Effect of Combined Spinal and Epidural Block Anesthesia on Elderly Patients after Total Hip Replacement

Abstract

Background: With aging, body functions of the elderly decline. Among the more prominent organs in decline is the skeleton, especially osteoporosis. The most serious consequence of osteoporosis is hip fracture with minimal trauma. Total hip arthroplasty is frequently used to repair hip fracture. The choice of anesthesia during an operation is extremely important, because it directly affects the postoperative recovery of the patients. In recent years, it has been found that combined spinal-epidural block anesthesia can blend the advantages of spinal and epidural block anesthesia, resulting in a better outcome for the patient. The objective of this study was to investigate the outcome of combined spinal-epidural block anesthesia on the stress response, inflammatory factors and immune function in elderly patients after total hip arthroplasty used to treat hip fracture. Methods: 116 elderly patients who underwent total hip arthroplasty after hip fracture were enrolled. Participants were assigned to a Control group (N = 58), which accepted epidural block anesthesia, and an Observation group (N = 58), which accepted combined spinal-epidural anesthesia. The blood levels of stress response [cortisol (Cor), epinephrine (E), adrenocorticotropin hormone (ACTH)], inflammatory factors [tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), interleukin-10 (IL-10)] and immune function [CD3⁺, CD4⁺, CD8⁺ and CD4⁺/CD8⁺ ratio] were compared before and at 24 hours and 72 hours after the operation. Results: Significant differences occurred in plasma concentrations of Cor, E and ACTH at 24 h after operation. The protein levels of serum TNF-α, IL-6 and IL-10 increased less in the Observation group than in the Control group (p < 0.05). Furthermore, CD3⁺, CD4⁺ and the ratio of CD4⁺/CD8⁺ were higher and CD8⁺ was lower (p < 0.05) in the Observation group than in the Control group. There were significantly fewer perioperative adverse reactions in the Observation group than in the Control group (p < 0.05). Conclusions: The effect of combined spinal-epidural block anesthesia for total hip arthroplasty in elderly patients with recent hip fracture is significant. Patients using combined spinal-epidural block anesthesia showed a reduced stress and inflammatory reaction which occurs after surgery, with faster recovery of immune function, and fewer adverse reactions, than did patients with epidural block anesthesia.