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TOTAL HIP REPLACEMENTS: ANAESTHESIA PREFERENCES AMONGST CONSULTANT ANAESTHETISTS IN A TERTIARY REFERRAL ORTHOPAEDIC CENTRE IN THE UK
ESRA Academy. Galitzine S. Sep 8, 2016; 138462; 0319 Topic: Hip Surgery
Dr. Svetlana Galitzine
Dr. Svetlana Galitzine

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Abstract
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Background and Aims:

In our tertiary orthopaedic centre hip replacements (THRs) constitute approximately 10% of the workload: approximately 1000 primary, complex primary and revision THRs.

Recent outcomes research, including large studies in the UK [1], showed benefits of central neuraxial anaesthesia (CNA). Therefore, we set out to clarify current anaesthetic practices in our centre.

Methods:

35 consultants with regular orthopaedic commitments were invited to complete an anonymous survey and select up to three preferred anaesthesia choices for THRs.

Results:


25/35(71%) respondents stated the following: 

• Spinal anaesthesia without opiates +/- sedation + high volume local infiltration analgesia (known as LA “cocktail”) was a preferred technique for primary THR in 73.9% consultant anaesthetists    (Table 1).

• GA + epidural was a preferred technique for complex primary/revisionTHRs in 82.6% (Table 2).




Conclusions:

The choice of anaesthesia technique is influenced by various factors including patients’ and surgeons’ preferences, recent research, and local guidelines.

Our survey of consultants’ practice for THRs in our centre showed overwhelming preference for CNA. This is well in line with the recent outcome analysis of the large databases.

Empowered by our results, we will develop sustainable local guidelines for THR anaesthesia as part of the multimodal pathway, to benefit our patients’ outcomes.

 

References:

  1. Hunt LP et al. 90-day mortality after 409,096 total hip replacements for osteoarthritis, from the National Joint Registry for England and Wales: a retrospective analysis. Lancet 2013; 382 (9898):1097-104.



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