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Epidural Versus General Anaesthesia for Total Hip Arthroplasty in Elderly Patients
Author(s) -
Hole A.,
Terjesen T.,
Breivik H.
Publication year - 1980
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/j.1399-6576.1980.tb01549.x
Subject(s) - medicine , general anaesthesia , anesthesia , bupivacaine , fentanyl , surgery , pulmonary embolism , hip replacement , arthroplasty
Sixty elderly patients were given at random either epidural analgesia with bupivacaine 0.75% or general anaesthesia with thiopentone, fentanyl, pancuronium, N 2 O/O 2 for total hip replacement. Preoperatively the patients were of equal physical status with normal and similar laboratory values. All patients were mentally normal for their age. On the 1st postoperative day, the general anaesthesia group had a signilicantly lower PaO 2 than the epidural group (p<0.025). Pao 2 in the general anaesthesia group was significantly lower than the preoperative value on the 1st and 3rd postoperative days (P<0.001 and P<0.01, respectively). None of the 29 patients in the epidural group but seven of 31 patients in the general anaesthesia group had signscant mental changes postoperatively (p<0. 01). Five of these patients still had mental changes which reduced their quality of life several months later. In the general anaesthesia group, one patient died from an acute myocardial infarction. Low postoperative PaO 2 might have contributed to this death. Two patients in the epidural group had symptoms of pulmonary embolism postoperatively. Thus elderly patients appear to do better after hip replacement with less deterioration of cerebral and pulmonary functions when given epidural analgesia than when surgery is performed under general anaesthesia. These patients should therefore be offered epidural analgesia whenever possible.