Neuraxial anesthesia for orthopedic surgery: systematic review and meta-analysis of randomized clinical trials

Abstract

CONTEXT AND OBJECTIVE: Taking the outcome of mortality into consideration, there is controversy about the beneficial effects of neuraxial anesthesia for orthopedic surgery. SciELO, EMBASE (1974 to November 2012 and reference lists of the studies included. Only randomized controlled trials were included. RESULTS: Out of 5,032 titles and abstracts, 17 studies were included. There were no statistically significant differences in mortality (risk difference, RD: -0.01; 95% confidence interval, CI: -0.04 to 0.01; n = 1903), stroke (RD: 0.02; 95% CI: -0.04 to 0.08; n = 259), myocardial infarction (RD: -0.01; 95% CI: -0.04 to 0.02; n = 291), length of hospitalization (mean difference, -0.05; 95% CI: -0.69 to 0.58; n = 870), postoperative cognitive dysfunction (RD: 0.00; 95% CI: -0.04 to 0.05; n = 479) or pneumonia (odds ratio, 0.61; 95% CI: 0.25 to 1.49; n = 167). CONCLUSION: So far, the evidence available from the studies included is insufficient to prove that neuraxial anesthesia is more effective and safer than general anesthesia for orthopedic surgery. However, this systematic review does not rule out clinically important differences with regard to mortality, stroke, myocardial infarction, length of hospitalization, postoperative cognitive dysfunction or pneumonia. CONCLUSÃO: Até o momento, as evidências são insuficientes nos estudos incluídos para provar que AN é mais efetiva e segura do que AG para cirurgias ortopédicas. Esta revisão sistemática não descartou diferenças clínicas importantes para mortalidade, acidente vascular encefálico, infarto miocárdico, tempo de internação, disfunção cognitiva pós-operatória e pneumonia. RESUMO IMSc. Professor,

Perioperative regional anaesthesia and postoperative longer-term outcomes

“…In a meta-analysis published in 2013, Barbosa et al . found no significant long-term benefit associated with regional anaesthesia as compared with general anaesthesia for orthopaedic surgery 22 . Memtsoudis et al .…”

Neuraxial block and postoperative epidural analgesia: effects on outcomes in the POISE-2 trial

“…13 Our results are consistent with a recent observational study in hip fracture patients, 30 but inconsistent with systematic reviews that do not support a difference in cardiovascular outcomes after hip fracture surgery, 27 total hip arthroplasty 36 or lower limb orthopaedic surgery. 37 However, none of these studies differentiated between spinal and epidural anaesthesia.…”

The effect of ketamine versus tramadol on prophylactic post-spinal shivering in those patients undergoing orthopedic surgery: a prospective cohort study design, 2020

“…Orthopedic surgery is a surgical procedure used to treat musculoskeletal problems that affect the bones, joints, muscles, tendons, and ligaments caused by accidents, trauma, injury, or chronic conditions [ 1 , 2 ]. The most common form of neuraxial technique used in orthopedic surgery is spinal anesthesia due to its excellent intraoperative pain control, decreased blood loss, and postoperative analgesia [ 3 , 4 ]. Even if spinal anesthesia is commonly preferred, post-spinal shivering (PSS) is one potential complication of spinal anesthesia that has a high incidence in orthopedic surgery in developing countries due to a lack of facilities to maintain normothermia [ 5 , 6 ].…”