Continuous spinal anesthesia/analgesia vs. single-shot spinal anesthesia with patient-controlled analgesia for elective hip arthroplasty.
BACKGROUND
In total hip replacement surgery several anesthesiological techniques can be used. In this study we compared continuous spinal anesthesia (CSA) and postoperative analgesia vs. single-shot spinal anesthesia (SPA) and postoperative patient-controlled intravenous analgesia with morphine (SPA).


METHODS
In a prospective randomized study, 68 patients, ASA I-III, between 50 and 85 years of age were allocated to these two groups. Quality of analgesia, hemodynamic stability and technical difficulties, as well as incidence of postoperative nausea and vomiting (PONV) and post dural puncture headache (PDPH), were recorded during a 24-h period.


RESULTS
Visual analog scale (VAS) scores were significantly lower in the CSA group from 3 h post operation (P < 0.05). Mean arterial pressure dropped by 21 +/- 11 mmHg in the CSA group and 29 +/- 14 in the SPA group during induction (P < 0.05). Technical difficulties and incidence of PDPH were similar in both groups. Postoperative nausea and vomiting was lower in the CSA group (P < 0.05).


CONCLUSIONS
Continuous spinal anesthesia/analgesia is a very practicable method providing better postoperative analgesia and better hemodynamic stability during anesthesia induction than SPA followed by morphine PCA analgesia after total hip replacement surgery.
Maurer
K
K
Department of Anesthesiology, University Hospital Zurich/Balgrist, Zurich, Switzerland.
Bonvini
J M
JM
Ekatodramis
G
G
Serena
S
S
Borgeat
A
A
D000368:Aged; D000369:Aged, 80 and over; D000698:Analgesia / Q000009:adverse effects / Q000379:methods*; D016058:Analgesia, Patient-Controlled / Q000009:adverse effects / Q000379:methods*; D000701:Analgesics, Opioid / Q000009:adverse effects / Q000627:therapeutic use; D000775:Anesthesia, Spinal / Q000009:adverse effects / Q000379:methods*; D000779:Anesthetics, Local / Q000009:adverse effects / Q000627:therapeutic use; D019644:Arthroplasty, Replacement, Hip; D002045:Bupivacaine / Q000009:adverse effects / Q000627:therapeutic use; D017558:Elective Surgical Procedures; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000009:adverse effects / Q000627:therapeutic use; D010149:Postoperative Pain / Q000517:prevention & control; D011446:Prospective Studies; D013997:Time Factors
D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D009020:Morphine; D002045:Bupivacaine