General vs Neuraxial Anesthesia in Direct Anterior Approach Total Hip Arthroplasty: Effect on Length of Stay and Early Pain Control

Kelly, McKayla; Turcotte, Justin; Aja, Jacob M.; MacDonald, James; King, Paul J.

doi:10.1016/j.arth.2020.09.050

Cited by 15 publications

(7 citation statements)

References 29 publications

(50 reference statements)

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“…Our series supports this claim and demonstrated a reduction in PACU length of stay of 25 minutes as well as a modest reduction in hospital length of stay of 0.1 day in patients treated with spinal anesthesia. Although small, this difference of 0.1 day is comparable with prior investigations that demonstrated spinal anesthesia’s association with significant reductions in hospital length of stay ranging from 0.1 to 0.6 day 29-32 . Likewise, aggregate data from the largest systematic review evaluating the outcomes of anesthetic techniques in total joint arthroplasties have suggested that spinal anesthesia afforded a 0.4-day reduction in hospital length of stay 12 .…”

Section: Discussionsupporting

confidence: 82%

Spinal Compared with General Anesthesia in Contemporary Primary Total Hip Arthroplasties

Owen¹,

Amundson²,

Fruth³

et al. 2022

Journal of Bone and Joint Surgery

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Background: The specific advantages of spinal anesthesia compared with general anesthesia for primary total hip arthroplasty (THA) remains unknown. Therefore, this study aimed to investigate the pain control, length of stay, and postoperative outcomes associated with spinal anesthesia compared with general anesthesia in a large cohort of primary THAs from a single, high-volume academic institution.Methods: We retrospectively identified 13,730 primary THAs (11,319 patients) from 2001 to 2016 using our total joint registry. Of these cases, 58% had general anesthesia and 42% had spinal anesthesia. The demographic characteristics were similar between groups, with mean age of 64 years, 51% female, and mean body mass index (BMI) of 31 kg/m 2 . Data were analyzed using an inverse probability of treatment weighted model based on a propensity score that accounted for numerous patient and operative factors. The mean follow-up was 6 years.Results: Patients treated with spinal anesthesia had lower Numeric Pain Rating Scale (NPRS) scores (p < 0.001) and required fewer postoperative oral morphine equivalents (OMEs) at all time points evaluated (p < 0.001). Patients treated with spinal anesthesia also had shorter hospital length of stay (p = 0.02), fewer altered mental status events (odds ratio [OR], 0.7; p = 0.02), and fewer intensive care unit (ICU) admissions (OR, 0.7; p = 0.01). There was no difference in the incidence of deep vein thrombosis (p = 0.8), pulmonary embolism (p = 0.4), 30-day readmissions (p = 0.17), 90-day readmissions (p = 0.18), all-cause revisions (p = 0.17), or all-cause reoperations (p = 0.14). Conclusions:In this large, single-institution study, we found that spinal anesthesia was associated with reduced pain scores and OME use postoperatively. Furthermore, spinal anesthesia resulted in fewer altered mental status events and ICU admissions. These data favor the use of spinal anesthesia in primary THAs.

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Section: Discussionsupporting

confidence: 82%

Spinal Compared with General Anesthesia in Contemporary Primary Total Hip Arthroplasties

Owen¹,

Amundson²,

Fruth³

et al. 2022

Journal of Bone and Joint Surgery

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“…Studies have shown that neuraxial anesthesia is associated with a reduction in length of hospital stay when compared with general anesthesia 13 24 25. For example, a recent study by Kelly et al 29 comparing neuraxial to general anesthesia in 500 total hip arthroplasty patients at their institution found a significant reduction in length of hospital stay in the neuraxial group (32.7 hours, SD 14.8 vs 38.1 hours, SD 24, p=0.003). However, these studies did not exclusively look at outpatient total joint patients where patients are expected to be discharged from the PACU.…”

Section: Discussionmentioning

confidence: 99%

Neuraxial and general anesthesia for outpatient total joint arthroplasty result in similarly low rates of major perioperative complications: a multicentered cohort study

Yap

Wei

Webb

et al. 2022

Reg Anesth Pain Med

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BackgroundNeuraxial anesthesia when compared with general anesthesia has shown to improve outcomes following lower extremity total joint arthroplasty. It is unclear whether these benefits are present in outpatient surgery given the selection of healthier patients.ObjectiveTo compare the effects of neuraxial versus general anesthesia on outcomes following ambulatory hip and knee arthroplasty.MethodsMulticentered retrospective cohort study in ambulatory hip or knee arthroplasty patients between January 2017 and December 2019. Primary endpoint examined 30-day major postoperative complications (mortality, myocardial infarction, deep venous thromboembolism, pulmonary embolism, stroke, and acute renal failure).ResultsOf 11 523 eligible patients identified, 10 003 received neuraxial anesthesia, while 1520 received general anesthesia. 30-day major complications did not differ between neuraxial anesthesia and general anesthesia groups (1.8% vs 2.3%; aOR=0.85, CI: 0.56 to 1.27, p=0.39). There was no difference in 30-day minor complications (surgical site infection, pneumonia, urinary tract infection; 3.3% vs 4.1%; aOR=0.83, CI: 0.62 to 1.14, p=0.23). The neuraxial group demonstrated reduced pain and analgesia requirements and had less postoperative nausea and vomiting (PONV). Median recovery room length of stay was shorter by 52 min in the general anesthesia group, but these patients were more likely to fail same day discharge (33% vs 23.4%; p<0.01).ConclusionAnesthesia type was not associated with an increased risk for complications. However, neuraxial anesthesia improved outcomes that predict readiness for discharge: patients had less pain, required less opioids, and had a lower incidence of PONV, thus improving the rate of same day discharge.Trial registration numberNCT04203732.

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“…At the same time, we also found that the MMSE score in the Outside group was lower than that in the Inside group at 6, 24, and 48 h postoperatively, while the incidence of POCD in the Outside group was higher than that in the Inside group at 6, 24, and 48 h postoperatively. Anesthesia protocol is an important factor impacting postoperative pain and the incidence of POCD ( 23 , 24 ). Our results have shown that the inside approach of the FICB was more effective in anesthetizing patients than the outside approach.…”

Section: Discussionmentioning

confidence: 99%

Anesthetic Effect of the Fascia Iliaca Compartment Block with Different Approaches on Total Hip Arthroplasty and Its Effect on Postoperative Cognitive Dysfunction and Inflammation

et al. 2022

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ObjectiveThe objective of this article is to make a comparison of the anesthetic effects of the inside and outside fascia iliaca compartment block (FICB) in total hip arthroplasty (THA) and to study the effect of the different approaches of the FICB on postoperative cognitive dysfunction (POCD) and serum inflammatory cytokines in THA patients.MethodsA total of 60 patients who received THA treatment from January 2021 to December 2021 were divided into two groups, namely, Inside group (inside approach of the FICB) and Outside group (outside approach of the FICB), according to the different approaches of the FICB. Forty-eight hours after surgery, we compared the use of ropacaine dosage, visual analogue scale (VAS) score, the use of patient-controlled analgesia (PCA), mini-mental state examination (MMSE) score, the incidence of POCD, and the serum levels of IL-1, IL-6. Secondary indicators include surgical indicators and the quality of anesthesia cannula.ResultsThe ratio of re-fix the catheter, intubation time, and the use of ropacaine dosage at 48 h after surgery in the Outside group were significantly higher than that in the Inside group (p < 0.05), while the depth of cannulation in the Outside group was significantly lower than that in the Inside group (p < 0.05). VAS scores were comparable between the Inside and the Outside groups, except at 24 h after surgery. The use of PCA from 24 to 48 h after surgery in the Outside group was significantly higher than that in the Inside group (p < 0.05). The MMSE score and the incidence of POCD in the Outside group were higher than that in the Inside group. At the same time, the serum IL-1β levels at 1 and 6 h after surgery and the serum IL-6 levels at 1, 6, 24, and 48 h after surgery in the Outside group were significantly higher than that in the Inside group (p < 0.05).ConclusionCompared with the outside approach of the FICB, the inside approach of the FICB has better anesthetic effect, better postoperative analgesia, fewer postoperative analgesics, lower incidence of POCD, and lower serum cytokines during the treatment of THA patients.

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General vs Neuraxial Anesthesia in Direct Anterior Approach Total Hip Arthroplasty: Effect on Length of Stay and Early Pain Control

Cited by 15 publications

References 29 publications

Spinal Compared with General Anesthesia in Contemporary Primary Total Hip Arthroplasties

Spinal Compared with General Anesthesia in Contemporary Primary Total Hip Arthroplasties

Neuraxial and general anesthesia for outpatient total joint arthroplasty result in similarly low rates of major perioperative complications: a multicentered cohort study

Anesthetic Effect of the Fascia Iliaca Compartment Block with Different Approaches on Total Hip Arthroplasty and Its Effect on Postoperative Cognitive Dysfunction and Inflammation

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