Combined subarachnoid and epidural anaesthesia for endoprosthetoplasty of the knee joint

Background. We investigated the efficacy of combined spinal epidural anaesthesia (CSEB) that combines the main spinal and the supporting epidural anaesthesia for pain treatment after total knee replacement (TKR). Material and methods. Fifty-eight patients scheduled for elective TKR surgery were randomly allocated into two groups: Group I (intraoperative Combined Spinal - Epidural Block) and Group II (intraoperative spinal anaesthesia). Postoperative analgesia was provided with continuous epidural infusion (CEI) of 0.25% bupivacaine + fentanyl solution in Group II and intravenous doses of paracetamol and/or tramadol on patient request in Group I. Results and Discussion. There were no significant changes in intraoperative readings of hemodynamic parameters, respiratory rate and SaO2 in both groups. However systolic arterial blood pressure (SABP), diastolic arterial blood pressure (DABP) and respiratory rate were decreased postoperatively in Group II, while an increase of these parameters in Group I was observed. CEI was well tolerated by all patients and the only reported side effect (skin itching) was of minor clinical concern. We conclude that CSEB provides better pain relief for patients having knee joint replacement what consequently leads to faster knee rehabilitation and therefore eventually decreases the risk of postoperative cardiogenic complications, embolia and phlebothrombosis.