Comparison of General and Spinal Anaesthesia on Systemic Inflammatory Response in Patients Undergoing Total Knee Arthroplasty: A Propensity Score Matching Analysis

Abstract

Background and Objectives: Some of the postoperative complications following orthopaedic surgeries are associated with a systemic inflammatory response (SIR), which varies depending on the anaesthetic technique. We aimed to compare the effects of general and spinal anaesthesia on the SIR after total knee arthroplasty (TKA), based on C-reactive protein (CRP) levels, the platelet-lymphocyte ratio (PLR), and the neutrophil-lymphocyte ratio (NLR). Materials and Methods: Patients who underwent TKA between January 2014 and December 2018 were included. Electronic medical records of the patients were retrospectively reviewed and analysed. To reduce the impact of potential confounding factors, we performed propensity score matching according to the anaesthetic technique. Results: A total of 1311 TKA cases were analysed. After propensity score matching, the maximal CRP value and changes in CRP levels in the general anaesthesia group were higher than those in the spinal anaesthesia group. However, the maximal NLR and PLR and the changes in NLR and PLR were not different between the two groups. There were no differences in postoperative clinical outcomes. Conclusion: Spinal anaesthesia tended to induce a lower inflammatory response than general anaesthesia when considering CRP levels in patients undergoing TKA. However, the effects of anaesthetic techniques on the overall outcomes were not significant.

Comparison of general and regional anesthesia on short-term complications in patients undergoing total knee arthroplasty: A retrospective study using national health insurance service-national sample cohort

“…Several studies have claimed many benefits of RA, such as reducing wound infections, transfusions, thromboembolic events, including MI and stroke, length of stay, and operation time. [8][9][10][11] However, other researchers have reported that there is no significant difference in the serious adverse events, including thromboembolic events and surgical site infections, transfusions, and length of stay between RA and GA. [12][13][14] In this study, contrary to our expectations, 30-day mortality, transfusion rate, hospital stay, and most complications, including delirium, were not significantly different between the GA and RA groups. This may be due to the overall decline in the incidence of complications with advances in the management of patients receiving TKA.…”

“…Several studies have claimed many benefits of RA, such as reducing wound infections, transfusions, thromboembolic events, including MI and stroke, length of stay, and operation time. [8–11] However, other researchers have reported that there is no significant difference in the serious adverse events, including thromboembolic events and surgical site infections, transfusions, and length of stay between RA and GA. [12–14]…”

“…[8][9][10][11] Conversely, other researchers have reported no significant differences in blood transfusion, pain control, and complications between GA and RA. [12][13][14] As the volume of TKA increases, so does the number of studies on TKA. However, most of the research is based on Western populations; however, research based on Asian populations is scarce.…”

“…[8–11] Conversely, other researchers have reported no significant differences in blood transfusion, pain control, and complications between GA and RA. [12–14]…”

Effects of Intravenous Anesthetic Drugs on Leukocytes for Patients Undergoing Surgery: A Diagnostic Clinical study

“…An interpretation on the effect of anesthetic practice on post-operative natural killer T-lymphocytes also declared no difference in the nerve block anesthesia group comparison to the general anesthesia group (12).…”