Clinical Evaluation of Hypobaric Spinal Anesthesia for Total Hip Replacement in Lateral Decubitus Position

Shin, Yang Sik; Chung, Kyung Suk; Bang, Eun Chi; Shim, Jae Sun; Kim, Jong Rae

Abstract

Hypobaric spinal anesthesia for fifty patients(spinal group) undergoing total hip replacement were compared with general anesthesia(general group) in respect to intraoperative blood loss, changes of blood pressures, postoperative analgesics, etc. Furthermore, the technical aspects were evaluated for hypobaric spinal anesthesia in the lateral position when 1% tetracaine in distilled water (epinephrine 1: 200,000) was administered. The lowest blood pressure parameters were significantly lower in the spinal group(29%) than in the general group(22%). The amount of blood loss in the spinal group was less than that in the general group even though there was no difference in blood replacement between groups. The time period before analgesic use longer in the spinal group(4.1 hours)than the general group(2.7 hours). The most common complication in either group was urinary retention(50% in the spinal and 44% in the general) in which urinary catheterization was necessary. In the general group, thirty-six per cent of the patients had mild fever in the first or second postoperative day which were not consistently related to pulmonary complications. For spinal anesthesia, 5 or 6 mg of 1%-tetracaine in distilled water mixed to 1: 200,000 epinephrine was used. The spinal puncture was performed by a 22G needle on the L2-3 or L3-4 in- tervertebral space with lateral aproach in the position of the operation. Injection speed was controlled to 1 ml/sec in all patients. Sensory levels were reached to T7-8 and T9-10 in the non-dependent and dependent side, respectively. Motor funetion on knee and ankle was lost in the non-dependent side, but not in the dependent side. There were some intraoperative complaintments including positional discomfort on hip rest and shoulder bar. However, there was no remarkable problem in hypobaric spinal anesthesia intraoperatively. The results of our study indicate that hypobaric spinal anesthesia in lateral decubitus position is a recommendable anesthetic technique for total hip replacement surgery.