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

TY - JOUR

T1 - Recovery after total intravenous general anaesthesia or spinal anaesthesia for total knee arthroplasty

T2 - a randomized trial

AU - Harsten, A

AU - Kehlet, H

AU - Toksvig-Larsen, S

PY - 2013/9

Y1 - 2013/9

N2 - BackgroundThis study was undertaken to compare the effects of general anaesthesia (GA) and spinal anaesthesia (SA) on the need for postoperative hospitalization and early postoperative comfort in patients undergoing fast-track total knee arthroplasty (TKA).MethodsOne hundred and twenty subjects were randomly allocated to receive either intrathecal bupivacaine (SA group) or GA with target controlled infusion of propofol and remifentanil (GA group). Primary outcome was length of hospital stay (LOS) defined as time from end of surgery until the subject met the hospital discharge criteria. Secondary outcome parameters included actual time of discharge, postoperative pain, intraoperative blood loss, length of stay in the Post Anaesthesia Care Unit, dizziness, postoperative nausea and vomiting, need for urinary catheterization and subject satisfaction.ResultsGA resulted in shorter LOS (46 vs 52 h, P<0.001), and less nausea and vomiting (4 vs 15, P<0.05) and dizziness (VAS 0 mm vs 20 mm, P<0.05) compared with SA. During the first 2 postoperative hours, GA patients had higher pain scores (P<0.001), but after 6 h the SA group had significantly higher pain scores (P<0.001). Subjects in the GA group used fewer patient-controlled analgesia doses and less morphine (P<0.01), and were able to walk earlier compared with the SA group (P<0.001). Subjects receiving SA would request a change in the method of anaesthesia in the event of a subsequent operation more often than the GA subjects (P<0.05).ConclusionGA had more favourable recovery effects after TKA compared with SA.

AB - BackgroundThis study was undertaken to compare the effects of general anaesthesia (GA) and spinal anaesthesia (SA) on the need for postoperative hospitalization and early postoperative comfort in patients undergoing fast-track total knee arthroplasty (TKA).MethodsOne hundred and twenty subjects were randomly allocated to receive either intrathecal bupivacaine (SA group) or GA with target controlled infusion of propofol and remifentanil (GA group). Primary outcome was length of hospital stay (LOS) defined as time from end of surgery until the subject met the hospital discharge criteria. Secondary outcome parameters included actual time of discharge, postoperative pain, intraoperative blood loss, length of stay in the Post Anaesthesia Care Unit, dizziness, postoperative nausea and vomiting, need for urinary catheterization and subject satisfaction.ResultsGA resulted in shorter LOS (46 vs 52 h, P<0.001), and less nausea and vomiting (4 vs 15, P<0.05) and dizziness (VAS 0 mm vs 20 mm, P<0.05) compared with SA. During the first 2 postoperative hours, GA patients had higher pain scores (P<0.001), but after 6 h the SA group had significantly higher pain scores (P<0.001). Subjects in the GA group used fewer patient-controlled analgesia doses and less morphine (P<0.01), and were able to walk earlier compared with the SA group (P<0.001). Subjects receiving SA would request a change in the method of anaesthesia in the event of a subsequent operation more often than the GA subjects (P<0.05).ConclusionGA had more favourable recovery effects after TKA compared with SA.

U2 - 10.1093/bja/aet104

DO - 10.1093/bja/aet104

M3 - Journal article

C2 - 23578860

SN - 0007-0912

VL - 111

SP - 391

EP - 399

JO - British Journal of Anaesthesia

JF - British Journal of Anaesthesia

IS - 3

ER -