Effects of different anesthesia techniques on intraoperative blood loss in acetabular fractures undergoing the Modified Stoppa approach

BACKGROUND: This study aims to evaluate the effects of the anesthesia technique on the intraoperative blood loss in acetabular fracture patients undergoing the Modified Stoppa approach.
METHODS: We retrospectively identified 63 patients who underwent a Modified Stoppa approach for acetabular fracture from January 2014 to July 2018. A total of 20 patients were excluded from this study for the following reasons: bilateral acetabular fractures (n=6), undergoing antiaggregant treatment (n=3), incomplete anesthesia records (n=3), emergency pelvic surgery due to hemodynamic instability (n=5), splenic rupture (n=2), and liver laceration (n=1). The patients were divided into two groups as follows: patients undergoing general anesthesia (GA) (n=22) and patients undergoing combined epidural-general anesthesia (CEGA) (n=21). The main outcome measurements studied were the intraoperative blood loss and the need for intraoperative and/or postoperative blood transfusions.
RESULTS: No statistically significant differences were found between the groups concerning the age, gender, type of fracture, mechanism of injury, time from injury to surgery, Injury Severity Score, associated injuries, and comorbidities (p>0.05). The mean intraoperative blood losses were 717.27 ml (300–1.600 ml) in the GA group and 473.81 ml (150–1.020 ml) in the CEGA group (p<0.001). In the cases with only an isolated acetabular fracture, the intraoperative blood transfusion means were 2.43 units (1–5 units) in 14 patients in the GA group and 1.27 units (1–4 units) in 15 patients in the CEGA group (p<0.001).
CONCLUSION: Less intraoperative bleeding was seen in those patients undergoing CEGA when compared to those undergoing GA. This is a significant advantage for acetabular surgery, which has a long learning curve and a high risk of bleeding.

Modifiye Stoppa yaklaþýmý ile ameliyat edilen asetabulum kýrýklarýnda farklý anestezi tekniklerinin intraoperatif kan kaybý üzerine etkisi

AMAÇ: Asetabulum kýrýðý nedeniyle Modifiye Stoppa yaklaþýmý ile ameliyat edilen hastalardaki intraoperatif kanama miktarýna, anestezi tekniðinin etkisini deðerlendirmektir.
GEREÇ VE YÖNTEM: Ocak 2014 ve Temmuz 2018 tarihleri arasýnda asetabulum kýrýðý nedeniyle Modifiye Stoppa yaklaþýmý ile ameliyat edilen 63 hasta geriye dönük olarak deðerlendirildi. Ýki taraflý asetabulum kýrýðý (n=6), antiagregan tedavisi (n=3), anestezi kayýtlarýnda eksiklik (n=3), hemodinamik instabilite nedeniyle acil pelvik cerrahi geçirmiþ (n=5), dalak yýrtýðý (n=2) ve karaciðer yýrtýðý (n=1) olan, toplam 20 hasta çalýþmadan dýþlandý. Hastalar genel anestezi yapýlanlar (GA) (n=22) ve kombine epidural-genel anestezi yapýlanlar (CEGA) (n=21) olmak üzere iki gruba ayrýldý. Ýntraoperatif kanama miktarý ve intraoperatif ve/veya ameliyat sonrasý kan transfüzyon ihtiyacý, deðerlendirilen ana ölçüm parametreleriydi.
BULGULAR: Gruplar arasýnda yaþ, cinsiyet, kýrýk tipi, yaralanma mekanizmasý, yaralanma ile cerrahi arasýndaki süre, yaralanma þiddet skoru, eþlik eden yaralanmalar ve komorbiditeler açýsýndan istatistiksel anlamlý fark yoktu (p>0.05). Ortalama intraoperatif kanama miktarý GA grubunda 717.27 ml (300–1.600 ml) ve CEGA grubunda 473.81 ml (150–1.020 ml) bulundu (p<0.001). Ýzole asetabulum kýýrðý olan olgularda ise, intraoperatif kan transfüzyon ortalamasý, GA grubundaki 14 hastada 2.43 ünite (1–5 ünite) ve CEGA grubundaki 15 hastada 1.27 ünite (1–4 ünite) bulundu (p<0.001).
TARTIÞMA: CEGA yapýlan hastalarda, GA yapýlan hastalara göre daha az intraoperatif kanama görüldü. Bu, uzun öðrenme eðrisi ve yüksek kanama riski olan asetabulum cerrahi için önemli bir avantajdýr.