[Ways to decrease blood loss during total hip joint endoprosthesis]

Area of Science:

• Anesthesiology
• Orthopedic Surgery
• Surgical Hemorrhage Control

Background:

• Total hip replacement surgery involves significant blood loss, particularly in patients with preoperative circulating blood volume deficiency.
• Traditional anesthesia methods like neuroleptanalgesia may not optimally manage blood loss during lengthy procedures.

Purpose of the Study:

• To evaluate the efficacy of prolonged epidural blockade combined with isovolemic hemodilution in reducing blood loss during total hip replacement.
• To compare the effectiveness of prolonged epidural blockade against neuroleptanalgesia and ataralgesia in managing intraoperative hemodynamics and blood loss.

Main Methods:

• A comparative study involving 93 patients (aged 18-60) undergoing total hip replacement.
• Anesthesia techniques included prolonged epidural blockade (16 patients), neuroleptanalgesia (66 patients), and ataralgesia (16 patients).
• All patients received isovolemic hemodilution due to preoperative circulating blood volume deficiency.

Main Results:

• The prolonged epidural block group exhibited the lowest mean arterial pressure.
• Isovolemic hemodilution effectively decreased blood loss in patients with preoperative deficits.
• Prolonged epidural blockade with isovolemic hemodilution and spontaneous respiration reduced true blood loss by approximately 70% compared to neuroleptanalgesia.

Conclusions:

• Prolonged epidural blockade, when combined with isovolemic hemodilution and spontaneous respiration, offers a superior method for minimizing blood loss during total hip replacement.
• This anesthetic strategy provides better hemodynamic stability and significantly reduces surgical bleeding compared to traditional neuroleptanalgesia.