General Anesthesia Leads to Increased Adverse Events Compared With Spinal Anesthesia in Patients Undergoing Unicompartmental Knee Arthroplasty

Lu, Yining; Cregar, William M.; Goodloe, J. Brett; Khazi, Zain; Gerlinger, Tad L.

doi:10.1016/j.arth.2020.03.012

“…These findings are supported by institutional and database studies demonstrating increased major and minor adverse events, as well as readmission in arthroplasty patients treated with general anaesthesia. [26][27][28][29] Our data also suggest that there is increased risk of all-cause revision and reoperation in patients receiving general anaesthesia; however, other large registry studies have reported no difference in the rate of these longterm outcomes. 28 In contrast, general anaesthesia demonstrated fewer episodes of postoperative urinary retention than spinal anaesthesia.…”

Section: Discussionsupporting

confidence: 59%

Spinal versus general anaesthesia in contemporary primary total knee arthroplasties

Owen

¹

,

Amundson

²

,

Larson

³

et al. 2022

The Bone & Joint Journal

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Aims Spinal anaesthesia has seen increased use in contemporary primary total knee arthroplasties (TKAs). However, controversy exists about the benefits of spinal in comparison to general anaesthesia in primary TKAs. This study aimed to investigate the pain control, length of stay (LOS), and complications associated with spinal versus general anaesthesia in primary TKAs from a single, high-volume academic centre. Methods We retrospectively identified 17,690 primary TKAs (13,297 patients) from 2001 to 2016 using our institutional total joint registry, where 52% had general anaesthesia and 48% had spinal anaesthesia. Baseline characteristics were similar between cohorts with a mean age of 68 years (SD 10), 58% female (n = 7,669), and mean BMI of 32 kg/m2 (SD 7). Pain was evaluated using oral morphine equivalents (OMEs) and numerical pain rating scale (NPRS) data. Complications including 30- and 90-day readmissions were studied. Data were analyzed using an inverse probability of treatment weighted model based on propensity score that included many patient and surgical factors. Mean follow-up was seven years (2 to 18). Results Patients treated with spinal anaesthesia required fewer postoperative OMEs (p < 0.001) and had lower NPRS scores (p < 0.001). Spinal anaesthesia also had fewer cases of altered mental status (AMS; odds ratio (OR) 1.3; p = 0.044), as well as 30-day (OR 1.4; p < 0.001) and 90-day readmissions (OR 1.5; p < 0.001). General anaesthesia was associated with increased risk of any revision (OR 1.2; p = 0.021) and any reoperation (1.3; p < 0.001). Conclusion In the largest single institutional report to date, we found that spinal anaesthesia was associated with significantly lower OME use, lower risk of AMS, and lower overall 30- and 90-day readmissions following primary TKAs. Additionally, spinal anaesthesia was associated with reduced risk of any revision and any reoperation after accounting for numerous patient and operative factors. When possible and safe, spinal anaesthesia should be considered in primary TKAs. Cite this article: Bone Joint J 2022;104-B(11):1209–1214.

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“…Currently, intravenous analgesia with intravenous opioid anesthetics is a mainstay to abate postoperative pain, but a regular dosage may induce discomfort such as nausea and vomiting among elderly patients [ 12 ]. With increasing aging worldwide, the number of patients given TKRS is growing dramatically each year [ 13 ]. Therefore, the selection of appropriate anesthetic methods to alleviate pain caused by TKRS in elderly patients exerts a tremendous fascination on scholars.…”

Section: Discussionmentioning

confidence: 99%

“…Currently, intravenous analgesia with intravenous opioid anesthetics is a mainstay to abate postoperative pain, but a regular dosage may induce discomfort such as nausea and vomiting among elderly patients [12]. With increasing aging worldwide, the number of patients given TKRS is growing dramatically each year [13].…”

Section: Discussionmentioning

confidence: 99%

Application of General Anesthesia Combined with Saphenous Nerve-Tibial Nerve Block in Total Knee Arthroplasty

Li

¹

,

Wang

²

,

Qiu

³

et al. 2022

Evidence-Based Complementary and Alternative Medicine

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Background. The study aimed to evaluate the safety and efficiency of the saphenous nerve plus selective tibial nerve block combined with general anesthesia in total knee replacement surgery (TKRS). Methods. Sixty-four patients who underwent unilateral TKRS between October 2019 and June 2020 were selected as study subjects. All patients were divided into the control and observation groups using the random number table method, with 32 patients in each group. Conventional general anesthesia was performed preoperatively in both groups. The control group was given an ultrasound-guided saphenous nerve block before anesthesia induction, and the observation group was given a selective tibial nerve block on the basis of the control group. The dosage of general anesthetic drugs, recovery time from general anesthesia, hemodynamic index, inflammatory response, postoperative analgesic effect, and adverse reaction rate were compared between the two groups. Results. Compared with the control group, the total amount of propofol and remifentanil used in the observation group was significantly less ( P < 0.05 ). Compared with the control group, patients in the observation group experienced remarkably shorter time to recovery from respiration, time to extubation, and time in the PACU ( P < 0.05 ). Compared with the control group, the observation group showed a significantly reduced SBP and MAP at T2, T3, and T4, respectively, and also showed a prominently lower HR at T3 and T4 ( P < 0.05 ). Markedly lower CRP and IL-6 levels at 6 h and 24 h after surgery were found in the observation group compared to the control group ( P < 0.05 ). Compared with the control group, patients receiving nerve block intervention got significantly lower VAS scores at 6 h, 24 h, and 48 h postoperatively ( P < 0.05 ). However, there was no statistically significant difference in the incidence of adverse reactions between the two groups of patients ( P > 0.05 ). Conclusion. The application of the saphenous nerve plus selective tibial nerve block combined with general anesthesia in TKRS yields a promising analgesic effect, stable hemodynamics, low levels of postoperative inflammatory responses, and high safety.

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“…Riku Palanne et al found that spinal anaesthesia was associated with a higher incidence of postoperative pain and vomiting than GA, and there was no difference in LOS [ 4 ]. According to the study of Yining Lu et al, spinal anaesthesia was associated with reduced perioperative adverse events and reduced operating room time, and there was no difference in the LOS under different anaesthesia methods [ 23 ]. We analysed these studies with results that were inconsistent with ours, and we speculated that the differences might be due to the following factors: (1) the study population was different; (2) the relationship between anaesthesia method and LOS was not analysed separately; and (3) the conditions and methods of postoperative rehabilitation and nursing differ in different countries and regions.…”

Section: Discussionmentioning

confidence: 99%

Two types of anaesthesia and length of hospital stay in patients undergoing unilateral total knee arthroplasty (TKA): a secondary analysis based on a single-centre retrospective cohort study in Singapore

Ji

¹

,

Ke

²

2021

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Background Evidence regarding the relationship between the type of anaesthesia and length of hospital stay is controversial. Therefore, the objective of this research was to investigate whether the type of anaesthesia was independently related to the length of hospital stay in patients undergoing unilateral total knee arthroplasty (TKA) after adjusting for other covariates. Methods The present study was a cohort study. A total of 2622 participants underwent total knee arthroplasty (TKA) at a hospital in Singapore from 2013 to 1-1 to 2014-6-30. The target independent variable and the dependent variable were two types of anaesthesia and length of hospital stay, respectively. The covariates included age, BMI, hemoglobin (Hb), length of stay (LOS), duration of surgery, sex, ethnicity, American Society of Anesthesiologist (ASA) Status, smoking, obstructive sleep apnea (OSA), diabetes mellitus (DM), DM on insulin, ischemic heart disease (IHD), congestive cardiac failure (CCF), cerebrovascular accident (CVA), creatinine > 2 mg/dl, day of week of operation. Multivariate linear and logistic regression analyses were performed on the variables that might influence the choice of the two types of anaesthesia and the LOS. This association was then tested by subgroup analysis using hierarchical variables. Results The average age of 2366 selected participants was 66.57 ± 8.23 years old, and approximately 24.18% of them were male. The average LOS of all enrolled patients was 5.37 ± 4.87 days, 5.92 ± 6.20 days for patients receiving general anaesthesia (GA) and 5.09 ± 3.98 days for patients receiving regional anaesthesia (RA), P < 0.05. The results of fully adjusted linear regression showed that GA lasted 0.93 days longer than RA (β = 0.93, 95% CI (0.54, 1.32)), P < 0.05. The results of fully adjusted logistic regression showed that LOS > 6 days was 45% higher for GA than for RA (OR = 1.45, 95% CI (1.15, 1.84)), P < 0.05. Through the subgroup analysis, the results were basically stable and reliable. Conclusion Our study showed that GA increased the length of stay during unilateral TKA compared with RA. This finding needs to be validated in future studies.

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General Anesthesia Leads to Increased Adverse Events Compared With Spinal Anesthesia in Patients Undergoing Unicompartmental Knee Arthroplasty

Cited by 12 publications

References 50 publications

Spinal versus general anaesthesia in contemporary primary total knee arthroplasties

Spinal versus general anaesthesia in contemporary primary total knee arthroplasties

Application of General Anesthesia Combined with Saphenous Nerve-Tibial Nerve Block in Total Knee Arthroplasty

Two types of anaesthesia and length of hospital stay in patients undergoing unilateral total knee arthroplasty (TKA): a secondary analysis based on a single-centre retrospective cohort study in Singapore

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