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

Aasvang, Eske Kvanner; Laursen, Mogens Berg; Madsen, Jacob; Krøigaard, Mogens; Solgaard, Søren; Kjærsgaard‐Andersen, Per; Mandøe, Hans; Hansen, Torben Bæk; Nielsen, Jørgen Ulrich; Krarup, Niels; Skøtt, Annette Elisabeth; Kehlet, Henrik

doi:10.1111/aas.13118

Cited by 18 publications

(14 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Failed spinal anaesthesia was associated with no other factors but longer procedure times and younger age. 2 This corroborates what has been known before; namely, that the duration of bupivacaine spinal anaesthesia increases with increasing dose 4 and growing age. 5,6 The findings 2 do not allow the generalisation that intraoperative FSA is a relatively frequent outcome in TKA and THA patients.…”

supporting

confidence: 90%

“…As the frequency of a successful fast-track recovery was the primary endpoint, 3 a sub-analysis of this parameter might be suitable, but not of failed spinal anaesthesia (FSA). 2 From the fairly large number of analysed patients (n = 1451), 57 patients (3.9%) fulfilled the criterion for FSA, ie, a patient required general anaesthesia at any time during surgery. 2 Supplemental analgesia or sedation with remifentanil or propofol per se was not considered as FSA, unless laryngeal mask placement or tracheal intubation was deemed necessary.…”

mentioning

confidence: 98%

“…However, between the 5 participating centres, 3 the failure rate varied significantly from 2.2% to 7.1%. 2 There are no data about the time when FSA was diagnosed after the start of surgery. 2 By reviewing the 57 FSA anaesthesia charts for the starting time of general anaesthesia and by using this parameter as a surrogate, it might be possible to discriminate between cases where the spinal turned out ineffective soon after incision and those where the spinal wore off gradually.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Biased data about the frequency of failed spinal anaesthesia

Förster

Pitkänen

2018

Acta Anaesthesiol Scand

View full text Add to dashboard Cite

Editor,Regardless of possible biases related to post hoc testing, a sub-analysis can be appropriate when the primary point of interest has been reached and one wants to inspect whether sub-groups might have reacted to treatment differently than the main group. 1 The data presented in the recent "sub-analysis" by Aasvang et al 2 derive from a remarkable trial 3 addressing the question whether discharge from the post-anaesthesia care unit might be advisable and safe without assessment of lower limb motor function after total hip arthroplasty (THA) or total knee arthroplasty (TKA) performed under spinal anaesthesia. As the frequency of a successful fast-track recovery was the primary endpoint, 3 a sub-analysis of this parameter might be suitable, but not of failed spinal anaesthesia (FSA). 2 From the fairly large number of analysed patients (n = 1451), 57 patients (3.9%) fulfilled the criterion for FSA, ie, a patient required general anaesthesia at any time during surgery. 2 Supplemental analgesia or sedation with remifentanil or propofol per se was not considered as FSA, unless laryngeal mask placement or tracheal intubation was deemed necessary. As clinicians, we appreciate this definition of FSA. However, between the 5 participating centres, 3 the failure rate varied significantly from 2.2% to 7.1%. 2 Could the handling of intraoperative pain and problems have differed substantially from centre to centre and thus influenced the rate of FSA? A third of FSA occurred in TKA and two-thirds in THA. How should the reader interpret this difference without more details about the spinal technique? Only the rather small amounts of bupivacaine (5 mg/mL) were presented (2.2 [1.8-2.5] mL [mean [95% confidence intervals]]), but combined for TKA and THA. These 2 procedures were put under one umbrella without mentioning the distribution between plain and hyperbaric bupivacaine, the positions in which the spinal anaesthetics were injected, and for how long the patients were kept, eg, in the lateral position before return to the supine position. All these factors could have affected the efficacy of spinal anaesthesia.There are no data about the time when FSA was diagnosed after the start of surgery. 2 By reviewing the 57 FSA anaesthesia charts for the starting time of general anaesthesia and by using this parameter as a surrogate, it might be possible to discriminate between cases where the spinal turned out ineffective soon after incision and those where the spinal wore off gradually.Failed spinal anaesthesia was associated with no other factors but longer procedure times and younger age. 2 This corroborates what has been known before; namely, that the duration of bupivacaine spinal anaesthesia increases with increasing dose 4 and growing age. 5,6 The findings 2 do not allow the generalisation that intraoperative FSA is a relatively frequent outcome in TKA and THA patients. We are not sure how to interpret the authors' inference that pre-operative identification of risk factors is not feasible. When dealing with younger patients,...

show abstract

supporting

confidence: 90%

mentioning

confidence: 98%

mentioning

confidence: 99%

See 1 more Smart Citation

Biased data about the frequency of failed spinal anaesthesia

Förster

Pitkänen

2018

Acta Anaesthesiol Scand

View full text Add to dashboard Cite

show abstract

“…

Response to the letter by Dr. Förster and Pitkanen regarding our manuscript "Incidence and related factors for intraoperative failed spinal anaesthesia for lower limb arthroplasty"We thank Dr. Förster and Dr. Pitkanen for their interest in our studies. 1,2 The current study regarding failed spinal anaesthesia (FSA) confirms previous small-scale studies, by using real-life data from high-volume expert orthopaedic centres with standardized anaesthetic technique. Our study confirms that FSA is indeed an unpredictable clinical problem in a minor proportion of patients.

…”

supporting

confidence: 80%

Response to the letter by Dr. Förster and Pitkanen regarding our manuscript “Incidence and related factors for intraoperative failed spinal anaesthesia for lower limb arthroplasty”

Aasvang

Kehlet

2018

Acta Anaesthesiol Scand

Self Cite

View full text Add to dashboard Cite

show abstract

“…SA failure may occur when the subarachnoid space is not reached, or analgesia is not sufficient for surgery after drug injection. Repeated trials after failed dural puncture, conversion to GA in patients with high respiratory risk, and the need for sedation after positioning the patient may increase anesthesia-related complications [3,4].…”

Section: Introductionmentioning

confidence: 99%

Incidence and Causes of Failed Spinal Anesthesia

Yüksek¹,

Miniksar²,

Honca³

et al. 2020

Dubai Med J

View full text Add to dashboard Cite

Introduction: Spinal anesthesia (SA) is one of the most frequently applied anesthesia procedures today. However, SA failure rate varies between 1 and 17%. The age of the patient, the position at which the procedure is performed, or the characteristics of the technical operation can affect success. In this study, we aimed to compare the most frequent SA failures according to the types of surgery and causes of failure. The results of SA procedures performed in a university hospital were compare to those published in the current literature. Materials and Methods: After obtaining ethics committee approval for our study, the hospital archives were examined retrospectively for 1 year with respect to SA procedures. SA application and failure rates were examined. Three or more SA attempts, failed dural puncture, or unsuccessful injection, and anesthesia applications that did not provide sufficient sensory block for surgery despite successful drug treatment were defined as failure. Results: Of all anesthesia procedures, SA was applied at a rate of 23.5%. Our SA failure rate was calculated as 16.6%. Considering a single surgical procedure, obstetric anesthesia was the most common surgery with failed SA (28.7%). The most common cause of failure was insufficient analgesia (32.9%). Discussion: SA failure rates were observed to be in a variable distribution range in the literature, and in some studies, SA failure was defined as a block that did not occur despite a full dose and successful injection, and this rate was found to be 3.9%. The high rate in our study group may be explained by differences in the definition of SA: blocks performed with several trials and any block that could not be applied were also recorded as SA failure. The reasons for failing to apply this procedure is an issue that is worth examining also in terms of patient satisfaction and safety, which is an important issue. Conclusion: Although the definition of unsuccessful SA is confusing, SA failure rates are worth examining and improving for each hospital.

show abstract

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

Abstract: 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.

Cited by 18 publications

References 39 publications

Biased data about the frequency of failed spinal anaesthesia

Biased data about the frequency of failed spinal anaesthesia

Response to the letter by Dr. Förster and Pitkanen regarding our manuscript “Incidence and related factors for intraoperative failed spinal anaesthesia for lower limb arthroplasty”

Incidence and Causes of Failed Spinal Anesthesia

Contact Info

Product

Resources

About