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AP 2-9 Does epidural anaesthesia decrease desaturations frequency during postoperative period ?

Materials and Methods: 60 patients with femur fractures (ASA III) were randomly allocated in 2 groups to receive hypobaric (2 ml isobaric 0,5% bupivacaine+4 ml twice-distilled water) for unilateral (Group 1) or isobaric (3-3,5 ml 0,5%) bupivacaine for bilateral (Group 2) spinal anesthesia. After spinal anesthesia epidural catheter was placed for postoperative analgesia. In case of first signs of sensitivity recovery epidural catheter was used for extension of anesthesia – patients received 4 ml 0,5% isobaric bupivacaine. The difference between groups in incidence of hypotension and/or bradicardia, inadequate anesthesia and needs in additional epidural anesthesia due to short duration of spinal block were compared with analysis of proportions: Fisher’s test, Relative Risk (RR), Number Needed to Treat (NNT), Number Needed to Harm (NNH). Results and Discussion: Both groups had similar characteristics for sex, age, surgery, and duration of surgery. Significant different in hypotension and/ or bradycardia was observed (two-tailed Fisher’s p=0,012): 1 from 30 patients in Group 1 and 9 from 30 patient in Group 2, RR = 9 (95%C.I. 1,21-66,75), OR=12,43 (95%C.I. 1,47-363,05), NNT=3,75. In uSA Group number of patients who needed in additional epidural anesthesia was significantly greater: 9/30 vs. 2/30 (p=0,042), RR=4,5 (95%C.I. 1,06-19,11), OR=6 (1,05-61,03), NNH=4,3. Using uSA considerably reduces risk of hypotension and/or bradicardia in high risk trauma patients with femur fractures but due to shorter duration of blockade often requires additional anesthesia. It can be suggested for potential long-term surgery. Epidural or subarachnoid catheterization solves this potential problem. Conclusion(s): uSA with hypobaric bupivacaine for high risk trauma patients with femur fractures reduces risk of hypotension but requires epidural or subarachnoid catheterization for additional anesthesia in case of long-term surgery. Acknowledgements: “Partners in Health” and Prof. V.V. Vlassov for Summer School “Reseasch effectiveness in biomedicine”.