Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Kaltenegger, L.
A Comparison between Spinal Anesthesia versus General Anesthesia with and without the Use of Peripheral Nerve Blocks in Total Knee Arthroplasty.
Humanmedizin; [ Diplomarbeit ] Graz Medical University; 2020. pp. 77
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- Autor*innen der Med Uni Graz:
- Betreuer*innen:
- Hauer Georg
- Sadoghi Patrick
- Schittek Gregor Alexander
- Altmetrics:
- Abstract:
- Background Total knee arthroplasty (TKA) is one of the most performed surgeries and there have been a lot of debates to determine the best anesthetic approach, including general anesthesia, spinal anesthesia, with or without peripheral nerve blocks. The aim of this study was to analyze and compare the different anesthetic methods for TKA and their effects on the postoperative clinical outcome. Patients and Methods In the period from January 2018 until February 2019, 656 patients underwent primary TKA in University Hospital of Graz. The patients were divided into four groups according their received anesthesia: general anesthesia and spinal anesthesia, with and without peripheral nerve block. One to 24 months after operation, the effects of those anesthetic techniques on the postoperative clinical outcome were retrospectively examined. The main focus was on the effect on the opioid consume and on the perception of pain. Secondary emphasis was placed on mortality and complication rates, blood management, anesthetic induction time, hospitalization time and other parameters of the postoperative course. Results Of 656 patients, 425 (64.8%) received general anesthesia and 231 (35.2%) spinal anesthesia when undergoing TKA. Multivariable analysis revealed significantly lower total opioid intake when applying spinal anesthesia by 2.08 mg (95% CI 0.1-4.1, P<0.04) of morphine-equivalent and a reduction of 6.95 minutes (95% CI 5.17–8.72, P<0.001) till skin incision. In return, a higher perioperative blood loss of 90.1 ml (CI 95% 17.91–162.23, P=0.015) was observed. The application of a peripheral nerve block achieved a reduction of early-postoperative piritramide intake of 3.59 mg (95% CI 1.5-5.7, P=0.001), but lengthened induction time by 8.48 minutes (95% CI 6.63–10.36, P<0.001). No statistically significant differences were found regarding the complication and mortality rate, need of blood transfusions, length of stay, time until gait training started, and postoperative flexibility (P>0.05). Conclusion In this study, shorter anesthetic induction times and lower postoperative opioid dosages were observed for patients undergoing total knee arthroplasty with spinal anesthesia. The additional implementation of peripheral nerve blocks led to a lower need for opioids and to lower pain levels in the early postoperative phase.