Comparison of hypotensive epidural anesthesia and hypotensive total intravenous anesthesia on intraoperative blood loss during total hip replacement.

STUDY OBJECTIVE

To compare hypotensive epidural anesthesia (HEA) and hypotensive total intravenous anesthesia (HTIVA) with propofol and remifentanil on blood loss during primary total hip replacement.

DESIGN

Prospective, randomized clinical study.

SETTING

University hospital.

PATIENTS

Forty ASA physical status I, II, and III patients presenting for primary total hip replacement.

INTERVENTIONS

Patients received either HEA with bupivacaine (HEA group, n = 20) or HTIVA with propofol and remifentanil (HTIVA group, n = 20) to maintain mean arterial pressure between 50 and 60 mm Hg.

MEASUREMENTS

Duration of hypotension, blood loss, blood transfusions, hemodynamics, and coagulation studies were recorded in both groups.

MAIN RESULTS

Intraoperative blood loss, percentage of patients receiving blood substitution, and total packed red blood cells transfused were less in those patients receiving HEA than those receiving HTIVA (P = .001, .04, and .015, respectively). Mean central venous pressure was lower in the HEA group than in the HTIVA group intraoperatively (P = .019). Mean hemoglobin concentrations and coagulation studies were similar between the groups. Neurologic examinations of all patients were intact in the postoperative period.

CONCLUSIONS

In spite the similar mean arterial pressure levels noted between groups, HEA results in less intraoperative blood loss than HTIVA during primary total hip replacement. This outcome may be associated with non-positive pressure ventilation, distribution of blood flow, and lower mean intraoperative central venous pressure in the HEA group.