Similar incidence of hypotension with combined spinal-epidural or epidural alone for knee arthroplasty.
BACKGROUND
We hypothesized that the incidence of hypotension during total knee replacement (TKR) surgery is lower in patients given combined spinal-epidural (CSE) anesthesia vs those receiving epidural anesthesia alone.


METHODS
In a prospective study, 80 American Society of Anesthesiologists I-II patients (aged 40-80 yr), undergoing elective TKR surgery were randomly assigned to either CSE anesthesia (CSE, n = 40) or epidural anesthesia alone (Epidural, n = 40). Hemodynamic measurements included oscillometric mean arterial blood pressure (MAP), heart rate (HR), and cardiac index (CI) as determined by thoracic bioimpedance; systemic vascular resistance (SVR) was calculated. Our primary endpoint (outcome) was the number of hypotension episodes (defined as MAP < 70 mmHg).


RESULTS
Using univariate analysis, we found no differences between the groups in regards to MAP, HR, CI, or SVR during the perioperative period. The incidence of hypotension was similar in both groups (two patients in each group), as was the incidence of bradycardia (12 patients in CSE, 7 in Epidural; P = 0.2). There were no differences between groups in other hemodynamic measurements including CI and calculated SVR. Analgesia supplementation with fentanyl was more frequently required in the Epidural group (20 vs 6 patients - P = 0.03).


CONCLUSIONS
Combined spinal-epidural anesthesia and epidural anesthesia alone during TKR surgery are associated with the same incidence of hypotension with statistically and clinically similar hemodynamic responses.
Ezri
Tiberiu
T
Department of Anesthesia, the Edith Wolfson Medical Center, Holon 58100, Israel. tezri@netvision.net.il
Zahalka
Islam
I
Zabeeda
Deeb
D
Feldbrin
Zeev
Z
Eidelman
Alexander
A
Zimlichman
Reuven
R
Medalion
Benjamin
B
Evron
Shmuel
S
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000767:Anesthesia, Epidural / Q000009:adverse effects*; D000775:Anesthesia, Spinal / Q000009:adverse effects*; D000779:Anesthetics, Local; D019645:Arthroplasty, Replacement, Knee; D001794:Blood Pressure; D002045:Bupivacaine; D005260:Female; D006801:Humans; D007022:Hypotension / Q000209:etiology*; D008297:Male; D008875:Middle Aged
D000779:Anesthetics, Local; D002045:Bupivacaine