Does the type of anesthesia influence the outcome after modular proximal mega prosthesis for bone metastases of the femur?

Abstract

Background: Proximal femoral reconstruction with modular mega prosthesis after large oncologic resection is a long-lasting painful procedure associated with prolonged hospital stay and significant blood loss. We evaluated the influence of regional anesthesia on intraoperative and postoperative complications as well as length of hospital stay (LOS). Materials and Methods: We performed a retrospective study comparing three regimens of anesthesia on intraoperative and postoperative complications after proximal femoral reconstruction with mega prosthesis. Seventy-two patients were included. 26 of whom had general anesthesia (GA) alone (group 1), 21 had GA combined to lumbar epidural anesthesia (group 2) and 25 had GA combined to lumbar plexus block (group 3). Surgical procedures were similar and carried out by the same surgeon. Results: Demographic characteristics were equivalent between 3 groups, except for age and ASA score. Intraoperative variables were similar between groups except for intraoperative blood loss (p = 0.007), blood transfusion (p = 0.004) and opioids consumption (p = 0.01). Pulmonary infections were more frequent in group 1 compared to other groups (p = 0.036). Postoperative hypoventilations were less frequent in group 3 (p = 0.022). There were no difference for local complications, luxation and LOS. Type of anesthesia was found to be an independent predictive factor for intraoperative blood loss (p = 0.014), postoperative respiratory hypoventilation (p = 0.014) and respiratory infection (p = 0.011). Conclusion: Loco regional anesthesia, especially lumbar plexus block, may reduce blood loss, transfusion and postoperative complications after modular mega prosthesis for proximal femoral malignant lesions.SCOPUS: ar.jinfo:eu-repo/semantics/publishe