Clinical Observation On Combined Spinal-Epidural Anesthesia And The General Anesthesia Used In Total Knee Arthroplasty

Objective:To achieve a comprehensive comparison between spinal and epidural anesthesia(CSEA) and general anesthesia(GA) in total knee arthroplasty, according to the clinical observation of the patients’hemodynamics, inflammatory response, postoperative thrombosis, postoperative analgesia, oxygenation index, economic benefits and so on.Patients and methods:1hundred ASA Ⅰ～Ⅱ patients in our hospital(Shandong Provincial Hospital) in Joint Oncology were included in this study. The patients ranged in age40-60years and in body weight45-80kg and were scheduled for total knee arthroplasty. Patients were randomly divided into2groups (A group, B group, n=50). CSEA is for A group, and GA is for B group. The following observation and detection provided a comprehensive comparison between the2groups:①All the patients hemodynamics were monitored in A and B groups.②Venous blood were collected at the same time, for the detection of inflammatory factor C-Reactive Protein(CRP) and Interleukin-6(IL-6).③The expansion and abnormal signals of deep veins of lower limb were observed postoperatively, using2-dimensional Doppler ultrasonography.④Visual analog scale(VAS) was used on postoperative pain, and total number of button pressing of PCA and the consumption of PCIA solution were also recorded.⑤Oxygenation index of A and B groups were compared in preoperative and postoperative phases through blood gas analysis.⑥The costs of anesthesia and hospitalization and the number of hospitalization days were compared.Results:There was no statistically significant difference in the2groups’ hemodynamic changes (P>0.05). The CRP and IL-6of group B were significantly higher than those of group B postoperatively (P<0.05). Statistically more patients with abnormal signals of lower limb’s deep vein in group A than group B were got (P<0.05). VAS pain score was significantly higher in group B than that in group B (P<0.05). The total number of button pressing and the consumption of PCIA solution were significantly higher in group B than those in group A (P<0.05). Postoperative oxygenation index of group A was significantly higher than that of group B(.P<0.05). The costs of anesthesia and hospitalization in A groups were significantly lower than those in B groups (P<0.05, P<0.05).Conclusion:CSAE and GA, they could both guarantee the operation’s successful completement and the hemodynamic stability. Compared to GA, CSAE could reduce the strength of inflammatory reaction by surgery, had a lower incidence of postoperative thrombi, provided better postoperative oxygenation, and reduced the costs. Therefore, for patients without contraindication of CSAE, who are scheduled for total knee arthroplasty, the choice of CSAE is to be better.