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Randomized Controlled Trial
. 2023 Oct 20;28(1):450.
doi: 10.1186/s40001-023-01435-6.

The effect of spinal versus general anaesthesia on perioperative muscle weakness in patients having bilateral total hip arthroplasty: a single center randomized clinical trial

Sam Van Boxstael #  1   2 , Laurens Peene #  3 , Dimitri Dylst  3 , Joris Penders  4 , Admir Hadzic  3 , Ingrid Meex  3 , Kristoff Corten  5 , Dieter Mesotten  3   6 , Steven Thiessen  3
Affiliations
Randomized Controlled Trial

The effect of spinal versus general anaesthesia on perioperative muscle weakness in patients having bilateral total hip arthroplasty: a single center randomized clinical trial

Sam Van Boxstael et al. Eur J Med Res. .

Abstract

Background: Perioperative neuro-endocrine stress response may contribute to acquired muscle weakness. Regional anaesthesia has been reported to improve the outcome of patients having total hip arthroplasty. In this study, it was hypothesized that spinal anaesthesia (SA) decreases the perioperative neuro-endocrine stress response and perioperatively acquired muscle weakness (PAMW), as compared to general anaesthesia (GA).

Methods: Fifty subjects undergoing bilateral total hip arthroplasty (THA) were randomly allocated to receive a standardized SA (n = 25) or GA (n = 25). Handgrip strength was assessed preoperatively, on the first postoperative day (primary endpoint) and on day 7 and 28. Respiratory muscle strength was measured by maximal inspiratory pressure (MIP). Stress response was assessed by measuring levels of Adrenocorticotropic hormone (ACTH), cortisol and interleukin-6 (IL-6).

Results: Handgrip strength postoperatively (day 1) decreased by 5.4 ± 15.9% in the SA group, versus 15.2 ± 11.7% in the GA group (p = 0.02). The handgrip strength returned to baseline at day 7 and did not differ between groups at day 28. MIP increased postoperatively in patients randomized to SA by 11.7 ± 48.3%, whereas it decreased in GA by 12.2 ± 19.9% (p = 0.04). On day 7, MIP increased in both groups, but more in the SA (49.0 ± 47.8%) than in the GA group (14.2 ± 32.1%) (p = 0.006). Postoperatively, the levels of ACTH, cortisol and IL-6 increased in the GA, but not in the SA group (p < 0.004).

Conclusion: In patients having bilateral THA, SA preserved the postoperative respiratory and peripheral muscle strength and attenuated the neuro-endocrine and inflammatory responses.

Trial registration: clinicaltrials.gov NCT03600454.

Keywords: Bilateral total hip arthroplasty; General anaesthesia; Neuro-endocrine stress response; Perioperative muscle weakness; Spinal anaesthesia.

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Conflict of interest statement

AH has consulted, advised and/or performed industry-sponsored research for Philipps, GE, Sonosite, Konica Minolta, Codman & Shurtleff, Inc (Johnson and Johnson), Cadence, Insitu Biologics, Heron Therapeutics, Pacira, Baxter and BBraun Medical. Dr. Hadzic receives royalty income from BBraun Medical. He owns and directs NYSORA, the New York School of Regional Anesthesia. The other authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Consolidated standards of reporting trials diagram
Fig. 2
Fig. 2
The evolution over time of changes in handgrip strength and the effect of type of anaesthesia. Mean and standard deviation of handgrip strength are shown on different time points as a percentage relative to baseline being the preoperative values and this for the different types of anaesthesia. P-values indicate the relative difference between the two types of anaesthesia on the different time points. GA general anaesthesia, SA spinal anesthesia, MIP maximum inspiratory pressure
Fig. 3
Fig. 3
The evolution over time of changes in MIP and the effect of type of anaesthesia. Mean and standard deviation of MIP are shown on different time points as a percentage relative to baseline being the preoperative values and this for the different types of anaesthesia. P-values indicate the relative difference between the two types of anaesthesia on the different time points. GA general anaesthesia, SA spinal anesthesia, MIP maximum inspiratory pressure
Fig. 4
Fig. 4
The Numeric pain scores on postoperative day 1 and the type of anaesthesia (p = 0.61)
Fig. 5
Fig. 5
The evolution over time of changes of markers of the neuro-endocrine and inflammatory stress response and the effect of type of anesthesia. Mean values and standard deviations of ACTH, Cortisol and IL-6 are shown on different time points for the different types of anaesthesia. P-values indicate the relative difference between the two types of anaesthesia on the different time points. ACTH adrenocorticotropic hormone, IL-6 interleukin-6
See this image and copyright information in PMC

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