Incidence and related factors for intraoperative failed spinal anaesthesia for lower limb arthroplasty

E K Aasvang; M B Laursen; J Madsen; M Krøigaard; S Solgaard; P Kjaersgaard-Andersen; H Mandøe; T B Hansen; J U Nielsen; N Krarup; A E Skøtt; H Kehlet

doi:10.1111/aas.13118

Incidence and related factors for intraoperative failed spinal anaesthesia for lower limb arthroplasty

E K Aasvang, M B Laursen, J Madsen, M Krøigaard, S Solgaard, P Kjaersgaard-Andersen, H Mandøe, T B Hansen, J U Nielsen, N Krarup, A E Skøtt, H Kehlet

Department of Clinical Medicine

5 Citations (Scopus)

Abstract

Background: Spinal anaesthesia is the preferred choice for total hip- and knee arthroplasty (THA/TKA), due to the claimed superior outcome profile, relative simple technique and without the need for advanced airway support. However, choosing and informing about spinal anaesthesia should also include the risk for intraoperative failed spinal anaesthesia with associated pain, discomfort and suboptimal settings for airway management. Small-scale studies suggest incidences from 1 to 17%; however, no multi-institutional large data exists on failed spinal incidence and related factors during THA/TKA, hindering evidence-based information and potential anaesthesia stratification. Methods: In a sub-analysis, data from a prospective study on spinal anaesthesia for THA/TKA were examined for incidence of intraoperative conversion to general anaesthesia. Potential perioperative factors (age, gender, American Society of Anaesthesiologist (ASA) score, height, weight, BMI, procedure, bupivacaine dosage and duration of time from spinal administration until end of surgery) were analysed with logistic regression for relation to failed spinal anaesthesia. Results: In all, 1451 patients were included for analysis, whereof 57 (3.9%) had failed spinal anaesthesia. Spinal failure patients were significantly younger (61 vs. 67 years, P = 0.003), and operation time longer in the failed spinal group vs no-failure, respectively (133 vs. 89 min, P < 0.001). No significant differences were found with regard to bupivacaine volume, gender, ASA-score, height, weight, BMI or THA vs. TKA. Conclusion: Failed spinal anaesthesia for THA and TKA is a relatively frequent occurrence and identification of risk patients is not feasible. These results should be considered when choosing anaesthesia and included in the information to patients.

Original language	English
Journal	Acta Anaesthesiologica Scandinavica
Volume	62
Issue number	7
Pages (from-to)	993-1000
Number of pages	8
ISSN	0001-5172
DOIs	https://doi.org/10.1111/aas.13118
Publication status	Published - Aug 2018

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10.1111/aas.13118

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Aasvang, E. K., Laursen, M. B., Madsen, J., Krøigaard, M., Solgaard, S., Kjaersgaard-Andersen, P., Mandøe, H., Hansen, T. B., Nielsen, J. U., Krarup, N., Skøtt, A. E., & Kehlet, H. (2018). Incidence and related factors for intraoperative failed spinal anaesthesia for lower limb arthroplasty. Acta Anaesthesiologica Scandinavica, 62(7), 993-1000. https://doi.org/10.1111/aas.13118

Aasvang, EK, Laursen, MB, Madsen, J, Krøigaard, M, Solgaard, S, Kjaersgaard-Andersen, P, Mandøe, H, Hansen, TB, Nielsen, JU, Krarup, N, Skøtt, AE & Kehlet, H 2018, 'Incidence and related factors for intraoperative failed spinal anaesthesia for lower limb arthroplasty', Acta Anaesthesiologica Scandinavica, vol. 62, no. 7, pp. 993-1000. https://doi.org/10.1111/aas.13118

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title = "Incidence and related factors for intraoperative failed spinal anaesthesia for lower limb arthroplasty",

abstract = "Background: Spinal anaesthesia is the preferred choice for total hip- and knee arthroplasty (THA/TKA), due to the claimed superior outcome profile, relative simple technique and without the need for advanced airway support. However, choosing and informing about spinal anaesthesia should also include the risk for intraoperative failed spinal anaesthesia with associated pain, discomfort and suboptimal settings for airway management. Small-scale studies suggest incidences from 1 to 17%; however, no multi-institutional large data exists on failed spinal incidence and related factors during THA/TKA, hindering evidence-based information and potential anaesthesia stratification. Methods: In a sub-analysis, data from a prospective study on spinal anaesthesia for THA/TKA were examined for incidence of intraoperative conversion to general anaesthesia. Potential perioperative factors (age, gender, American Society of Anaesthesiologist (ASA) score, height, weight, BMI, procedure, bupivacaine dosage and duration of time from spinal administration until end of surgery) were analysed with logistic regression for relation to failed spinal anaesthesia. Results: In all, 1451 patients were included for analysis, whereof 57 (3.9%) had failed spinal anaesthesia. Spinal failure patients were significantly younger (61 vs. 67 years, P = 0.003), and operation time longer in the failed spinal group vs no-failure, respectively (133 vs. 89 min, P < 0.001). No significant differences were found with regard to bupivacaine volume, gender, ASA-score, height, weight, BMI or THA vs. TKA. Conclusion: Failed spinal anaesthesia for THA and TKA is a relatively frequent occurrence and identification of risk patients is not feasible. These results should be considered when choosing anaesthesia and included in the information to patients.",

author = "Aasvang, {E K} and Laursen, {M B} and J Madsen and M Kr{\o}igaard and S Solgaard and P Kjaersgaard-Andersen and H Mand{\o}e and Hansen, {T B} and Nielsen, {J U} and N Krarup and Sk{\o}tt, {A E} and H Kehlet",

year = "2018",

month = aug,

doi = "10.1111/aas.13118",

language = "English",

volume = "62",

pages = "993--1000",

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TY - JOUR

T1 - Incidence and related factors for intraoperative failed spinal anaesthesia for lower limb arthroplasty

AU - Aasvang, E K

AU - Laursen, M B

AU - Madsen, J

AU - Krøigaard, M

AU - Solgaard, S

AU - Kjaersgaard-Andersen, P

AU - Mandøe, H

AU - Hansen, T B

AU - Nielsen, J U

AU - Krarup, N

AU - Skøtt, A E

AU - Kehlet, H

PY - 2018/8

Y1 - 2018/8

N2 - Background: Spinal anaesthesia is the preferred choice for total hip- and knee arthroplasty (THA/TKA), due to the claimed superior outcome profile, relative simple technique and without the need for advanced airway support. However, choosing and informing about spinal anaesthesia should also include the risk for intraoperative failed spinal anaesthesia with associated pain, discomfort and suboptimal settings for airway management. Small-scale studies suggest incidences from 1 to 17%; however, no multi-institutional large data exists on failed spinal incidence and related factors during THA/TKA, hindering evidence-based information and potential anaesthesia stratification. Methods: In a sub-analysis, data from a prospective study on spinal anaesthesia for THA/TKA were examined for incidence of intraoperative conversion to general anaesthesia. Potential perioperative factors (age, gender, American Society of Anaesthesiologist (ASA) score, height, weight, BMI, procedure, bupivacaine dosage and duration of time from spinal administration until end of surgery) were analysed with logistic regression for relation to failed spinal anaesthesia. Results: In all, 1451 patients were included for analysis, whereof 57 (3.9%) had failed spinal anaesthesia. Spinal failure patients were significantly younger (61 vs. 67 years, P = 0.003), and operation time longer in the failed spinal group vs no-failure, respectively (133 vs. 89 min, P < 0.001). No significant differences were found with regard to bupivacaine volume, gender, ASA-score, height, weight, BMI or THA vs. TKA. Conclusion: Failed spinal anaesthesia for THA and TKA is a relatively frequent occurrence and identification of risk patients is not feasible. These results should be considered when choosing anaesthesia and included in the information to patients.

AB - Background: Spinal anaesthesia is the preferred choice for total hip- and knee arthroplasty (THA/TKA), due to the claimed superior outcome profile, relative simple technique and without the need for advanced airway support. However, choosing and informing about spinal anaesthesia should also include the risk for intraoperative failed spinal anaesthesia with associated pain, discomfort and suboptimal settings for airway management. Small-scale studies suggest incidences from 1 to 17%; however, no multi-institutional large data exists on failed spinal incidence and related factors during THA/TKA, hindering evidence-based information and potential anaesthesia stratification. Methods: In a sub-analysis, data from a prospective study on spinal anaesthesia for THA/TKA were examined for incidence of intraoperative conversion to general anaesthesia. Potential perioperative factors (age, gender, American Society of Anaesthesiologist (ASA) score, height, weight, BMI, procedure, bupivacaine dosage and duration of time from spinal administration until end of surgery) were analysed with logistic regression for relation to failed spinal anaesthesia. Results: In all, 1451 patients were included for analysis, whereof 57 (3.9%) had failed spinal anaesthesia. Spinal failure patients were significantly younger (61 vs. 67 years, P = 0.003), and operation time longer in the failed spinal group vs no-failure, respectively (133 vs. 89 min, P < 0.001). No significant differences were found with regard to bupivacaine volume, gender, ASA-score, height, weight, BMI or THA vs. TKA. Conclusion: Failed spinal anaesthesia for THA and TKA is a relatively frequent occurrence and identification of risk patients is not feasible. These results should be considered when choosing anaesthesia and included in the information to patients.

U2 - 10.1111/aas.13118

DO - 10.1111/aas.13118

M3 - Journal article

C2 - 29578248

SN - 0001-5172

VL - 62

SP - 993

EP - 1000

JO - Acta Anaesthesiologica Scandinavica

JF - Acta Anaesthesiologica Scandinavica

IS - 7

ER -

Incidence and related factors for intraoperative failed spinal anaesthesia for lower limb arthroplasty

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