The effect of spinal versus general anaesthesia on perioperative muscle weakness in patients having bilateral total hip arthroplasty: a single center randomized clinical trial.
Bilateral total hip arthroplasty
General anaesthesia
Neuro-endocrine stress response
Perioperative muscle weakness
Spinal anaesthesia
Journal
European journal of medical research
ISSN: 2047-783X
Titre abrégé: Eur J Med Res
Pays: England
ID NLM: 9517857
Informations de publication
Date de publication:
20 Oct 2023
20 Oct 2023
Historique:
received:
29
08
2022
accepted:
07
10
2023
medline:
31
10
2023
pubmed:
21
10
2023
entrez:
20
10
2023
Statut:
epublish
Résumé
Perioperative neuro-endocrine stress response may contribute to acquired muscle weakness. Regional anaesthesia has been reported to improve the outcome of patients having total hip arthroplasty. In this study, it was hypothesized that spinal anaesthesia (SA) decreases the perioperative neuro-endocrine stress response and perioperatively acquired muscle weakness (PAMW), as compared to general anaesthesia (GA). Fifty subjects undergoing bilateral total hip arthroplasty (THA) were randomly allocated to receive a standardized SA (n = 25) or GA (n = 25). Handgrip strength was assessed preoperatively, on the first postoperative day (primary endpoint) and on day 7 and 28. Respiratory muscle strength was measured by maximal inspiratory pressure (MIP). Stress response was assessed by measuring levels of Adrenocorticotropic hormone (ACTH), cortisol and interleukin-6 (IL-6). Handgrip strength postoperatively (day 1) decreased by 5.4 ± 15.9% in the SA group, versus 15.2 ± 11.7% in the GA group (p = 0.02). The handgrip strength returned to baseline at day 7 and did not differ between groups at day 28. MIP increased postoperatively in patients randomized to SA by 11.7 ± 48.3%, whereas it decreased in GA by 12.2 ± 19.9% (p = 0.04). On day 7, MIP increased in both groups, but more in the SA (49.0 ± 47.8%) than in the GA group (14.2 ± 32.1%) (p = 0.006). Postoperatively, the levels of ACTH, cortisol and IL-6 increased in the GA, but not in the SA group (p < 0.004). In patients having bilateral THA, SA preserved the postoperative respiratory and peripheral muscle strength and attenuated the neuro-endocrine and inflammatory responses. clinicaltrials.gov NCT03600454.
Sections du résumé
BACKGROUND
BACKGROUND
Perioperative neuro-endocrine stress response may contribute to acquired muscle weakness. Regional anaesthesia has been reported to improve the outcome of patients having total hip arthroplasty. In this study, it was hypothesized that spinal anaesthesia (SA) decreases the perioperative neuro-endocrine stress response and perioperatively acquired muscle weakness (PAMW), as compared to general anaesthesia (GA).
METHODS
METHODS
Fifty subjects undergoing bilateral total hip arthroplasty (THA) were randomly allocated to receive a standardized SA (n = 25) or GA (n = 25). Handgrip strength was assessed preoperatively, on the first postoperative day (primary endpoint) and on day 7 and 28. Respiratory muscle strength was measured by maximal inspiratory pressure (MIP). Stress response was assessed by measuring levels of Adrenocorticotropic hormone (ACTH), cortisol and interleukin-6 (IL-6).
RESULTS
RESULTS
Handgrip strength postoperatively (day 1) decreased by 5.4 ± 15.9% in the SA group, versus 15.2 ± 11.7% in the GA group (p = 0.02). The handgrip strength returned to baseline at day 7 and did not differ between groups at day 28. MIP increased postoperatively in patients randomized to SA by 11.7 ± 48.3%, whereas it decreased in GA by 12.2 ± 19.9% (p = 0.04). On day 7, MIP increased in both groups, but more in the SA (49.0 ± 47.8%) than in the GA group (14.2 ± 32.1%) (p = 0.006). Postoperatively, the levels of ACTH, cortisol and IL-6 increased in the GA, but not in the SA group (p < 0.004).
CONCLUSION
CONCLUSIONS
In patients having bilateral THA, SA preserved the postoperative respiratory and peripheral muscle strength and attenuated the neuro-endocrine and inflammatory responses.
TRIAL REGISTRATION
BACKGROUND
clinicaltrials.gov NCT03600454.
Identifiants
pubmed: 37864209
doi: 10.1186/s40001-023-01435-6
pii: 10.1186/s40001-023-01435-6
pmc: PMC10588152
doi:
Substances chimiques
Hydrocortisone
WI4X0X7BPJ
Interleukin-6
0
Adrenocorticotropic Hormone
9002-60-2
Banques de données
ClinicalTrials.gov
['NCT03600454']
Types de publication
Randomized Controlled Trial
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
450Informations de copyright
© 2023. BioMed Central Ltd., part of Springer Nature.
Références
Reg Anesth Pain Med. 2002 Sep-Oct;27(5):469-75
pubmed: 12373693
Anesthesiology. 2003 Feb;98(2):499-510
pubmed: 12552211
Clin Rehabil. 2017 Jul;31(7):881-890
pubmed: 27353247
BMC Anesthesiol. 2011 Jun 26;11:14
pubmed: 21703029
Acta Anaesthesiol Scand. 1984 Jun;28(3):266-9
pubmed: 6741442
Arthroplasty. 2023 Feb 9;5(1):7
pubmed: 36759916
Br J Surg. 1990 Jul;77(7):796-800
pubmed: 2383755
Anesth Analg. 2005 Oct;101(4):1202-1208
pubmed: 16192545
J Bone Joint Surg Am. 2011 Aug 3;93(15):1392-8
pubmed: 21915544
Lancet. 2015 Jul 18;386(9990):266-73
pubmed: 25982160
J Arthroplasty. 2017 Jun;32(6):1918-1922
pubmed: 28110849
Anesthesiology. 2000 May;92(5):1467-72
pubmed: 10781293
Am J Respir Crit Care Med. 2002 Aug 15;166(4):518-624
pubmed: 12186831
Surg Open Sci. 2019 Jun 29;2(1):1-21
pubmed: 32754703
Clin Nutr. 2002 Jun;21(3):199-206
pubmed: 12127927
J Am Acad Orthop Surg. 2023 Aug 21;:
pubmed: 37603703
PLoS One. 2016 Oct 4;11(10):e0163917
pubmed: 27701433
Physiol Rev. 2015 Jul;95(3):1025-109
pubmed: 26133937
Surgery. 2015 Feb;157(2):362-80
pubmed: 25616950
Can Respir J. 2014 Jan-Feb;21(1):43-50
pubmed: 24137574
Am J Respir Crit Care Med. 2008 Aug 1;178(3):261-8
pubmed: 18511703
Int Wound J. 2023 Aug 30;:
pubmed: 37649253
Int Surg. 2000 Oct-Dec;85(4):353-7
pubmed: 11589607
Anesth Analg. 2020 Feb;130(2):341-351
pubmed: 30855340
Respir Care. 2009 Oct;54(10):1321-8
pubmed: 19796411
Crit Care. 2015 Aug 05;19:274
pubmed: 26242743
BJA Educ. 2020 Sep;20(9):321-328
pubmed: 33456967
Eur J Orthop Surg Traumatol. 2013 Jul;23(5):553-6
pubmed: 23412162
Korean J Anesthesiol. 2010 Mar;58(3):299-303
pubmed: 20498782