Turkiye Klinikleri Journal of Medical Sciences

.: ORIGINAL RESEARCH
Should We Use Hypobaric Bupivacaine in Spinal Anesthesia for ERAS Patients Undergoing Total Hip Arthroplasty
ERAS Protokolü ile Total Kalça Protezi Yapılan Hastalarda Hipobarik Bupivakain ile Spinal Anestezi Uygulamalı mıyız?
Ayça Sultan ŞAHİNa, Necmiye AYa, Ece SALİHOĞLUb, Barış SANDALc, Abdurrahim DERBENTa
aClinic of Anesthesiology and Reanimation, Health Sciences University Kanuni Sultan Süleyman Training and Research Hospital,
bDepartment of Pediatric Cardiovascular Surgery, İstanbul Bilim University, Avrupa Florence Nightingale Hospital Research and Application Center,
cDepartment of Mechanical Engeenering, İstanbul University-Cerrahpaşa Faculty of Engineering, İstanbul, TURKEY
Turkiye Klinikleri J Med Sci. 2019;39(1):1-8
doi: 10.5336/medsci.2018-61998
Article Language: EN
Full Text
ABSTRACT
 Objective: Enhanced Recovery After Surgery (ERAS) is a standardized perioperative care within a programme aims to reduce postoperative morbidity and length of hospital stay. The aim of this study was to evaluate which technique (hyperbaric or hypobaric spinal anesthesia) should we use in geriatric patients undergoing total hip arthroplasty according to ERAS. Material and Methods: 104 patients' records (52 of them hypobaric spinal, 52 of them had been applied hyperbaric spinal anesthesia), American Society of Anesthesiologists (ASA) I-III, undergoing total hip arthroplasty between June 2017-December 2017 was elected for study. Haemodynamic values, postoperative complications, hospital length of stay, readmission or reoperation after surgery, intensive care unit (ICU) length of stay, mortality, 30-day readmission two months' mortality rates, duration of surgery, gender, age, ASA and additional co-morbidities were recorded from the patients' files. Results: 38 males and 66 females were involved in the study, and their mean age was 76.24 years. The hospital length of stay, readmission or reoperation after surgery, ICU length of stay, duration of surgery were statistically significant differences between the groups. There were no statistically significant differences between the groups in 30-day readmission and mortality rates. When compared the blood pressures before and after the spinal block there were statistically significant differences between the groups. Conclusion: The aim of ERAS in the arthroplasty is to reduce the hospitalization time without increasing complications and readmission. We conclude that hypobaric solutions are suitable for ERAS protocol in total hip arthroplasty, but more studies should be done for evaluate effect of hypobaric spinal anesthesia related with ERAS protocol.

Keywords: ERAS; hypobaric; arthroplasty
ÖZET
 Amaç: Cerrahi Sonrası Hızlandırılmış İyileşme (ERAS), bir program dahilinde standart bir perioperatif bakım olup, postoperatif morbidite ve hastanede kalış süresini azaltmayı amaçlamaktadır. Bu çalışmanın amacı, ERAS'a göre total kalça artroplastisi uygulanan geriatrik hastalarda hangi tekniği (hiperbarik veya hipobarik spinal anestezi) kullanmamız gerektiğini değerlendirmektir. Gereç ve Yöntemler: Çalışmamıza Haziran 2017-Aralık 2017 tarihleri arasında total kalça artroplastisi uygulanan Amerikan Anesteziyoloji Derneği (ASA) I-III olan 104 hasta (52'sinde hipobarik spinal, 52'sinde hiperbarik spinal anestezi) kaydedildi. Hemodinamik değerler, postoperatif komplikasyonlar, hastanede kalış süresi, tekrar hastaneye yatış veya yeniden ameliyat olup olmadığı, yoğun bakım ünitesi (YBÜ) kalış süresi, mortalite, 30 gün içinde tekrar yatış, iki aylık mortalite oranları, ameliyat süresi, cinsiyet, yaş, ASA ve ek hastalıklar hastaların dosyalarından kaydedildi. Bulgular: Çalışmaya 38 erkek ve 66 kadın katıldı ve yaş ortalamaları 76,24 yıl idi. Ameliyat sonrası hastanede kalış süresi, tekrar hastaneye yatış veya yeniden ameliyat, YBÜ kalış süresi, ameliyat süresi gruplar arasında istatistiksel olarak anlamlı farklılık gösterdi. Gruplar arasında 30 gün içinde geri yatış ve mortalite oranları açısından istatistiksel olarak anlamlı fark yoktu. Spinal bloktan önce ve sonra kan basınçları karşılaştırıldığında gruplar arasında istatistiksel olarak anlamlı farklar vardı. Sonuç: Artroplastide ERAS'ın amacı komplikasyonları ve geri kabulleri arttırmadan hastanede yatış süresini azaltmaktır. Hipobarik spinal anestezinin total kalça artroplastisinde ERAS protokolü için uygun olduğunu ancak ERAS protokolüne bağlı kalarak hipobarik spinal anestezinin etkisini değerlendirmek için daha fazla çalışma yapılması gerektiğini düşünmekteyiz.

Anahtar Kelimeler: ERAS; hipobarik; artroplasti
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