Abstract
BackgroundAlthough several anesthesia procedures have been explored for orthopedic surgery, the complications of anesthesia remain not well resolved. This study aimed to explore the influence of different anesthesia methods on the complications after orthopedic surgery.MethodsAccording to the searching strategy, anesthesia associated studies in orthopedic surgery were screened from Pubmed, Embase, and the Cochrane Library up to Mar. 10th, 2018. Then, complications and demographic data were extracted and quality of studies was assessed using Cochrane Collaboration recommendations. ADDIS software was used to perform the network meta-analysis. Pooled effect size was calculated using random effective model or consistency model, and presented with odds ratio (OR) and 95% confidence interval (CI).ResultsAccording to the selective criteria, a total of 23 studies with 2393 patients were enrolled in this study. Quality assessment revealed all studies had an ordinary quality. Network meta-analyses revealed that nerve block analgesia (NBA) presented a lower effect on the occurrence of post-operative nausea or vomiting (PONV; OR = 0.17, 95% CI: 0.06–0.39) and urine retention (OR = 0.07, 95% CI: 0.01–0.37) compared with epidural anesthesia (EA). Interscalene block (ISB) and local infiltration analgesia (LIA) could significantly reduce the occurrence of back pain compared with EA (OR = 0.00, 95% CI = 0.00–0.30; OR = 0.00, 95% CI = 0.00–0.25).ConclusionNBA presented an effective role in reliving the occurrence of PONV and urine retention, and ISB and LIA relieved the back pain compared with EA after orthopedic surgery.
Highlights
Several anesthesia procedures have been explored for orthopedic surgery, the complications of anesthesia remain not well resolved
nerve block analgesia (NBA) presented an effective role in reliving the occurrence of post-operative nausea or vomiting (PONV) and urine retention, and Interscalene block (ISB) and local infiltration analgesia (LIA) relieved the back pain compared with epidural anesthesia (EA) after orthopedic surgery
A total of 2393 patients were enrolled in this study, including 753 in general anesthesia (GA) group, 215 in epidural anesthesia (EA) group, 473 in local infiltration analgesia (LIA) group, 238 in nerve block analgesia (NBA) group, Fig. 1 Study enrollment and quality assessment. a, Flow chart of study enrollment; b, Quality assessment of enrolled studies
Summary
Several anesthesia procedures have been explored for orthopedic surgery, the complications of anesthesia remain not well resolved. This study aimed to explore the influence of different anesthesia methods on the complications after orthopedic surgery. Since it emerged in the eighteenth century, the discipline of orthopedic surgery has been remarkably developed [1]. With the development of few decades, several anesthesia manners have been explored for orthopedic surgery, the complications of anesthesia are still not well resolved. A previous study has revealed that patients managed with general anesthesia perform a low risk of complications compared with patients undergoing spinal anesthesia during the total knee arthroplasty [7]. Compared with the general anesthesia, regional anesthesia presents a better outcome than general anesthesia in total hip arthroplasty, including reductions
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