Anesthesia for hip replacement surgery

Abstract

Hip replacement surgery is a common and effective procedure for the relief of pain and loss of function. The number of procedures is increasing and great interest is shown for the manner of outcome improvement following hip replacement surgery. Last decade (2001-2010) is declared as the Bone and Joint Decade and has been characterized by many innovations in hip replacement surgery including minimally invasive technique but also by improvements in anesthetic technique. However there is no consensus about most appropriate anesthetic and analgesic techniques to use. Total hip replacement is procedure characterized by great perioperative disturbances including cardiovascular complications, high incidence of thromboembolic complications, possible significant perioperative blood loss, possible bone cement effect and high level of postoperative pain. Anesthetic assessment of patients include preoperative preparations, intraoperative and postoperative care. Most important factors determining outcome of patients include preoperative assessment and planning in order to minimize potential anesthetic problems, optimize co-morbidity and provide the most appropriate anesthetic for the patient. In this article all problems of preoperative assessment are discussed. The recent data of advantages of regional anesthetic technique are outlined. All the problems of intraoperative course and how to avoid them are presented. The possible techniques of postoperative pain therapy are also presented. The importance of thromboprophylaxis is outlined and recent guidelines for thromboprophylaxis are given including recommendations for new antithrombotic drugs. Our recommendation is to always prepare a patient for this procedure, analyse preoperative status, choose optimal anesthetic technique, provide thromboprophylaxis and multimodal pain therapy according to accepted guidelines.