Combined spinal and epidural anesthesia with dexmedetomidine sedation during hip and knee arthroplasty

Background. Hip and knee arthroplasty (HKA) is a common surgical procedure. One of the common diseases that negatively affect the results of these operations is diabetes. The aim of the study: to determine the effectiveness and safety of combined multimodal low-opioid anesthesia with dexmedetomidine sedation in patients undergoing HKA in concomitant diabetes mellitus. Materials and methods. In total, the study included 45 patients who underwent HKA. They were divided into 3 groups depending on the scheme of anesthesia. In group 1 (n = 15), multicomponent low-flow anesthesia with artificial lung ventilation was performed; in group 2 (n = 15), spinal anesthesia was used; in group 3 (n = 15), combined spinal and epidural anesthesia with dexmedetomidine sedation was performed. Results. The course of anesthesia in all groups was satisfactory, but patients in group 3 were less likely to experience hyperdynamic reactions (tachycardia and hypotension), postoperative nausea and vomiting. Only one person from group 3 required ondansetron for the treatment of postoperative nausea and vomiting against 3 and 2 patients from groups 1 and 2, respectively (p < 0.05). Conclusions. Any of the proposed techniques can be used for anesthesia in HKA, but the best results have been obtained in combined spinal and epidural anesthesia with dexmedetomidine sedation.