Recovery after total intravenous general anaesthesia or spinal anaesthesia for total knee arthroplasty: a randomized trial

Harsten, Andreas; Kehlet, Henrik; Toksvig‐Larsen, Sören

doi:10.1093/bja/aet104

Cited by 116 publications

(62 citation statements)

References 21 publications

(36 reference statements)

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“…However, the NRS scores at the 24 th hour were significantly higher. As in this study, Harsten et al observed that during the first 2 hours after general anaesthesia, patients had higher pain scores, but after 6 hours the spinal group had significantly higher pain scores [33]. This finding may be due to the pain perception of the patients; during the first postoperative hours the analgesic action of spinal anaesthesia continues and the patients are pain free.…”

Section: Discussionsupporting

confidence: 54%

Factors associated with acute and chronic pain after inguinal herniorraphy

Erdoğan

Özenç

2018

Rom J Anaesth Int Care

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Objectives: The aim of this study was to analyse the relationship between types of anaesthesia, patients' demographic variables, preoperative emotional states and the prevalence of postoperative pain.Method: In this randomized prospective study, postoperative pain was assessed in 100 patients, who were ASA (American Society of Anaesthesiologist) I-II and between 18-65 years old, undergoing inguinal herniorrhaphy with either general or spinal anaesthesia. In addition, postoperative pain compared with patients' demographic properties and psychological conditions in each group was also considered. Acute pain was evaluated at 1, 2, 4, 6, 12 and 24 th hours with the Numerical Rating Scale (NRS) and chronic neuropathic pain was at 1, 2 and 3 rd months with Douleur Neuropathique 4 Questions (DN4). All patients were treated with the same analgesics after operation.Results: Group spinal anaesthesia had lower acute pain at 1 and 2 nd hours but they felt more severe pain at the 24 th hour. Also patients' anxieties were correlated with acute and chronic postoperative pain. Ten patients complained about postoperative chronic pain after 3 months and there was no significant difference between groups.Conclusion: Spinal anaesthesia decreased acute pain intensity at the first postoperative hours. Patients with anxiety felt high pain levels and they had an increased chronic pain prevalence.

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Section: Discussionsupporting

confidence: 54%

Factors associated with acute and chronic pain after inguinal herniorraphy

Erdoğan

Özenç

2018

Rom J Anaesth Int Care

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“…[12] As opioids alone are not sufficient for an adequate analgesia, a multimodal analgesic approach has been accepted recently. [3] Analgesic benefits of peripheral nerve blocks are well described.…”

Section: Discussionmentioning

confidence: 99%

“…Adequate analgesia is essential after total knee arthroplasty (TKA)[12] to improve postoperative mobilization and reduce the length of hospital stay (LOS). It is difficult to achieve good analgesia only with opioids, even when combined with nonsteroidal anti-inflammatory drugs.…”

Section: Introductionmentioning

confidence: 99%

The effect of pregabalin and s-ketamine in total knee arthroplasty patients: A randomized trial

Kadic

Haren

Wilder–Smith

et al. 2016

J Anaesthesiol Clin Pharmacol

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Background and Aims:Pain reduction is important for rehabilitation after total knee arthroplasty. Intra- and peri-articular infiltration with local anesthetics may be an alternative to commonly used locoregional techniques. Adding pregabalin orally and s-ketamine intravenously may further reduce postoperative pain.Material and Methods:This prospective, randomized, double-blind, placebo-controlled study compared two methods of perioperative analgesia. Control patients received a standardized multimodal postoperative analgesic regime of paracetamol, diclofenac, and piritramide-patient-controlled analgesia, including ropivacaine knee infiltration during surgery. The study group received pregabalin orally and s-ketamine intravenously as an additional medication to the standard multimodal regimen. The control group received placebo.Results:The study group showed lower piritramide consumption during the first 24 h (P: 0.043), but with more side effects such as diplopia and dizziness.Conclusion:Addition of pregabalin and s-ketamine resulted in lower piritramide consumption during the first 24 h postoperatively. However, more investigation on benefits versus side effects of this medication is required.

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“…We also found anesthesia and its administration to have a role in LOS: THA patients who underwent general, endotracheal anesthesia were associated with a longer LOS than THA patients who had spinal, regional anesthesia. This factor does not seem to be widely reported in the existing literature, though Harsten et al found that subjects receiving general anesthesia had a shorter LOS and their patients preferred receiving general anesthesia if they had to redo their surgery [24]. This may require further research with a study of higher power and more focus on the anesthesiology side of perioperative care, particularly as to its role in the JSH.…”

Section: Discussionmentioning

confidence: 99%

“…The existing literature points to the fact that these operations should be best conducted in tertiary-care institutions, with early and thorough patient education, early and consistent physical therapy, and individual planning to minimize LOS [10, 11, 20, 21, 23, 25, 27]. Other factors that have a dramatic impact are management of depression and anxiety and the importance of appropriate pain management in decreasing LOS [12, 24]. Further research into anesthesia (in relation to pain management, ASA score, and operative anesthesia administration) should be conducted to improve this pathway.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of a Joint Replacement Surgical Home Model Clinical Pathway

Chaurasia

Garson

Kain

et al. 2014

BioMed Research International

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Optimizing perioperative care to provide maximum benefit at minimum cost may be best achieved using a perioperative clinical pathway (PCP). Using our joint replacement surgical home (JSH) model PCP, we examined length of stay (LOS) following total joint arthroplasty (TJA) to evaluate patient care optimization. We reviewed a spectrum of clinical measurements in 190 consecutive patients who underwent TJA. Patients who had surgery earlier in the week and who were earlier cases of the day had a significantly lower LOS than patients whose cases started both later in the week and later in the day. Patients discharged home had significantly lower LOS than those discharged to a secondary care facility. Patients who received regional versus general anesthesia had a significantly lower LOS. Scheduling patients discharged to home and who will likely receive regional anesthesia for the earliest morning slot and earlier in the week may help decrease overall LOS.

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Recovery after total intravenous general anaesthesia or spinal anaesthesia for total knee arthroplasty: a randomized trial

Abstract: GA had more favourable recovery effects after TKA compared with SA.

Cited by 116 publications

References 21 publications

Factors associated with acute and chronic pain after inguinal herniorraphy

Factors associated with acute and chronic pain after inguinal herniorraphy

The effect of pregabalin and s-ketamine in total knee arthroplasty patients: A randomized trial

Outcomes of a Joint Replacement Surgical Home Model Clinical Pathway

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