Neuraxial anesthesia may reduce bone cement implantation syndrome rate in hemiarthroplasty
Key takeaways:
- General anesthesia yielded higher bone cement implantation syndrome rates vs. neuraxial anesthesia.
- Bone cement implantation syndrome was associated with postoperative hypoxia and prolonged intubation.
Published results showed the type of anesthetic regimen used during cemented hemiarthroplasty was markedly associated with development of bone cement implantation syndrome.
“The current study analyzes the broader hip fracture population treated with cemented implants, which also demonstrates that patients undergoing neuraxial anesthesia (spinal or epidural), appeared to be associated with a lower risk of [bone cement implantation syndrome] BCIS,” Adam S. Levin, MD, associate professor of orthopedic surgery and oncology at Johns Hopkins University, told Healio.
Levin and colleagues retrospectively reviewed data from 137 patients aged 50 years or older who underwent cemented hemiarthroplasty for hip fracture between January 2017 and December 2022. Extracted data included patient demographics, comorbidities, procedural factors, anesthetic characteristics including anesthetic regiment (general, general plus regional or neuraxial), cement timing, BCIS development, postoperative complications and mortality.
After careful review of patient records, results showed 43% developed BCIS. Although there were no notable differences in demographics, comorbidities or procedural characteristics between patients who developed BCIS and those who did not, Levin and colleagues found patients who received general anesthesia had higher BCIS rates (55%) compared with general plus regional anesthesia (45%) and neuraxial anesthesia (19%).
According to results, patients who received general anesthesia and those who received general plus regional anesthesia had 6.8 and 5.5 times greater odds of developing BCIS, respectively, compared with neuraxial anesthesia. Researchers noted an association between developing BCIS with significantly higher rates of postoperative hypoxia and unplanned prolonged intubation.
Because this was a retrospective analysis, Levin said researchers cannot say that using neuraxial anesthesia is definitely a preventative solution for BCIS.
“What we can say is in those that had neuraxial anesthesia, we do not see as much of the bone cement implant syndrome. In those that had general anesthesia, we see more of the bone cement implant syndrome,” Levin said. “In the future, we plan to do a prospective study [to see if there is] a difference based off the anesthesia regimen. Right now, we are seeing an association where the spinal or epidural are the patients that were less likely to have bone cement implantation syndrome. And if they did, it is less likely to be severe.”
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