Spinal anaesthesia versus general anaesthesia (SAGA) on recovery after hip and knee arthroplasty: A study protocol for three randomized, single‐blinded, multi‐centre, clinical trials

Abstract

Mobilisation difficulties, due to muscle weakness, and urinary retention are common reasons for prolonged admission following hip and knee arthroplasty procedures. Whether spinal anaesthesia is detrimental to early mobilisation is controversial. Previous studies have reported differences in post‐operative recovery between spinal anaesthesia and general anaesthesia; however, up‐to‐date comparisons in fast‐track setups are needed. Our randomized, single‐blinded, multi‐centre, clinical trials aim to compare the post‐operative recovery after total hip (THA), total knee (TKA), and unicompartmental knee arthroplasties (UKA) respectively when using either spinal anaesthesia (SA) or general anaesthesia (GA) in a fast‐track setup. Included patients (74 THA, 74 TKA, and 74 UKA patients) are randomized (1:1) to receive either SA (2 mL 0.5% Bupivacaine) or GA (Induction: Propofol 1.0–2.0 mg/kg iv with Remifentanil 3–5 mcg/kg iv. Infusion: Propofol 3–5 mg/kg/h and Remifentanil 0.5 mcg/kg/min iv). Patients undergo standard primary unilateral hip and knee arthroplasty procedures in an optimized fast‐track setup with intraoperative local infiltrative analgesia in TKA and UKA, post‐operative multimodal opioid sparing analgesia, immediate mobilisation with full weightbearing, no drains and in‐hospital only thromboprophylaxis. Data will be collected on the day of surgery and until patients are discharged. The primary outcome is the ability to be safely mobilised during a 5‐m walking test within 6 h of surgery. Secondary outcomes include fulfilment of discharge criteria, post‐operative pain, dizziness, and nausea as well as patient reported recovery and opioid related side effects. Data will also be gathered on all hospital contacts within 30‐days of surgery. This study will offer insights into advantages and disadvantages of anaesthetic methods used in fast‐track arthroplasty surgery.

Response to Letter to the Editor on “Spinal anesthesia versus general anesthesia (SAGA) on recovery after hip and knee arthroplasty: A study protocol for three randomized, single‐blinded, multi‐center, clinical trials”

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We would like to thank Endersby et al for their interest in our study protocol and for contributing to the discussion regarding the choice of anesthesia for hip and knee arthroplasty in a fast-track setting. 1,2 The authors provided a great summary of the emerging evidence supporting the promising newer short-acting local anesthetics (LA) in spinal anesthesia (SA), 3-5 such as mepivacaine. The prospect of earlier discharge, rapid safe mobilization, and earlier return of muscle and urinary function align well with the aims of fast-track surgery.However, as the authors state, bupivacaine remains the most widely used LA in SA for hip and knee arthroplasties.

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