Neuraxial vs general anaesthesia for total hip and total knee arthroplasty: a systematic review of comparative-effectiveness research

Johnson, Rebecca L.; Kopp, Sandra L.; Burkle, Christopher M.; Duncan, Christopher M.; Jacob, Adam K.; Erwin, Patricia J.; Murad, M. Hassan; Mantilla, Carlos B.

doi:10.1093/bja/aev455

Cited by 205 publications

(130 citation statements)

References 120 publications

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“…It is considered to be superior in reducing blood loss, tourniquet pain, and analgesia, and the decreased incidence of VTE as a result of using epidural anesthesia is considered to be one of the reasons why epidural anesthesia is chosen over general anesthesia for TKA. Recent systematic reviews and meta-analysis studies have shown that although patient outcomes support regional anesthesia over general anesthesia during hospitalization, it has not been definitely concluded that there is a causal link between a particular anesthetic method and the improvement in the postoperative outcome for TKA [17,18]. In our results, we found no differences in the incidence of VTE, compared between epidural and general anesthesia for TKA.…”

Section: Discussioncontrasting

confidence: 79%

Comparison of the incidence of venous thromboembolism between epidural and general anesthesia for total knee arthroplasty: a retrospective study

et al. 2018

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With increasing average life expectancy and the physical activeness of the population aged 60 and older, major orthopedic arthroplasty is becoming more common. In particular, total knee arthroplasty (TKA) has become a major orthopedic procedure in the aging population in Korea; additionally, venous thromboembolism (VTE) is one of the major compliThis is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Background: Substantial variation exists in the reported rates of postoperative venous thromboembolism (VTE) following total knee arthroplasty (TKA) in the Asian population. This retrospective study aimed to compare the early postoperative VTE incidence between patients managed with epidural anesthesia and those managed by general anesthesia at the time of TKA. Methods:We reviewed 589 cases of unilateral primary TKA performed between January 2011 and June 2014. We selected epidural versus general anesthesia groups as the main anesthetic choices, with postoperative patient-controlled analgesia. All the patients underwent deep vein thrombosis (DVT) computed tomography angiography on postoperative day 7. The incidence of DVT and pulmonary thromboembolism (PTE) was evaluated and compared between epidural and general anesthesia.Results: The overall incidence of VTE was 8.0% in the two groups together. The incidence did not differ between the groups. The odds ratio in the generalized estimation equations analysis showed a higher incidence of DVT and PTE in the epidural group; however, this result was not statistically significant. Although, the odds ratio for age showed that the risk of developing DVT and PTE increased 1.12 times per year.Conclusions: Total VTE incidence was not significantly different between patients who underwent general anesthesia and those who underwent epidural anesthesia for TKA. A prospective multicenter study is required to evaluate the nature of the Korean VTE status in major orthopedic surgeries, and to prepare guidelines and protocols for medical prophylaxis for DVT and PTE in Korea.

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Section: Discussioncontrasting

confidence: 79%

Comparison of the incidence of venous thromboembolism between epidural and general anesthesia for total knee arthroplasty: a retrospective study

et al. 2018

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“…Whereas some metaanalysis demonstrated a benefit with the use of neuraxial techniques, others could not. 18,19 General anesthesia is still widely used for THA. In a recent article, Memtsoudis et al 20 demonstrated that in a sample of 124,993 patients, general anesthesia was used in 78%.…”

Section: Discussionmentioning

confidence: 99%

A Longitudinal Supra-Inguinal Fascia Iliaca Compartment Block Reduces Morphine Consumption After Total Hip Arthroplasty

Desmet

Vermeylen

Herreweghe

et al. 2017

Regional Anesthesia and Pain Medicine

150

137

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“…Total hip and total knee replacement are promising management strategies which are forecasted to increase dramatically during the next 20 yr [25,26] . However, most major orthopedic surgery like THR and TKR involves large injured tissues and requires much time under general or regional anesthesia.…”

Section: Discussionmentioning

confidence: 99%

Early Unpleasant Postoperative Symptoms for Patients Undergoing Primary Hip versus Primary Knee Replacement: Patient Perception

Kader¹,

Shrief²,

Salama³

2017

IOSR JNHS

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Neuraxial vs general anaesthesia for total hip and total knee arthroplasty: a systematic review of comparative-effectiveness research

Cited by 205 publications

References 120 publications

Comparison of the incidence of venous thromboembolism between epidural and general anesthesia for total knee arthroplasty: a retrospective study

Comparison of the incidence of venous thromboembolism between epidural and general anesthesia for total knee arthroplasty: a retrospective study

A Longitudinal Supra-Inguinal Fascia Iliaca Compartment Block Reduces Morphine Consumption After Total Hip Arthroplasty

Early Unpleasant Postoperative Symptoms for Patients Undergoing Primary Hip versus Primary Knee Replacement: Patient Perception

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