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

Medicina ◽  
2021 ◽  
Vol 57 (11) ◽  
pp. 1250
Author(s):  
Ha-Jung Kim ◽  
Priodarshi Roychoudhury ◽  
Stuti Lohia ◽  
Jin-Sun Kim ◽  
Hyung-Tae Kim ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Propensity Score ◽  
Inflammatory Response ◽  
Propensity Score Matching ◽  
General Anaesthesia ◽  
Spinal Anaesthesia ◽  
Knee Arthroplasty ◽  
Systemic Inflammatory Response ◽  
Lymphocyte Ratio ◽  
Total Knee

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.

Which is more important after total knee arthroplasty: Local inflammatory response or systemic inflammatory response?

The Knee ◽  
2011 ◽  
Vol 18 (2) ◽  
pp. 113-116 ◽  
Author(s):  
Ali Akın Ugraş ◽  
Cemal Kural ◽  
Alev Kural ◽  
Fatma Demirez ◽  
Macit Koldaş ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Inflammatory Response ◽  
Knee Arthroplasty ◽  
Systemic Inflammatory Response ◽  
Local Inflammatory Response ◽  
Total Knee

scholarly journals Relationship of epidural patient-controlled analgesia with postoperative bleeding after unilateral total knee arthroplasty: a propensity score-matching analysis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Kyung-Don Hahm ◽  
Seok-Joon Jin ◽  
Seong-Sik Cho ◽  
Jihoon Park ◽  
Han Park ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Postoperative Pain ◽  
Propensity Score ◽  
Blood Loss ◽  
Propensity Score Matching ◽  
Knee Arthroplasty ◽  
Postoperative Bleeding ◽  
Patient Controlled Analgesia ◽  
Total Knee ◽  
Relationship Of

AbstractAlthough epidural patient-controlled analgesia (PCA) to control postoperative pain after total knee arthroplasty (TKA), the relationship of epidural PCA with postoperative bleeding remains controversial. Therefore, we aimed to evaluate the effect of epidural and intravenous PCA on postoperative bleeding in patients undergoing unilateral TKA. Total of 2467 patients who underwent TKA were divided to intravenous PCA (n = 2339) or epidural PCA (n = 128) group. After 1:1 propensity score-matching, 212 patients were analyzed to assess the associations between the perioperative blood loss and epidural PCA between the groups. Mean postoperative blood loss was significantly greater in epidural PCA than in intravenous PCA (900.9 ± 369.1 mL vs. 737.8 ± 410.1 mL; P = 0.007). The incidence of red blood cell (RBC) administration (> 3 units) was significantly higher in epidural PCA than in intravenous PCA (30.2% vs. 16.0%; OR 2.5; 95% CI 1.201–5.205; P = 0.014). Epidural PCA may be strongly related to postoperative bleeding and the incidence of RBC transfusion of more than 3 units after unilateral TKA, as compared to intravenous PCA. Therefore, the use of epidural PCA may be carefully considered for postoperative pain management in TKA.

scholarly journals Randomised controlled study comparing general and spinal anaesthesia with and without a tourniquet on the outcomes of total knee arthroplasty: study protocol

BMJ Open ◽  
2018 ◽  
Vol 8 (12) ◽  
pp. e025546 ◽  
Author(s):  
Mikko Tuomas Rantasalo ◽  
Riku Palanne ◽  
Katarina Juutilainen ◽  
Pekka Kairaluoma ◽  
Rita Linko ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
General Anaesthesia ◽  
Spinal Anaesthesia ◽  
Knee Arthroplasty ◽  
Length Of Hospital Stay ◽  
Postoperative Nausea And Vomiting ◽  
Controlled Study ◽  
Total Knee ◽  
Randomised Controlled ◽  
End Stage

IntroductionTotal knee arthroplasty is a highly effective treatment for end-stage knee osteoarthritis, and it is usually performed under spinal or general anaesthesia with or without a surgical tourniquet. Some debate about the preferred mode of anaesthesia regarding patient outcomes remains. The aim of this study, which compares general and spinal anaesthesia with and without a tourniquet on the outcomes of total knee arthroplasty, is to determine the optimal type of anaesthesia regimen and assess the effect of a tourniquet on the patient’s recovery following total knee arthroplasty.Methods and analysisThis study is a randomised, controlled, parallel-group, four-arm study comparing spinal and general anaesthesia with and without a tourniquet in 400 patients undergoing fast-track total knee arthroplasty, with a 12-month follow-up. The primary outcome is cumulative intravenous oxycodone consumption by patient-controlled analgesia during the first 24 postoperative hours. Secondary outcomes include postoperative nausea and vomiting, the length of hospital stay, the duration of the surgery, blood loss, demand for surgical unit resources, complications, readmissions, postoperative knee function, range of motion, health-related quality of life, prolonged pain and mortality.Ethics and disseminationThis study’s protocol is in accordance with the declaration of Helsinki. The results of this study will be disseminated in international peer-reviewed journals.Trial registration numberNCT03364088; Pre-results.

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