| Abstract [eng] |
Objectives. The average age of people who suffer a femoral fracture is 80 years. This is a significant challenge for medical professionals – due to their advanced age, frailty and comorbidities, many of these patients are at high risk. The literature remains controversial regarding the safest type of anaesthesia for hip replacement after femoral fracture. The aim of this study was to compare the impact of anaesthetic choice on perioperative outcomes in such patients. Methods. A retrospective analysis of data from patients treated at Republican Vilnius University Hospital in 2018–2020 under spinal or general anaesthesia for hip replacement surgery after femoral trauma was performed. The medical records of 39 patients over 73 years of age were selected. Correlations and differences in clinical parameters between comparison groups were considered statistically significant at p < 0.05. Results. General anaesthesia was used in 30.77 % and spinal anaesthesia in 69.23 % of patients. In general anaesthesia patients, lower minimum values of systolic, diastolic and mean arterial blood pressures (p = 0.003, p = 0.002, p = 0.003) were recorded during surgery. Also, during surgery, these patients lost more blood (p = 0.007), required more crystalloid infusion and noradrenaline for haemodynamic correction (p = 0.049, p = 0.024) and fentanyl (p < 0.001). During the postoperative period of general anaesthesia, oxygen saturation levels were lower (p = 0.028) and these patients were more likely to be admitted to the intensive care unit (p = 0.002). Conclusions. We found that spinal anaesthesia, in the absence of contraindications, is safer in elderly patients undergoing hip replacement surgery after femoral fracture. Spinal anaesthesia results in less operative time; haemodynamic stability and less bleeding; less opioid consumption and no residual respiratory depression postoperatively, which would require further resuscitation of the patient. |
