuous epidural anesthesia Continuous spinal anesthesia dynamic hip screw elderly patients Fentanyl Ropivacaine. | ||
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How to Cite
1.
Kattamanchi S, Tharigonda B, Meenakshi GS, Neelakrishnaveni K. A Comparative Randomized Control Study of Continuous Spinal Anaesthesia with Continuous Epidural Anaesthesia in Elderly Patients Undergoing Dynamic Hip Screw Surgeries. Arch Anesth & Crit Care. 2022;8(Supp. 1):387-392.
