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Open Access 01-06-2011 | Research

Goal-directed haemodynamic therapy during elective total hip arthroplasty under regional anaesthesia

Authors: Maurizio Cecconi, Nicola Fasano, Nicola Langiano, Michele Divella, Maria G Costa, Andrew Rhodes, Giorgio Della Rocca

Published in: Critical Care | Issue 3/2011

Abstract

Introduction

Total hip replacement is one of the most commonly performed major orthopaedic operations. Goal-directed therapy (GDT) using haemodynamic monitoring has previously demonstrated outcome benefits in high-risk surgical patients under general anaesthesia. GDT has never been formally assessed during regional anaesthesia.

Methods

Patients undergoing total hip replacement while under regional anaesthesia were randomised to either the control group (CTRL) or the protocol group (GDT). Patients in the GDT group, in addition to standard monitoring, were connected to the FloTrac sensor/Vigileo monitor haemodynamic monitoring system, and a GDT protocol was used to maximise the stroke volume and target the oxygen delivery index to > 600 mL/minute/m².

Results

Patients randomised to the GDT group were given a greater volume of intravenous fluids during the intraoperative period (means ± standard deviation (SD): 6,032 ± 1,388 mL vs. 2,635 ± 346 mL; P < 0.0001), and more of the GDT patients received dobutamine (0 of 20 CTRL patients vs. 11 of 20 GDT patients; P < 0.0003). The GDT patients also received more blood transfused during the intraoperative period (means ± SD: 595 ± 316 mL vs. 0 ± 0 mL; P < 0.0001), although the CTRL group received greater volumes of blood replacement postoperatively (CTRL patients 658 ± 68 mL vs. GDT patients 198 ± 292 mL; P < 0.001). Overall blood consumption (intraoperatively and postoperatively) was not different between the two groups. There were an increased number of complications in the CTRL group (20 of 20 CTRL patients (100%) vs. 16 of 20 GDT patients (80%); P = 0.05). These outcomes were predominantly due to a difference in minor complications (20 of 20 CTRL patients (100%) vs. 15 of 20 GDT patients (75%); P = 0.047).

Conclusions

GDT applied during regional anaesthesia in patients undergoing elective total hip replacement changes intraoperative fluid management and may improve patient outcomes by decreasing postoperative complications. Larger trials are required to confirm our findings.

Trial registration

SRCTN11616985

Available only for authorised users

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Title: Goal-directed haemodynamic therapy during elective total hip arthroplasty under regional anaesthesia
Authors: Maurizio Cecconi
Nicola Fasano
Nicola Langiano
Michele Divella
Maria G Costa
Andrew Rhodes
Giorgio Della Rocca
Publication date: 01-06-2011
Publisher: BioMed Central
Published in: Critical Care / Issue 3/2011
Electronic ISSN: 1364-8535
DOI: https://doi.org/10.1186/cc10246

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Goal-directed haemodynamic therapy during elective total hip arthroplasty under regional anaesthesia

Abstract

Introduction

Methods

Results

Conclusions

Trial registration

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusions

Trial registration

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