Comparison of two anesthesia methods in patients to undergo partial hip prosthesis

Patients were randomly divided into two groups as spinal anesthesia group (Group SA)(n=25) and T12-L1 paravertebral block combined with psoas compartment block and sciatic nerve block group (Group PCSL)(n=25). All patients taken to the operation table were monitored by noninvasive arterial blood pressure, heart rate (HR), and peripheral oxygen saturation (SpO2). Before performing the block, peripheral vascular access was provided by 18G cannula on patients and 500 mL 0.9% NaCl solution was infused in 20 minutes. Hemodynamic parameters were recorded in 5-minute intervals till the end of preoperative and peroperative operation times. Patients in each group were administered 50microgr fentanyl IV before the procedure. Patients into Group SA were administered 2mL hyperbaric bupivacaine hydrochloride (Marcain Heavy 0.5%, Astra Zeneca ) with 25G Quincke spinal needle (Braun) from the selected intervertebral distance (L4-L5 or L3-L4) following local sterilization in lateral decubitus position. Following the procedure, patients left in this position for 15 minutes were positioned in lateral position so that the surgical side is on top. After observing dorsal and plantar flexion on feet with the help of a nerve stimulator (Multiplex, Pajunk, Germany) by using a 10cm-long block needle by Labat technique 7, sciatic nerve block was then obtained on patients in Group PCSL with 15mL bupivacaine hydrochloride (by mixing 5mg/mL Marcaine, AstraZeneca and 10mL 0.9% NaCl, making a total volume of 25mL) following negative aspiration technique. Then, when observed lumbar plexus stimulation (quadriceps muscle fasciculation) with the help of nerve stimulator by Winnie technique, psoas compartment block was obtained with 15mL bupivacaine hydrochloride (by mixing 5mg/mL Marcaine, AstraZeneca and 10mL 0.9% NaCl, making a total volume of 25mL) following negative aspiration technique. Later on, L1 paravertebral block was obtained with 5mL bupivacaine hydrochloride (by mixing 5mg/mL Marcaine, AstraZeneca and 5mL 0.9% NaCl, making a total volume of 10mL) by using the technique of Moore. Implementation time of both techniques, anesthesia preparation time, and the period until the beginning of surgical intervention were recorded as surgical preparation period. Level of analgesia was evaluated with pinprick test and motor block degree was assessed by modified Bromage scale (0: No block, 1: hip flexion blocked while knee is in extension, 2: Knee flexion blocked, 3: Complete motor block); following the administration of drug, sensory and motor block were evaluated with the measurement of hemodynamic parameters in 5-minute intervals. Sensory, motor and hemodynamic evaluations performed by an anesthesiologist who does not know which applied regional anesthesia techniques. After a complete motor block was developed, surgical intervention was initiated. The time from the beginning of surgical incision up to the completion of procedure was recorded as the operation time. A decrease of 25% and above in basal mean arterial pressure was accepted to be hypotension, and in that case, 5mg ephedrine IV and an additional 5mL/kg crystalloid fluid were administered. Heart rate reduced to 50/min was accepted as bradycardia and 0.5mg atropine IV was administered. The entire patients were given 3L/min O2 with mask and 5mL/kg/hour maintenance crystalloid fluid at the time of operation. Motor block return time and initial time of the need for analgesia were recorded.