Abstract
Regional anesthesia for knee and hip arthroplasty may have favorable outcome effects compared with general anesthesia by effectively blocking afferent input, providing initial postoperative analgesia, reducing endocrine metabolic responses, and providing sympathetic blockade with reduced bleeding and less risk of thromboembolic complications but with undesirable effects on lower limb motor and urinary bladder function. Old randomized studies supported the use of regional anesthesia with fewer postoperative pulmonary and thromboembolic complications, and this has been supported by recent large non-randomized epidemiological database cohort studies. In contrast, the data from newer randomized trials are conflicting, and recent studies using modern general anesthetic techniques may potentially support the use of general versus spinal anesthesia. In summary, the lack of properly designed large randomized controlled trials comparing modern general anesthesia and spinal anesthesia for knee and hip arthroplasty prevents final recommendations and calls for prospective detailed studies in this clinically important field.
Highlights
Introduction and contextThe discussion on the optimal anesthetic technique for most surgical procedures regarding the use of regional anesthetic versus general anesthetic techniques has been going on for decades
In hip and knee replacement, several randomized trials performed several decades ago were in favor of spinal or epidural analgesia[1,2]
This is probably explained by the positive physiological effects of the provided afferent blockade with better initial pain relief, a reduced endocrine metabolic response, and sympathetic blockade with less blood loss and increased leg blood flow, all resulting in reduced cardiopulmonary and thromboembolic morbidity, but at the potential cost of reduced capability for early postoperative mobilization, urinary bladder dysfunction, and rare but potentially severe neurological complications
Summary
Faculty Reviews are written by members of the prestigious Faculty Opinions Faculty. They are commissioned and are peer reviewed before publication to ensure that the final, published version is comprehensive and accessible. A balanced view of all available data from within a reasonably recent time frame may support the use of regional anesthesia, there is a severe need for large-scale prospective randomized controlled trials to compare general versus spinal anesthesia, knowing that the choice of anesthesia represents only one of the many factors that influence outcome In this context, the focus must include potential identification of subgroups of patients who may or may not benefit from a given anesthetic procedure. The focus must include potential identification of subgroups of patients who may or may not benefit from a given anesthetic procedure Such studies must use an evidence-based approach when choosing the two anesthetic techniques, especially within the context of a fast-track setup with provision of an optimized multimodal, oral opioid-sparing analgesia to facilitate early mobilization and reduce adverse events, including the possibility for early mobilization and urinary bladder dysfunction[34]. Grant information The author(s) declared that no grants were involved in supporting this work
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