A comparison of the effect of combined spinal epidural anesthesia and psoas compartment + sciatic nerve block in the geriatric partial hip prosthesis

Objective:Regional techniques are increasingly used in partial hip prosthesis surgeries. The most common and effective regional method is central neuraxial methods. Although central blocks are active, they have their own specific side effects and contraindications. Therefore, the search for alternative regional anesthesia methods continues. In our study, we aimed to compare combined spinal-epidural anesthesia (CSE) and a more traditional method of a combined psoas compartment-sciatic nerve block (PCSNB) that is one of the peripheral nerve blocks, in terms of intraoperative and postoperative pain, hemodynamics and side effects. Method:Fifty patients who underwent elective partial hip prosthesis and PCSNB and CSE between 60-99 years of age with ASA 3 and below were included in the study. Twenty-five patients underwent CSE anesthesia with 1 mL plain bupivacain and PCSNB and iliac crest blocks were applied in 25 patients. Perioperative anesthetic efficacy, blood pressure pulse rate, saturation values, postoperative analgesia requirement and side effects were observed in the groups. Findings:Demographic data were similar in both groups. At the end of the operation, the mean arterial pressure was lower in both groups compared to the baseline (initial) values and the decline in the CSE group was statistically significant compared to the PCSNB group. 11 (44%) patients in the CSE group and 2 (8%) patients in the PCSNB group had hypotension. There was no difference between intra-groups and inter-groups in terms of pulse and saturation values. Active analgesia was obtained in all patients in the CSE group and in 5 (20%) of the patients, additional pain medication was performed on the epidural catheter for pain during the ongoing minutes. In the PCSNB group, 15 (60%) patients completed the operation without pain. 3 (12%) patients received adequate anesthesia with 1 μg / kg fentanyl. 7 (28%) patients required sedation with propofol infusion. The first postoperative analgesic hour was longer in the PCSNB group ( 4.84 ± 2.54 hours vs. 1.64 ±0.9 hours). Conclusion: The combination of the psoas compartment, parasacral sciatic and iliac crest blocks maintains hemodynamic stability of the hip prosthesis operations in elderly patients even if it occasionally requires sedation, while its analgesia is also an effective and safe alternative in the postoperative period.