Total intravenous general anaesthesia vs. spinal anaesthesia for total hip arthroplasty: a randomised, controlled trial

TY - JOUR

T1 - Total intravenous general anaesthesia vs. spinal anaesthesia for total hip arthroplasty

T2 - a randomised, controlled trial

AU - Harsten, A

AU - Kehlet, H

AU - Ljung, P

AU - Toksvig-Larsen, S

N1 - © 2014 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

PY - 2015/3/1

Y1 - 2015/3/1

N2 - Background: The choice of anaesthetic technique for patients undergoing joint arthroplasty is debatable. The hypothesis of this study was that general anaesthesia would generate a more favourable recovery profile than spinal anaesthesia. Methods: We randomly allocated 120 patients to either intrathecal bupivacaine or general anaesthesia with target-controlled infusion of remifentanil and propofol. Length of hospital stay assessed as meeting discharge criteria was the primary outcome parameter. Other outcome parameters were actual time of discharge, pain, use of rescue pain medication, blood loss, length of stay in the postoperative care unit, dizziness, post-operative nausea, need of urinary catheterisation and patient satisfaction. Results: General anaesthesia resulted in slightly reduced length of hospital stay (26 vs. 30 h, P = 0.004), less nausea (P = 0.043) and dizziness (P < 0.001). General anaesthesia patients had higher pain scores during the first two post-operative hours (P < 0.001) but lower after 6 h compared with the spinal anaesthesia group (P < 0.01 and P < 0.05). General anaesthesia patients had better orthostatic function compared with spinal anaesthesia patients (P = 0.008). Patients in the spinal anaesthesia group fulfilled the discharge criteria from the post-operative care unit earlier compared with the general anaesthesia patients (P = 0.004). General anaesthesia patients requested a change in the method of anaesthesia for a subsequent operation less often than the spinal anaesthesia patients (5 vs. 13, P = 0.022). Conclusion: General anaesthesia resulted in a more favourable recovery profile compared with spinal anaesthesia.

AB - Background: The choice of anaesthetic technique for patients undergoing joint arthroplasty is debatable. The hypothesis of this study was that general anaesthesia would generate a more favourable recovery profile than spinal anaesthesia. Methods: We randomly allocated 120 patients to either intrathecal bupivacaine or general anaesthesia with target-controlled infusion of remifentanil and propofol. Length of hospital stay assessed as meeting discharge criteria was the primary outcome parameter. Other outcome parameters were actual time of discharge, pain, use of rescue pain medication, blood loss, length of stay in the postoperative care unit, dizziness, post-operative nausea, need of urinary catheterisation and patient satisfaction. Results: General anaesthesia resulted in slightly reduced length of hospital stay (26 vs. 30 h, P = 0.004), less nausea (P = 0.043) and dizziness (P < 0.001). General anaesthesia patients had higher pain scores during the first two post-operative hours (P < 0.001) but lower after 6 h compared with the spinal anaesthesia group (P < 0.01 and P < 0.05). General anaesthesia patients had better orthostatic function compared with spinal anaesthesia patients (P = 0.008). Patients in the spinal anaesthesia group fulfilled the discharge criteria from the post-operative care unit earlier compared with the general anaesthesia patients (P = 0.004). General anaesthesia patients requested a change in the method of anaesthesia for a subsequent operation less often than the spinal anaesthesia patients (5 vs. 13, P = 0.022). Conclusion: General anaesthesia resulted in a more favourable recovery profile compared with spinal anaesthesia.

KW - Aged

KW - Anesthesia, General

KW - Anesthesia, Intravenous

KW - Anesthesia, Spinal

KW - Anesthetics, Intravenous

KW - Anesthetics, Local

KW - Arthroplasty, Replacement, Hip

KW - Bupivacaine

KW - Female

KW - Humans

KW - Length of Stay

KW - Male

KW - Patient Satisfaction

KW - Piperidines

KW - Postoperative Complications

KW - Prospective Studies

U2 - 10.1111/aas.12456

DO - 10.1111/aas.12456

M3 - Journal article

C2 - 25522681

SN - 0001-5172

VL - 59

SP - 298

EP - 309

JO - Acta Anaesthesiologica Scandinavica

JF - Acta Anaesthesiologica Scandinavica

IS - 3

ER -