Document Type: RESEARCH PAPER

Authors

1 Anesthesiology Research Center, Guilan University of Medical Sciences (GUMS), Rasht, Iran

2 Orthopedic Research Center, Guilan University of Medical Sciences (GUMS), Rasht, Iran

3 Shahid Beheshti University of Medical Sciences (SBUMC), Tehran, Iran

Abstract

Background: To evaluate general anesthesia with sevoflurane vs spinal anesthesia with low dose lidocaine 5% on
hemodynamics changes in patients undergoing hip fracture surgery.
Methods: In this randomized double blind trial 100 patients (50 patients in each group) older than 60 years under
hip surgery were randomized in general anesthesia with sevoflurane and spinal anesthesia with lidocaine 5%.
Hemodynamic changes including mean arterial pressure (MAP) and heart rate, blood loss, pain severity, nausea and
vomiting and opioids consumption were compared in two groups.
Results: During surgery, difference between two groups regarding changes in mean arterial pressure was not
significant, but the changes in heart rate were significantly different. Mean arterial pressure changes during recovery
between two groups were significantly different. But there was no significant difference in heart rate changes. Bleeding
in the sevoflurane group was significantly more than spinal group (513.ml vs. 365 ml). Moreover, AS Score, opioid
consumption, and the nausea and vomiting in spinal anesthesia group was significantly lower than the sevoflurane
group.
Conclusion: We showed that general anesthesia with sevoflurane and spinal anesthesia with low dose lidocaine 5%
have comparable effects on hemodynamics changes in patients undergoing hip fracture surgery. However postoperative
pain score, vomiting and morphine consumption in patients with spinal anesthesia were lower than general anesthesia.

Keywords

Main Subjects

1. Johnell O, Kanis JA. An estimate of the worldwide
prevalence and disability associated with osteoporotic
fractures. Osteoporos Int. 2006; 17(12):1726-33.
2. Cooper C, Campion G, Melton LJ 3rd. Hip fractures in
the elderly: a world-wide projection. Osteoporos Int.
1992; 2(6):285-9.
3. Parker MJ, Handoll HH, Griffiths R. Anaesthesia for
hip fracture surgery in adults. Cochrane Database Syst
Rev. 2004; (4):CD000521.
4. Urwin SC, Parker MJ, Griffiths R. General versus
regional anaesthesia for hip fracture surgery: a metaanalysis
of randomized trials. Br J Anaesth. 2000;
84(4):450-5.
5. McKenzie PJ, Wishart HY, Smith G. Long-term outcome
after repair of fractured neck of femur. Comparison of
subarachnoid and general anaesthesia. Br J Anaesth.
1984; 56(6):581-5.
6. O’Hara DA, Duff A, Berlin JA, Poses RM, Lawrence VA,
Huber EC, et al. The effect of anesthetic technique
on postoperative outcomes in hip fracture repair.
Anesthesiology. 2000; 92(4):947-57.
7. Soleimanha M, Sedighinejad A, Haghighi M, Nabi BN,
Mirbolook AR, Mardani-Kivi M. Hemodynamic and
arterial blood gas parameters during cemented hip
hemiarthroplasty in elderly patients. Arch Bone Jt
Surg. 2014; 2(3):163-7.
8. Soleimanha M, Haghighi M, Mirbolook A, Sedighinejad
A, Mardani-Kivi M, Naderi-Nabi B, et al. A survey on
transfusion status in orthopedic surgery at a trauma
center. Arch Bone Jt Surg. 2016 ; 4(1):70-4.
9. Haghighi M, Sedighinejad A, Mirbolook A, Naderi
Nabi B, Farahmand M, Kazemnezhad Leili E, et al.
Effect of intravenous intraoperative esmolol on
pain management following lower limb orthopedic
surgery. Korean J Pain. 2015; 28(3):198-202.
10. Modig J, Borg T, Bagge L, Saldeen T. Role of extradural
and of general anaesthesia in fibrinolysis and
coagulation after total hip replacement. Br J Anaesth.
1983; 55(7):625-9.
11. 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. BMJ.
2000; 321(7275):1493.
12. Bar-Yosef S, Melamed R, Page GG, Shakhar G,
Shakhar K, Ben-Eliyahu S. Attenuation of the tumorpromoting
effect of surgery by spinal blockade in rats.
Anesthesiology. 2001; 94(6):1066-73.
13. Nishikawa K, Yoshida S, Shimodate Y, Igarashi M,
Namiki A. A comparison of spinal anesthesia with
small-dose lidocaine and general anesthesia with
fentanyl and propofol for ambulatory prostate biopsy
procedures in elderly patients. J Clin Anesth. 2007;
19(1):25-9.
14. Gonano C, Leitgeb U, Sitzwohl C, Ihra G, Weinstabl
C, Kettner SC. Spinal versus general anesthesia for
orthopedic surgery: anesthesia drug and supply costs.
Anesth Analg. 2006; 102(2):524-9.
15. Hu S, Zhang ZY, Hua YQ, Li J, Cai ZD. A comparison of
regional and general anaesthesia for total replacement
of the hip or knee: a meta-analysis. J Bone Joint Surg
Br. 2009; 91(7):935-42.
16. Richman JM, Rowlingson AJ, Maine DN, Courpas GE,
Weller JF, Wu CL. Does neuraxial anesthesia reduce
intraoperative blood loss? A meta-analysis. J Clin
Anesth. 2006; 18(6):427-35
17. Macfarlane AJ, Prasad GA, Chan VW, Brull R. Does
regional anaesthesia improve outcome after total hip
arthroplasty? A systematic review. Br J Anaesth. 2009;
103(3):335-45
18. Mauermann WJ, Shilling AM, Zuo Z. A comparison of
neuraxial block versus general anesthesia for elective
total hip replacement: a meta-analysis. Anesth Analg.
2006; 103(4):1018-25.
19. Minville V, Asehnoune K, Delussy A, Fourcade O,
Colombani A, Rabinowitz A, et al. Hypotension during
surgery for femoral neck fracture in elderly patients:
effect of anaesthetic techniques. A retrospective study.
Minerva Anestesiol. 2008; 74(12):691-6.
20. Liu SS, Strodtbeck WM, Richman JM, Wu CL. A
comparison of regional versus general anesthesia
for ambulatory anesthesia: a meta-analysis of
randomized controlled trials. Anesth Analg. 2005;
101(6):1634-42.
21. Block BM, Liu SS, Rowlingson AJ, Cowan AR, Cowan JA,
Jr., Wu CL. Efficacy of postoperative epidural analgesia:
a meta-analysis. JAMA. 2003; 290(18):2455-63.