Ropivacaine Epidural Anesthesia and Analgesia Versus General Anesthesia and Intravenous Patient-Controlled Analgesia with Morphine in the Perioperative Management of Hip Replacement

Wulf, Hinnerk; Biscoping, J.; Beland, Benjamin; Bachmann-Mennenga, B.; Motsch, J.

doi:10.1213/00000539-199907000-00019

Cited by 65 publications

(16 citation statements)

References 25 publications

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“…19,20 Two studies generated more than one publication each, but were counted only once. 6,[21][22][23] Finally, 21 studies were included in the review [3][4][5][6]8,9,[12][13][14]21,[24][25][26][27][28][29][30][31][32][33][34] (Table I). We assessed the presence of publication bias by examining funnel plots which displayed the studies included in the metaanalysis in a plot of effect size against sample size.…”

Section: Resultsmentioning

confidence: 99%

“…Data on the operating time were found in 17 studies with a total of 1483 patients. [3][4][5][6]12,13,21,[24][25][26][27][28][29][30][31][32][33] There was a decrease in the length of the operating time with regional compared with general anaesthesia (standard mean difference -0.12; 95% CI -0.23 to -0.021; Fig. 1).…”

Section: Resultsmentioning

confidence: 99%

“…Three studies recorded the length of hospital stay. 29,32,33 There was no discernible difference between the groups (standardised mean difference -0.55; 95% CI -2.47 to +1.37; Table II).…”

Section: Study Number Of Regional Anaesthesia Number Of General Anaesmentioning

confidence: 93%

“…Continuous epidural Duration of surgery, blood loss, DVT, PE Modig et al 4 THR Continuous epidural Duration of surgery, blood loss, DVT, PE Modig et al 5 THR Continuous epidural Duration of surgery, blood loss, DVT, PE Davis et al 6 ‡ THR Spinal Duration of surgery, blood loss, number of patients transfused, DVT, PE Jørgensen et al 8 TKR Continuous epidural DVT, PE Nielsen et al 9 TKR Continuous epidural DVT Brueckner et al 12 THR Spinal Duration of surgery, blood loss Planes et al 13 THR Spinal Duration of surgery, blood loss, DVT Mitchell et al 14 TKR Continuous epidural DVT Borghi et al 21 ‡ THR Continuous epidural Duration of surgery, blood loss, number of patients transfused Gonano et al 24 THR or TKR Spinal Duration of surgery Lattermann et al 25 THR Combined spinal and epidural Duration of surgery, blood loss Kita et al 26 THR Continuous epidural Duration of surgery, blood loss, length of hospital stay Kudoh et al 27 TKR Spinal Duration of surgery, blood loss, PONV Modig and Karlstrom 28 THR Continuous epidural Duration of surgery, blood loss Wulf et al 29 THR Continuous epidural Duration of surgery, length of hospital stay Donatelli et al 30 THR or TKR Continuous epidural Duration of surgery, blood loss, number of patients transfused Hole et al 31 THR Single-injection epidural Duration of surgery, PE Jones et al 32 THR or TKR Spinal Duration of surgery, number of patients transfused, length of hospital stay, DVT, PE mortality Williams-Russo et al 33 TKR Continuous epidural Duration of surgery, blood loss, DVT, PE Keith 34 THR Single-injection epidural Blood loss, number of patients transfused * THR, total hip replacement; TKR, total knee replacement † DVT, deep-vein thrombosis; PE, pulmonary embolism; PONV, post-operative nausea and vomiting ‡ the data of the two publications of Davis et al (6,20) were from the same group as were those presented by Borghi et al (21,22) in their two publications…”

Section: Modig Et Al 3 Thrmentioning

confidence: 99%

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A comparison of regional and general anaesthesia for total replacement of the hip or knee

Zhang

Hua

et al. 2009

The Journal of Bone and Joint Surgery. British volume

207

117

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We performed a meta-analysis to evaluate the relative efficacy of regional and general anaesthesia in patients undergoing total hip or knee replacement. A comprehensive search for relevant studies was performed in PubMed (1966 to April 2008), EMBASE (1969 to April 2008) and the Cochrane Library. Only randomised studies comparing regional and general anaesthesia for total hip or knee replacement were included. We identified 21 independent, randomised clinical trials. A random-effects model was used to calculate all effect sizes. Pooled results from these trials showed that regional anaesthesia reduces the operating time (odds ratio (OR) -0.19; 95% confidence interval (CI) -0.33 to -0.05), the need for transfusion (OR 0.45; 95% CI 0.22 to 0.94) and the incidence of thromboembolic disease (deep-vein thrombosis OR 0.45, 95% CI 0.24 to 0.84; pulmonary embolism OR 0.46, 95% CI 0.29 to 0.80). Regional anaesthesia therefore seems to improve the outcome of patients undergoing total hip or knee replacement.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“…Three studies recorded the length of hospital stay. 29,32,33 There was no discernible difference between the groups (standardised mean difference -0.55; 95% CI -2.47 to +1.37; Table II).…”

Section: Study Number Of Regional Anaesthesia Number Of General Anaesmentioning

confidence: 93%

Section: Modig Et Al 3 Thrmentioning

confidence: 99%

See 2 more Smart Citations

A comparison of regional and general anaesthesia for total replacement of the hip or knee

Zhang

Hua

et al. 2009

The Journal of Bone and Joint Surgery. British volume

207

117

View full text Add to dashboard Cite

show abstract

“…In the only trial that commented on postoperative cognitive deficit after THA, those patients who received EA had 'superior mental clarity and cooperativeness' compared with the GA group. 78 The method of assessment for cognition was unclear.…”

Section: Cognitive Deficitmentioning

confidence: 99%

Does regional anaesthesia improve outcome after total hip arthroplasty? A systematic review

Macfarlane

Prasad

Chan

et al. 2009

British Journal of Anaesthesia

176

114

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Total hip arthroplasty (THA) is amenable to a variety of regional anaesthesia (RA) techniques that may improve patient outcome. We sought to answer whether RA decreased mortality, cardiovascular morbidity, deep venous thrombosis (DVT) and pulmonary embolism (PE), blood loss, duration of surgery, pain, opioid-related adverse effects, cognitive defects, and length of stay. We also questioned whether RA improved rehabilitation. To do so, we performed a systematic review of the contemporary literature to compare general anaesthesia (GA) and RA and also systemic and regional analgesia for THA. To reflect contemporary surgical and anaesthetic practice, only randomized controlled trials (RCTs) from 1990 onward were included. We identified 18 studies involving 1239 patients. Only two of the 18 trials were of Level I quality. There is insufficient evidence from RCTs alone to conclude if anaesthetic technique influenced mortality, cardiovascular morbidity, or the incidence of DVT and PE when using thromboprophylaxis. Blood loss may be reduced in patients receiving RA rather than GA for THA. Our review suggests that there is no difference in duration of surgery in patients who receive GA or RA. Compared with systemic analgesia, regional analgesia can reduce postoperative pain, morphine consumption, and nausea and vomiting. Length of stay is not reduced and rehabilitation does not appear to be facilitated by RA or analgesia for THA.

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Epidural analgesia for pain relief following hip or knee replacement

Choi

Bhandari

Scott

et al. 2003

Cochrane Database of Systematic Reviews

214

182

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Ropivacaine Epidural Anesthesia and Analgesia Versus General Anesthesia and Intravenous Patient-Controlled Analgesia with Morphine in the Perioperative Management of Hip Replacement

Cited by 65 publications

References 25 publications

A comparison of regional and general anaesthesia for total replacement of the hip or knee

A comparison of regional and general anaesthesia for total replacement of the hip or knee

Does regional anaesthesia improve outcome after total hip arthroplasty? A systematic review

Epidural analgesia for pain relief following hip or knee replacement

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