Compare the effectiveness of epidural bolus administration to continuous ei in posoperative pain treatment after total hip arthroplasty

Objective: Our objective is to compare the effectiveness of epidural bolus administration to continuous EI in posoperative pain treatment after total hip arthroplasty. Material and Methods: 60 patients, who are planned to have hip arthroplasty operation, in ASA 1-3 category, aged between 40 and 70, receiving combined spinal epidural anlgesia, are included in the study The patients in both groups are administered spinal anesthesia with 3 mL heavy bupivakain (Marcain®) through L3-L4 or L4-L5 space. Later a catheter is placed into the epidural space. The catheter is shown not to be placed in the intravenenous space by administering 10 μg adrenalin and 10 mg lidokain. The pulse value, systolic and diastolic blood pressure values, oxygen, stauration values, Bromage Scores are recoded before and after spinal anasthesia and 20, 25, 30, 40, 50, 60, 70, 80, 90, 110, 130 minutes after administering the spinal anesthesia. 330 ml solution with %0.125 bupivacain is prepared for analgesia after operation. Patient controlled analgesia (PCA) devices are prepared. The patients are randomly divided into two groups. For Group B, PCA device is adjusted to administer 6 ml/hour bolus with 30 minutes lockout time through epidural catheter for 48 hours. For Group İ, PCA device is adjusted to administer 6 ml infusion and 6 ml bolus with 30 minutes lockout time through epidural catheter for 48 hours. The KAH, OAB and SpO2 values at hours 12, 24 and 48, and at the time first sit and walker are compared between two groups. Moreover patient and surgeon satisfaction scores, VAS and VAS-H, motor block levels, the attempted, administered and total consumed drug levels through PCA device, the extra analgesia administered and the side effects are compared between two groups. Results: The values of VAS at hours 24 and 48 was significantly lower in Group B (p<0.05). Total consumed analgesia levels were significantly higher in Group İ at first sit, walker use, and at postop 12, 24 and 48 hours (p<0.0001). Surgeon and patient satisfaction scores were significantly higher in Group B at all time invervales (p<0.05). Extra analgesia consumption was significantly higher in Group İ at 24 and 48 hours. Motor block levels which is observed postoperatively were higher in Group İ at hours 12 and 24 (p<0.05). There were no side effects in both groups. Conclusion: We concluded that in arthoplasty operations, administration of intermittent bolus doses with PCA devices without an epidural infusion provides better postoperative analgesia high surgeon and patient satisfaction scores, with lower analgesic usage and without any motor block or side effects.