Neuraxial anesthesia in knee and hip arthroplasty in patients of different age groups

Background. According to the latest data from medical literature, hip and knee arthroplasty is one of the most common orthopedic procedures. Given the continuous aging of the population, safety requirements for anesthesia in this category of patients are increasing. At present, there is no single generally accepted and universal type of anesthesia for orthopedic surgery on the lower extremities, and the use of general anesthesia, neuraxial techniques, and regional peripheral nerve blocks each has advantages and disadvantages. Materials and methods. All patients who underwent arthroplasty of major joints of the lower limb were randomly divided into two groups: group 1 received spinal anesthesia (0.5% bupivacaine spinal, 15 mg); group 2 — combined spinal-epidural anesthesia (0.5% bupivacaine spinal, 7.5 mg administered subarachnoidally, and 0.25% bupivacaine, 10.0 ± 1.2 ml administered epidurally). The sensory block level in both groups was up to Th10. Each group was subdivided into age subgroups: under 65, 65–75, and over 75 years. Preoperative patient preparation and monitoring complied with the recommendations of the Enhanced Recovery After Surgery concept. Intraoperatively, sedation was administered until a score of –1 on the Richmond Agitation-Sedation Scale was achieved; midazolam was used. Postoperative analgesia in group 1 included intravenous paracetamol 1 g every 6 hours (up to 4 g/day, scheduled), ketorolac 30 mg every 8 hours (scheduled), and intramuscular morphine 10 mg when the VAS score was > 5. In group 2, the postoperative analgesic regimen was similar; however, when pain reached a VAS score ≥ 3, it was supplemented with epidural boluses of 0.125% bupivacaine solution, 10 ml. Results. Analysis of our own clinical cases revealed no statistically significant differences between the study groups in perioperative course parameters, systemic hemodynamic indicators, or plasma stress marker levels in patients under 65 years of age. However, such differences were observed in those older than 65 years. Conclusions. Given the data obtained, combined spinal-epidural anesthesia can be considered the optimal choice for older patients (> 65 years) with moderate comorbidity, while both spinal anesthesia alone and combined spinal-epidural anesthesia remain equally effective and safe for individuals younger than 65 years.