This Article Résumé de cet Article Full Text Full Text (PDF) Submit a scholarly reply Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Ezri, T. Articles by Evron, S. Search for Related Content PubMed PubMed Citation Articles by Ezri, T. Articles by Evron, S.

Similar incidence of hypotension with combined spinal-epidural or epidural alone for knee arthroplasty

[L’anesthésie rachidienne et péridurale combinée, et péridurale seule, ont une incidence similaire d’hypotension lors de l’arthroplastie du genou]

Tiberiu Ezri, MD^*,, Islam Zahalka, MD, Deeb Zabeeda, MD^*, Zeev Feldbrin, MD, Alexander Eidelman, MD, Reuven Zimlichman, MD^,¶, Benjamin Medalion, MD and Shmuel Evron, MD^*,

^* From the Departments of Anesthesia,
Orthopedics,
Internal Medicine,
^¶ Brunner Institute for Cardiovascular Research, and
Cardiothoracic Surgery, the Edith Wolfson Medical Center, Holon, Affiliated to Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; and the
OUTCOMES RESEARCH^TM Institute, University of Louisville, Kentucky, USA.

Address correspondence to: Dr. Tiberiu Ezri, Head, Department of Anesthesia, the Edith Wolfson Medical Center, Holon 58100, Israel. Phone: 972-3-5028229; Fax: 972-3-5028218; E-mail: tezri{at}netvision.net.il. On the world wide web: www.or.org.

Background: We hypothesized that the incidence of hypotension during total knee replacement (TKR) surgery is lower in patients given combined spinal-epidural (CSE) anesthesia vs those receiving epidural anesthesia alone.

Methods: In a prospective study, 80 American Society of Anesthesiologists I–II patients (aged 40–80 yr), undergoing elective TKR surgery were randomly assigned to either CSE anesthesia (CSE, n = 40) or epidural anesthesia alone (Epidural, n = 40). Hemodynamic measurements included oscillometric mean arterial blood pressure (MAP), heart rate (HR), and cardiac index (CI) as determined by thoracic bioimpedance; systemic vascular resistance (SVR) was calculated. Our primary endpoint (outcome) was the number of hypotension episodes (defined as MAP < 70 mmHg).

Results: Using univariate analysis, we found no differences between the groups in regards to MAP, HR, CI, or SVR during the perioperative period. The incidence of hypotension was similar in both groups (two patients in each group), as was the incidence of bradycardia (12 patients in CSE, 7 in Epidural; P = 0.2). There were no differences between groups in other hemodynamic measurements including CI and calculated SVR. Analgesia supplementation with fentanyl was more frequently required in the Epidural group (20 vs 6 patients – P = 0.03).

Conclusion: Combined spinal-epidural anesthesia and epidural anesthesia alone during TKR surgery are associated with the same incidence of hypotension with statistically and clinically similar hemodynamic responses.

This article has been cited by other articles:

				B. T. Veering Hemodynamic effects of central neural blockade in elderly patients/Les effets hemodynamiques du bloc nerveux central chez les patients ages Can J Anesth, February 1, 2006; 53(2): 117 - 121. [Full Text] [PDF]