Discussion
muscle weakness, atrophy, fatigue
MUSCLE WEAKNESS, ATROPHY
This exploratory prospective randomized controlled trial demonstrated that patients who underwent bilateral hip replacement developed generalized muscle weakness postoperatively. Thereby note that a bilateral hip replacement is more invasive than a unilateral replacement. The degree of muscle weakness was greater in patients who received GA compared to patients who received SA. The SA patients also had a higher postoperative handgrip strength, MIP and lower levels of ACTH, cortisol, and IL-6 in the immediate postoperative period. The modulating effect on the neuro-endocrine pathway of neuraxial anaesthesia has been reported previously [Handgrip dynamometry is an effective screening tool for global muscle weakness as a surrogate for the Medical Research Council (MRC) score and, it is associated with hospital mortality [Postoperative respiratory muscle function also appeared to recover faster in patients who had SA, as opposed to patients who received GA. In the GA group, there was a decrease in respiratory muscle strength on postoperative day 1, followed by a gradual recovery in MIP in the postoperative period. SA resulted in a better respiratory muscle strength in the direct postoperative period and this effect lasted during the following assessments on postoperative day 7 and day 28. It is well established that even a limited duration of mechanical ventilation may induce atrophy of the diaphragm, and that anaesthetics negatively affect the postoperative pulmonary function [The decrease in global health status in the immediate postoperative period, and its return to the pre-operative level after one month, was unaffected by the type of anaesthesia. The use of more sensitive questionnaires investigating fatigue and early recovery after surgery, such as QOR-15, in future larger studies could potentially clarify if this muscle strength preserving effect of SA translates in a better recovery after surgery.Our study findings are in agreement with Lattermann et al. who reported that neuraxial anaesthesia decreases the catabolic stress response after surgery, and protein catabolism [