PERI-RACHIANESTHESIE COMBINEE COMPAREE A LA RACHIANESTHESIE CONVENTIONNELLE DANS LA CHIRURGIE DE LA FRACTURE DE HANCHE OU DU FEMUR

Abstract

Summary: Combined spinal epidural anesthesia compared to conventional spinal anesthesia in surgery hip or femur fracture Introduction: Traumalogy and orthopedic surgery is surgery that is primarily intended for elderly patients with co-morbidity. The incidence of hip and femoral fractures is on the rise in Algeria and around the world. It is a functional surgery but at risk both per and postoperatively. Traumatology is the indication of choice for regional anesthesia. The objective: To compare intra and postoperative hemodynamic stability in patients undergoing either combined spinal epidural anesthesia (CSEA) or Conventional Spinal anesthesia (CSA). Methods and materials: A prospective single-blind controlled clinical trial of 160 patients, divided in two groups, group A (CSEA) received 5 mg of Bupivacaine 0.5% isobaric intrathecal, and titration of doses of local anesthetic by epidural catheter for reach the desired metameric level (T10), and group B (CSA) received 7,5- 10 mg of Bupivacaine 0.5% isobaric, in patients with a fracture of the hip or the femur, including both types, classified ASAI, II and III, aged 45-75 years, per and postoperative evaluation of the hemodynamic state (systolic blood pressure, mean blood pressure , heart rate) and the respiratory state, of the degree of the quality of the motor and sensory block and the quality postoperative analgesia. Results and discussion: The comparative parameters between the two socio-demographic technique, ASA classification, medical and surgical history show no statistically significant difference, but, motor and sensory block are reliable, but hypotension and bradycardia are higher in CSA compared to the CSEA with a very significant p (P = 0.001), the intraoperative and postoperative, complications in the CSEA are reduced compared to the CSA. The quality of postoperative analgesia is better in CSEA (EVA: 1.74 ± 0.90) compared to CSA (EVA: 3.18 ± 1.28). Conclusion: The administration of low doses of local anesthetic intrathecal and titration by the epidural catheter in the PRC confirmed the installation of a motor and sensory block of quality and a high rate of satisfaction with the hemodynamic stability and the management of postoperative analgesia