Comparison of combined psoas compartment–sciatic nerve block and unilateral spinal anaesthesia in high-risk geriatric patients with partial hip replacement

Objective: Partial hip replacement is a common surgery in the geriatric patient population. The use of regional techniques has started to increase in partial hip replacement surgery. The incidence of the use of anesthesia physicians in developing technology and USG technology increased the frequency of application of peripheral neuroaxial blocks due to side effects associated with central neuro-axial blocks. In our study, we aimed to compare the effects of unilateral spinal anesthesia (USA) and combined PSOAS compartment sciatic nerve block (PCSNB) on intraoperative hemodynamic parameters and postoperative pain that is frequently used in partial hip replacement surgeries in geriatric patients. Method: Sixty five years old and over with ASA III-IV fifty two patients who were operated elective partial hip replacement surgery were included in the study. Twenty five patients were admitted to USA and kept in lateral decubitus position for five minutes (min). Twenty seven patients were admitted to PCSNB and iliac crest block. Groups were monitored in the perioperative anesthesia efficiency, blood pressure, pulse, saturation values, postoperative analgesia requirement and side effects. Findings: Demographic data in both groups were similar. Intensive care was needed in 28.0% (n = 7) of USA patients who was performed USA, on the other hand, intensive care was needed in 24.0% (n = 6) of patients who was performed PCSNB. Intraoperative ephedrine requirement was developed in 40.0% (n = 10) of patients who was performed USA, but intraoperative ephedrine requirement was developed in only one patient (4.0%) in PCSNB patients. In patients who were performed PCSNB, operation time and postoperative pain onset time were significantly longer than patients who were performed USA. Systolic, diastolic and MAP blood pressure levels from the fifth minutes to postoperative measurements were determined higher at a statistically significant level in patients who performed PCSNB compared to patients who were performed USA (p<0.05). Preoperative systolic, diastolic and MAP blood pressure values were significantly higher than values that were in fifth and twenty fifth minutes were significantly higher in patients who performed USA. A statistically significant difference were not monitored between systolic, diastolic and MAP blood pressure measurements at the fifth and twenty fifth minutes of preoperative in patients who performed PCSNB (p>0,05). Conclusion: PSOAS compartment - sciatic nerve block when combined with the iliac crest block provides the necessary anesthesia even if sedation is needed from time to time in patients who were performed partial hip replacement. Especially in geriatric patients, it is a good alternative to central neuroaxial blocks because it provides hemodynamic stability and provides longer analgesic effect during postoperative period. Keywords: Geriatric, Hip Replacement, Unilateral Spinal Anesthesia, PSOAS Compartment Block, Sciatic Nerve Block, Postoperative Analgesia.