Comparison of hypotensive epidural anaesthesia and spinal anaesthesia on blood loss and coagulation during and after total hip arthroplasty

Background: Hypotensive epidural anaesthesia (HEA) is a technique for reduc ing peroperative blood loss by significantly lowering mean arterial pressur e (MAP). Methods: Thirty patients scheduled for primary total hip arthroplasty were given HEA (n=15) or spinal anaesthesia (SPA) (n=15) with bupivacaine in ran dom order. The dose of bupivacaine was titrated to provide epidural blockad e up to T1-T4 and spinal blockade at least to T10. Intravenous adrenaline i nfusion was adjusted to achieve a MAP of about 50-60 mmHg in the HEA group. During SPA MAP was maintained above 70 mmHg with ephedrine, as needed. Results: Intraoperative blood loss (median and 25th and 75th percentiles) w as 400 mi (163-575) in the HEA group and 900 mi (663-1100) in the SPA group (P<0.05). At 3 h postoperatively cumulative blood loss was still smaller i n the HEA group (600 mi versus 1100 mi, P<0.05). The cumulative number of t ransfused packed red cell concentrate (PRC) units was smaller in the HEA gr oup than in the SPA group during surgery and postoperatively. Prothrombin t ime value was smaller in the SPA than in the HEA group (69% versus 79%, P<0 .05) at 3 h postoperatively. D-dimer concentrations increased more in the S PA group at the end of the surgery and 3 h postoperatively (P<0.05). Conclusions: HEA resulted in reduced blood loss due to hypotension and redu ced number of transfused PRC units during total hip arthroplasty. Based on lower prothrombin time value and higher D-dimer concentrations in the SPA g roup, the coagulation system might be better preserved during HEA than SPA. (C) Acta Anaesthesiologica Scandinavica 44 (2000).