Comparison of Combined Lumbosacral Plexus and T12 Paravertebral Nerve Blocks With General Anesthesia in Older Adults Undergoing Primary Total Hip Arthroplasty: A Retrospective, Propensity Score-Matched Cohort Study

Li Min; Chen Chen; Yuan Yan; Shen Jiang; Yang Linyi; Bu Xiaoxuan; Zhang Liwei; Cao Dongmei

doi:10.1177/2151459320976531

Comparison of Combined Lumbosacral Plexus and T12 Paravertebral Nerve Blocks With General Anesthesia in Older Adults Undergoing Primary Total Hip Arthroplasty: A Retrospective, Propensity Score-Matched Cohort Study

Geriatr Orthop Surg Rehabil. 2020 Nov 24:11:2151459320976531. doi: 10.1177/2151459320976531. eCollection 2020.

Authors

Li Min¹, Chen Chen¹, Yuan Yan¹, Shen Jiang¹, Yang Linyi¹, Bu Xiaoxuan¹, Zhang Liwei², Cao Dongmei³

Affiliations

¹ Department of Anesthesiology, The Changzhou First People's Hospital, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, People's Republic of China.
² Department of Infection Control Management, The Changzhou First People's Hospital, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, People's Republic of China.
³ Hospital Medical Records Statistics Office, The Changzhou First People's Hospital, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, People's Republic of China.

Abstract

Background: Total Hip Arthroplasty(THA) is a surgical treatment for hip disease. A large amount of evidence has been reported on comparing outcomes of neuraxial(spinal or epidural) anesthesia and general anesthesia. However, it is unclear whether nerve blocks(NB) as main anesthesia technique compared with general anesthesia(GA) for THA could reduce perioperative complications. We conducted a retrospective evaluation of NB and GA, using a propensity score-matched analysis(PSMA).

Methods: A total of 902 patients older than 60 years old with hip disease undergoing primary THA received combined lumbosacral plexus and T₁₂ paravertebral nerve blocks (n = 143) or GA (n = 759) at our institution from 2012 to 2018.Binary logistic regression was used for comparison of the primary outcomes(the incidence of delirium) and the secondary outcomes(the percentage of postoperative hemoglobin(>10g/dl), transfusion(>2 units), major cardiac events(MACE), postoperative pulmonary complications (PPC) and 30-day mortality) in the matched cohorts.Statistical analysis was performed using SPSS v 23.0.

Results: Both cohorts were balanced in all included parameters after PSMA. The incidence of delirium was lower (OR 0.233,95% CI 0.064-0.845, p = 0.030) in NB group in matched cohorts. In the unmatched and matched cohorts, the percentage of Hb(>10g/dl) was higher in GA group but the incidence of transfusion(>2 units) was higher in NB group. No difference was found in the incidence of 30-day mortality in the unmatched and matched cohorts. In the unmatched cohorts, the incidence of PPC was higher and LOS was longer in NB cohort, but no difference was observed in the matched cohorts.

Conclusion: In patients older than 60 years old receiving primary THA, NB could be associated with a lower incidence of delirium.

Keywords: delirium; elderly; nerve blocks(NB); propensity score-matched analysis(PSMA); total hip arthroplasty(THA).