Anesthesia for the patient undergoing total knee replacement: current status and future prospects

Abstract

Total knee arthroplasty (TKA) has become one of the most common orthopedic surgical procedures performed nationally. As the population and surgical techniques for TKAs have evolved over time, so have the anesthesia and analgesia used for these procedures. General anesthesia has been the dominant form of anesthesia utilized for TKA in the past, but regional anesthetic techniques are on the rise. Multiple studies have shown the potential for regional anesthesia to improve patient outcomes, such as a decrease in intraoperative blood loss, length of stay, and patient mortality. Anesthesiologists are also moving toward multimodal analgesia, which includes peripheral nerve blockade, periarticular injection, and preemptive analgesia. The goal of multimodal analgesia is to improve perioperative pain control while minimizing systemic narcotic consumption. With improved postoperative pain management and rapid patient rehabilitation, new clinical pathways have been engineered to fast track patient recovery after orthopedic procedures. The aim of these clinical pathways was to improve quality of care, minimize unnecessary variations in care, and reduce cost by using streamlined procedures and protocols. The future of TKA care will be formalized clinical pathways and tracks to better optimize perioperative algorithms with regard to pain control and perioperative rehabilitation.

Effectiveness of intravenous acetaminophen for postoperative pain management in hip and knee arthroplasties: a population-based study

“…Therefore, they are highly sought after. Regional anesthesia is one candidate, demonstrating efficacious results with regard to pain and complication outcomes28; however, its use is associated with increased complexity, requirements for training, and potential complications. Widespread application of regional anesthetic techniques is not deemed feasible in all settings and is contraindicated in a number of settings, particularly when coagulation disorders are present 29.…”

Medicaid insurance as primary payer predicts increased mortality after total hip replacement in the state inpatient databases of California, Florida and New York

“…Disparities exist in the type of intraoperative anesthesia and analgesia used during total joint replacement surgeries [58, 59]. Neuraxial anesthesia during major joint procedures has been associated with superior perioperative outcomes [60–63]. However, a study of over 500,000 patients undergoing total knee arthroplasty or total hip arthroplasty from 2006–2010 showed that neuraxial anesthesia was used significantly less in Medicaid and Black patients [58].…”

Optimal dose of intrathecal isobaric bupivacaine in total knee arthroplasty

“…3 Therefore, they create new challenges in anesthesia protocols requiring dose optimization to allow immediate postoperative mobilization. 4,5 In fast-track TKA, intrathecal anesthesia is preferred over general anesthesia because of lower mortality and morbidity rates. [6][7][8][9] Moreover, spinal anesthesia yields lower postoperative pain scores and less nausea and vomiting after TKA.…”