Impact of Reduced Dose of Local Anesthetic in Intrathecal Anesthesia on the Efficiency of Sympathomimetics and Infusion Therapy During Hip Replacement

M.L. Homon, I.P. Shlapak

Abstract


We have investigated the dependence of sympathomimetic effect of mesaton during cement application in hip replacement on reducing the dose of local anesthetic (0.5% bupivacaine) for spinal anesthesia. Comparison of multimodal anesthesia course in the complex of anesthetic management for hip replacement in 43 patients with operational risk degree 3 by ASA has been carried out. Patients were divided into 2 groups depending on the method of anesthesia. In the 1st control group consisted of 22 patients we have used spinal anesthesia — 3.9 ± 0.1 ml of 0.5% bupivacaine, in the 2nd group included 21 patients — reduced spinal and peridural anesthesia. Reduction of spinal component dose was 13 % — 3.4 ± 0.1 ml (p = 0.001) of 0.5% bupivacaine. The comparative analysis of the dynamics of mean arterial pressure (MAP) and heart rate (HR) du­ring surgery and cement application has been carried out. As a marker of sympathoadrenal system sensitivity to sympathomimetic, we have analyzed a dose of titered (by 10 times) mesaton used during fixation of the prosthesis components on cement as hydrodynamic lock. Introduction of titered mesaton has been performed immediately after cement application to achieve initial, or by 10 % higher than the target hemodynamic indicators. The frequency of repeated administration of sympathomimetic was also studied.
Significantly smaller decrease of MAP and HR was detected when using a lower dose of bupivacaine in the second group before the application of prosthesis components on cement, compared with the first group. At the stage of the of prosthesis components application on cement, when using greater dose of bupivacaine intrathecally, we have recorded significant MAP decrease and bradycardia episodes that required the use of higher mesaton doses and use of atropine compared to the main group. We have detected a stable (r = 0.72) correlation between bupivacaine dose reduction up to 13 % during intrathecal anesthesia and decreased total dose of mesaton used in hip replacement. Correlation between bupivacaine dose reduction and reduced volume of infusion therapy during hip replacement was also revealed, which shows greater activity of sympathoadrenal system.Therefore, bupivacaine dose reduction up to 13 %, when using intrathecal anesthesia in hip replacement, provides a more stable hemodynamic parameters and a higher sensitivity of sympathoadrenal system to mesaton and infusion therapy. Increased pressure during the compression of nonpolymerized cement by prosthesis components provides less severity of toxical reactions of hypotension after hip replcement.


Keywords


reduced spinal and epidural anesthesia; hip replacement

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DOI: https://doi.org/10.22141/2224-0586.1.64.2015.79581

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