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Singh P, Ghatak T, Mani UA, Verma A, Jafri AD, Sundar S, Carlos ML, Dhawal M. The Effect of Bilateral Nasal Sphenopalatine Ganglion Block in Managing Headaches After Dural Puncture Following Lower Segment Cesarean Section: A Prospective Observational Study. Cureus 2025; 17:e80289. [PMID: 40201870 PMCID: PMC11977444 DOI: 10.7759/cureus.80289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2025] [Indexed: 04/10/2025] Open
Abstract
BACKGROUND Post-dural puncture headache (PDPH) is a common complication that occurs in a small percentage of patients who undergo spinal or epidural anesthesia. The current treatment modalities for PDPH involve both conservative management and interventional approaches. In cases where conservative management is ineffective or if the symptoms are severe, interventional treatments are considered. The gold standard treatment for PDPH is the epidural blood patch (EBP). In recent years, minimally invasive interventions such as sphenopalatine ganglion block (SPGB) have been practiced, where a local anesthetic is injected into the sphenopalatine ganglion to block pain signals. OBJECTIVE The primary objective of this study was to study the effectiveness of bilateral intranasal SPGB for the management of PDPH after lower segment cesarean section (LSCS). METHODS Hundred parturients diagnosed to have PDPH were recruited into this prospective observational study. Patients were allocated to either of the two groups. Descriptive statistics, the chi-squared test, and Student's t-test were used for statistical analysis. RESULTS The onset of analgesia in the SPGB group was 15 times faster than that of the conservatively treated control group. There was a reappearance of PDPH with a visual analogue scale(VAS) score >4 in three instances after SPGB. CONCLUSION SPGB is a very effective initial modality for managing severe headaches in patients with PDPH. Our study, beyond a reasonable doubt, indicates the excellent efficacy of SPGB over conservative management alone.
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Affiliation(s)
- Pushpraj Singh
- Anesthesiology, Career Institute of Medical Sciences and Hospital, Lucknow, IND
| | - Tanmoy Ghatak
- Emergency Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, IND
| | - Utsav Anand Mani
- Emergency Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, IND
| | - Alka Verma
- Emergency Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, IND
| | - Asif Dabeer Jafri
- Emergency Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, IND
- Internal Medicine, SUM Ultimate Medicare, Bhubaneswar, IND
| | - Shyam Sundar
- Emergency Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, IND
| | | | - Malika Dhawal
- Anesthesiology, King George's Medical University, Lucknow, IND
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Hong G, Zhong H, Illescas A, Reisinger L, Cozowicz C, Poeran J, Liu J, Memtsoudis SG. Trends in hip fracture surgery in the United States from 2016 to 2021: patient characteristics, clinical management, and outcomes. Br J Anaesth 2024; 133:955-964. [PMID: 39242278 DOI: 10.1016/j.bja.2024.07.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 07/08/2024] [Accepted: 07/19/2024] [Indexed: 09/09/2024] Open
Abstract
INTRODUCTION Hip fractures are a serious health concern and a major contributor to healthcare resource utilisation. We aimed to investigate nationwide trends in the USA in patient characteristics and outcomes in patients after hip fracture repair surgery. METHODS From the Premier Healthcare dataset, we extracted patient encounters for surgical hip fracture repair from 2016 to 2021. Patient characteristics, comorbidities, complications, and anaesthetic and surgical details were analysed. Cochran-Armitage trend tests and simple linear regression were used to determine trends. RESULTS We included 347 086 hip fracture repair encounters. Notable trends included the following: median patient age declined from 82 yr [interquartile range: 73-88 yr] to 81 yr [interquartile range: 73-88 yr], (P-value=0.002), the proportion of female patients decreased from 68% to 66.2% (P-value=0.019); internal fixation was the most common intervention initially, but with a declining percentage from 49.9% to 43.8% (P-value <0.001); in general, patients carried a greater comorbidity burden, with the proportion with three or more Elixhauser comorbidities increasing from 56.4% to 58.6% (P-value=0.006); general anaesthesia remained the most common anaesthetic technique, from 68.90% to 56.80% without a significant trend; per 1000 inpatient days, the most common complication remained acute renal failure; despite a higher comorbidity burden, no complication showed a statistically significant upward trend, and many showed downward trends. CONCLUSIONS Over the 6-yr period from 2016 to 2021, a majority of hip fracture repairs continued to be performed under general anaesthesia but with that percentage declining over time. Notable trends included a lower percentage of female patients, an increase in femoral neck fractures, a higher comorbidity burden among patients, and a decrease in complications.
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Affiliation(s)
- Genewoo Hong
- Department of Anaesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, NY, USA; Department of Anaesthesiology, Weill Cornell Medical College, New York, NY, USA.
| | - Haoyan Zhong
- Department of Anaesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, NY, USA
| | - Alex Illescas
- Department of Anaesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, NY, USA
| | - Lisa Reisinger
- Department of Anaesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, NY, USA
| | - Crispiana Cozowicz
- Department of Anaesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Jashvant Poeran
- Department of Anaesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, NY, USA
| | - Jiabin Liu
- Department of Anaesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, NY, USA; Department of Anaesthesiology, Weill Cornell Medical College, New York, NY, USA
| | - Stavros G Memtsoudis
- Department of Anaesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, NY, USA; Department of Anaesthesiology, Weill Cornell Medical College, New York, NY, USA
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Won D, Cho SY, No HJ, Lee J, Hwang JY, Kim TK, Chang JE, Kim H, Choi JH, Lee JM. The Effect of Anesthesia Type on the Stability of the Surgical View on the Monitor in Retrograde Intrarenal Surgery for Renal Stone: A Prospective Observational Trial. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1435. [PMID: 39336477 PMCID: PMC11434150 DOI: 10.3390/medicina60091435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2024] [Revised: 08/27/2024] [Accepted: 08/30/2024] [Indexed: 09/30/2024]
Abstract
Background and Objectives: Retrograde intrarenal surgery (RIRS) is a minimally invasive technique for nephrolithiasis. RIRS is performed via a monitor screen displaying a magnified surgical site. Respiration can affect the stability of the surgical view during RIRS because the kidneys are close to the diaphragm. The purpose of this trial is to compare the effect of anesthesia type on the stability of the surgical view during RIRS between spinal anesthesia and general anesthesia. Materials and Methods: Patients were allocated to the general anesthesia group or spinal anesthesia group. During surgery, movement of the surgical field displayed on the monitor screen was graded by the first assistant on a 10-grade numeric rating scale (0-10). Next, it was also graded by the main surgeon. After surgery, we evaluated the discomfort with the anesthesia method for all patients. Results: Thirty-four patients were allocated to the general anesthesia group and 32 patients to the spinal anesthesia group. The average values of the two surgeons for surgical field oscillation grade showed vision on the monitor screen was more stable in the general anesthesia group than the spinal anesthesia group (3.3 ± 1.6 vs. 5.0 ± 1.6, p < 0.001). The degrees of the inconvenience of the surgery did not differ between the groups (0.7 ± 1.8 vs. 1.6 ± 2.6, p = 0.114), even though more patients reported inconvenience with a grade of 3 or more in the spinal anesthesia group (8.8% vs. 28.1%, p = 0.042). Conclusions: In terms of the visualization of the surgical site, general anesthesia might provide a more stable surgical view during RIRS compared to spinal anesthesia without increasing inconvenience induced by the type of anesthesia.
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Affiliation(s)
- Dongwook Won
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul 07061, Republic of Korea; (D.W.); (J.-Y.H.); (T.K.K.); (J.-E.C.); (H.K.)
| | - Sung Yong Cho
- Department of Urology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea
| | - Hyun-Joung No
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Severance Hospital, Seoul 03722, Republic of Korea;
| | - Jiwon Lee
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul 06273, Republic of Korea;
| | - Jin-Young Hwang
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul 07061, Republic of Korea; (D.W.); (J.-Y.H.); (T.K.K.); (J.-E.C.); (H.K.)
| | - Tae Kyong Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul 07061, Republic of Korea; (D.W.); (J.-Y.H.); (T.K.K.); (J.-E.C.); (H.K.)
| | - Jee-Eun Chang
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul 07061, Republic of Korea; (D.W.); (J.-Y.H.); (T.K.K.); (J.-E.C.); (H.K.)
| | - Hyerim Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul 07061, Republic of Korea; (D.W.); (J.-Y.H.); (T.K.K.); (J.-E.C.); (H.K.)
| | - Jae-Hyun Choi
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea;
| | - Jung-Man Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul 07061, Republic of Korea; (D.W.); (J.-Y.H.); (T.K.K.); (J.-E.C.); (H.K.)
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Endersby RVW, Ip VHY, Moser JJ, Walker AM, Baghirzada L, Spencer AO, Ho ECY. Fast-track spinal anaesthesia reduces length of motor blockade and facilitates earlier discharge after joint arthroplasty. Acta Anaesthesiol Scand 2024; 68:1001-1002. [PMID: 38693899 DOI: 10.1111/aas.14435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 04/17/2024] [Indexed: 05/03/2024]
Affiliation(s)
| | - Vivian Hui Yun Ip
- Department of Anesthesia, University of Calgary, Calgary, Alberta, Canada
| | - Joanna J Moser
- Department of Anesthesia, University of Calgary, Calgary, Alberta, Canada
| | - Andrew M Walker
- Department of Anesthesia, University of Calgary, Calgary, Alberta, Canada
| | - Leyla Baghirzada
- Department of Anesthesia, University of Calgary, Calgary, Alberta, Canada
| | - Adam O Spencer
- Department of Anesthesia, University of Calgary, Calgary, Alberta, Canada
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Teulières M, Bérard E, Reina N, Marot V, Vari N, Ferre F, Minville V, Cavaignac E. Does spinal anesthesia for total hip or knee arthroplasty entail longer operating room occupancy compared to general anesthesia? Case-control study of 337 spinal versus 243 general anesthesias. Orthop Traumatol Surg Res 2024; 110:103794. [PMID: 38081357 DOI: 10.1016/j.otsr.2023.103794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 10/02/2023] [Accepted: 10/12/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Treatment protocols, including anesthesia, are constantly progressing to improve rapid early postoperative recovery in lower-limb arthroplasty. To the best of our knowledge, however, no studies compared general versus spinal anesthesia (GA vs. SA) in the surgical pathway of patients undergoing total knee or hip arthroplasty (TKA, THA). Better knowledge of the processes should improve efficacy in theater and optimize surgical planning. The present study comparing GA and SA in the operating room aimed to assess (1) theater occupancy times, and (2) times for each step in a surgery day according to type of anesthesia. HYPOTHESIS SA leads to longer theater occupancy than GA in TKA and THA. METHODS A single-center retrospective case-control study analyzed data for the period January 2019 to December 2020 in 303 TKAs (100 GA, 203 SA) and 277 THAs (143 GA, 134 SA), comparing times for all perioperative steps and particularly theater occupancy. RESULTS In TKA, occupancy did not differ between GA and SA: 98±16min versus 98±14min respectively; Δ=0min (p=0.78). In THA, occupancy was shorter with SA than GA: 117±23min versus 123±26min respectively; Δ=-6min (p=0.02). In THA, time to perform SA was longer than induction of GA: 28±13min versus 23±12min respectively; Δ=+5min (p<0.001). In TKA, time to leaving the operating room was shorter with SA than GA: 8±5min versus 14±7min respectively; Δ=-6min (p<0.001). DISCUSSION/CONCLUSION SA did not involve longer mean theater occupancy than GA for TKA, and reduced it by 6minutes for THA. LEVEL OF EVIDENCE III; case-control study.
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Affiliation(s)
- Maxime Teulières
- Institut de l'Appareil Locomoteur, Hôpital Pierre-Paul-Riquet, CHU Toulouse Purpan, 1, place Baylac, 31000 Toulouse, France
| | - Emilie Bérard
- Département d'Épidémiologie, Économie de la Santé et Santé Publique, Inserm, UPS, UMR 1295 CERPOP, Université de Toulouse, CHU de Toulouse, 37, allée Jules-Guesde, 31073 Toulouse cedex, France
| | - Nicolas Reina
- Institut de l'Appareil Locomoteur, Hôpital Pierre-Paul-Riquet, CHU Toulouse Purpan, 1, place Baylac, 31000 Toulouse, France
| | - Vincent Marot
- Unité d'Orthopédie, Hospital Nostra Senyora de Meritxell, Carrer dels Escalls, 19, 700 Escaldes-Engordany, Andorra
| | - Nicolas Vari
- Institut de l'Appareil Locomoteur, Hôpital Pierre-Paul-Riquet, CHU Toulouse Purpan, 1, place Baylac, 31000 Toulouse, France.
| | - Fabrice Ferre
- Institut de l'Appareil Locomoteur, Hôpital Pierre-Paul-Riquet, CHU Toulouse Purpan, 1, place Baylac, 31000 Toulouse, France
| | - Vincent Minville
- Institut de l'Appareil Locomoteur, Hôpital Pierre-Paul-Riquet, CHU Toulouse Purpan, 1, place Baylac, 31000 Toulouse, France
| | - Etienne Cavaignac
- Institut de l'Appareil Locomoteur, Hôpital Pierre-Paul-Riquet, CHU Toulouse Purpan, 1, place Baylac, 31000 Toulouse, France
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Indra Rachman R, Birowo P, Nurullah G, Cho PSY, Atmoko W, Widyahening IS, Rasyid N. General versus spinal anesthesia in percutaneous nephrolithotomy: A systematic review and meta-analysis. F1000Res 2023; 12:281. [PMID: 38618023 PMCID: PMC11016174 DOI: 10.12688/f1000research.124704.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/30/2023] [Indexed: 04/16/2024] Open
Abstract
Background: Percutaneous nephrolithotomy (PCNL) is the preferred treatment for the removal of large kidney stones, sized >20 mm. However, there is still an ongoing debate concerning the best anesthesia for PCNL. This study aimed to compare the efficacy and safety between general and spinal anesthesia for PCNL. Methods: A systematic review and meta-analysis study. A systematic, electronic literature search was performed in several databases, including PubMed, Scopus, and Google Scholar until July 1 st, 2022. The quality of the articles was examined using Crombie's Items (for non-randomized controlled trials (RCTs)) and Jadad Scale (for RCTs). The outcomes assessed were operation time, fluoroscopy time, length of stay, stone-free rate, overall complication rate, specific postoperative complications, cost, pain score, and postoperative analgesic requirement. The article selection was reported based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. We assessed four RCTs and eight retrospective studies. Meta-analysis of selected studies was performed using the Review Manager 5.3. Results: General anesthesia resulted in fewer Clavien-Dindo grade II (OR: 0.68; 95% CI: 0.49 - 0.94; p=0.02), major complications (OR: 0.65; 95% CI: 0.45 - 0.94; p=0.02, and lower transfusion rates (OR: 0.70; 95% CI: 0.53 - 0.94; p=0.02). Whereas spinal anesthesia resulted in faster operation time (Mean Difference: -12.98; 95% CI: -20.56 - -5.41; p<0.001, fluoroscopy time (MD: -26.15; 95% CI: -42.79 - -9.50; p=0.002), reduced length of stay (MD: -0.47; 95% CI: -0.75 - 0.20; p<0.001), and lower postoperative analgesic requirement and cost. No significant difference in stone-free rate (OR: 1.08; 95% CI: 0.92 - 1.26; p=0.37). PCNL performed using either general anesthesia or spinal anesthesia is equally safe and effective. Conclusions: Each method of anesthesia has its own advantages and disadvantages. The final choice between general and spinal anesthesia should be based on the patient's condition and surgical team preference.
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Affiliation(s)
- Rinaldo Indra Rachman
- Department of Urology, Faculty of Medicine. Universitas Indonesia. Cipto Mangunkusumo Hospital, Jalan Diponegoro No. 71, Jakarta, 10430, Indonesia
| | - Ponco Birowo
- Department of Urology, Faculty of Medicine. Universitas Indonesia. Cipto Mangunkusumo Hospital, Jalan Diponegoro No. 71, Jakarta, 10430, Indonesia
| | - Ghifari Nurullah
- Department of Urology, Faculty of Medicine. Universitas Indonesia. Cipto Mangunkusumo Hospital, Jalan Diponegoro No. 71, Jakarta, 10430, Indonesia
| | - Prof. Sung Yong Cho
- Department of Urology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, 101 Daehak-Ro Jongno-Gu, South Korea
| | - Widi Atmoko
- Department of Urology, Faculty of Medicine. Universitas Indonesia. Cipto Mangunkusumo Hospital, Jalan Diponegoro No. 71, Jakarta, 10430, Indonesia
| | - Indah Suci Widyahening
- Department of Community Medicine, Faculty of Medicine. Universitas Indonesia, Jalan Pegangsaan Timur no 16, Jakarta, 10430, Indonesia
| | - Nur Rasyid
- Department of Urology, Faculty of Medicine. Universitas Indonesia. Cipto Mangunkusumo Hospital, Jalan Diponegoro No. 71, Jakarta, 10430, Indonesia
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Chowdary AR, Beale J, Martinez J, Aggarwal V, Mounasamy V, Sambandam S. Postoperative complications of spinal vs general anesthesia in elderly patients undergoing hip hemiarthroplasty. Arch Orthop Trauma Surg 2023; 143:5615-5621. [PMID: 37061659 DOI: 10.1007/s00402-023-04876-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 04/03/2023] [Indexed: 04/17/2023]
Abstract
INTRODUCTION Elderly patients with hip fractures are at high risk for mortality due to postsurgical complications. Hip hemiarthroplasty is a routine procedure done in elderly patients for surgical repair of femoral neck fractures. Both general and spinal anesthesia can be used in elderly patients undergoing hemiarthroplasty. Rates of postoperative complications among the two anesthetic choices have not been directly compared. In this study, we compare the rates of postoperative complications in elderly patients (age greater than 70) undergoing hip hemiarthroplasty for femoral neck fractures using a national database. METHODS Data for the years 2015-2020 from the National Surgical Quality Improvement Program (NSQIP) were used for the study. Patients greater than 70 years of age who received a hip hemiarthroplasty with general anesthesia or spinal anesthesia were identified using CPT procedure codes. Pertinent preoperative variables and rates of postoperative complications were characterized and analyzed. RESULTS Our study found that elderly patients who received spinal anesthesia had, on average, longer length of stays but shorter operative times compared to patients who received general anesthesia. Furthermore, we found that patients who received spinal anesthesia had lower rates of systemic sepsis, cardiac arrests, and blood transfusions when compared to patients who received general anesthesia. Finally, we found that overall rates of mortality were significantly lower in the spinal anesthesia cohort compared to the general anesthesia cohort. CONCLUSION Our work suggests that patients who underwent spinal anesthesia for hip arthroplasty may have lower rates of postoperative complications. This work further highlights the role of anesthetic choice in preventing complications following hip hemiarthroplasty procedures.
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Affiliation(s)
| | - Jack Beale
- Department of Orthopedics, University of Texas Southwestern, Dallas, TX, USA
| | - Jack Martinez
- Department of Orthopedics, University of Texas Southwestern, Dallas, TX, USA
| | - Vikram Aggarwal
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Varatharaj Mounasamy
- Department of Orthopedics, University of Texas Southwestern, Dallas, TX, USA
- Department of Orthopedics, Dallas VA Medical Center, Dallas, TX, USA
| | - Senthil Sambandam
- Department of Orthopedics, University of Texas Southwestern, Dallas, TX, USA.
- Department of Orthopedics, Dallas VA Medical Center, Dallas, TX, USA.
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Agrawal H, Chaudhary S, Salhotra R. Comparison of Nalbuphine Versus Clonidine as an Adjuvant to Intrathecal Hyperbaric Bupivacaine in Orthopedic Lower Limb Surgeries: A Randomized Controlled Double-Blind Study. Cureus 2023; 15:e42857. [PMID: 37664267 PMCID: PMC10473549 DOI: 10.7759/cureus.42857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2023] [Indexed: 09/05/2023] Open
Abstract
BACKGROUND Nalbuphine and clonidine are used as adjuvants to intrathecal local anesthetics, but studies on their comparative efficacy have shown inconsistent results. This study aimed to compare nalbuphine, clonidine, or normal saline as adjuvants to intrathecal hyperbaric bupivacaine in orthopedic lower limb surgeries. Method: Sixty-three American Society of Anesthesiologists (ASA) I/II patients between 18 and 60 years old with lower limb fractures were randomized into three groups (n=21 each). Patients with contraindications to spinal block, bilateral lower limb fractures, or long-term opioid therapy were excluded. The subarachnoid block was given in L3-L4 interspace. Group N received 1 mg of nalbuphine, group Cl received 30 mcg of clonidine, and group C received 0.5 ml of normal saline with 15 mg (0.5%) of hyperbaric bupivacaine. Sensory and motor block characteristics, hemodynamic variables and side effects were noted, and the data were analyzed using Student's t-test, Mann-Whitney test, Chi-square test, and ANOVA followed by Tukey's test. RESULTS Patients receiving intrathecal nalbuphine (group N) and clonidine (group Cl) had a faster onset of the sensory and motor block than controls (group C) (p=0.000). The time to two-segment regression was more prolonged in group Cl when compared to group N (p=0.000). Duration of spinal analgesia was 216.75 ± 25.96 minutes, 292.86 ± 24.92 minutes, and 178.50 ± 16.06 minutes in groups N, Cl, and C, respectively (p=0.000). The 24-hour rescue analgesic requirement was maximum in group C and least in group Cl (p=0.000). The three groups were comparable to each other in terms of side effects. CONCLUSION Clonidine was found to be superior to nalbuphine as an intrathecal adjuvant with no significant side effects.
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Affiliation(s)
- Heena Agrawal
- Department of Anesthesia, Late Bisahu Das Mahant Memorial Medical College, Korba, Jhagarha, IND
| | - Sujata Chaudhary
- Department of Anesthesia, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND
| | - Rashmi Salhotra
- Department of Anesthesia, University College of Medical Sciences, New Delhi, IND
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Zhou SL, Zhang SY, Si HB, Shen B. Regional versus general anesthesia in older patients for hip fracture surgery: a systematic review and meta-analysis of randomized controlled trials. J Orthop Surg Res 2023; 18:428. [PMID: 37312156 PMCID: PMC10262548 DOI: 10.1186/s13018-023-03903-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 06/02/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND The optimal anesthesia technique for older patients undergoing hip fracture surgery remains controversial. We performed a systematic review and meta-analysis of updated randomized controlled trials (RCTs) to assess whether regional anesthesia was superior to general anesthesia in hip fracture surgery. METHODS We searched PubMed, EMBASE, Web of Science, and the Cochrane Central Register of Controlled Trials from January 2000 until April 2022. RCTs directly comparing regional and general anesthesia in hip fracture surgery were included in the analysis. The incidence of delirium and mortality were the primary outcomes and other perioperative outcomes including complications were secondary outcomes. RESULTS Thirteen studies involving 3736 patients were included in this study. There was no significant difference in the incidence of delirium (odds ratio [OR] 1.09; 95% confidence interval [CI] 0.86, 1.37) and mortality (OR 1.08; 95% CI 0.71, 1.64) between the two groups. Patients receiving regional anesthesia in hip fracture surgery were associated with a reduction in operative time (weighted mean difference [WMD]: - 4.74; 95% CI - 8.85, - 0.63), intraoperative blood loss (WMD: - 0.25; 95% CI - 0.37, - 0.12), postoperative pain score (WMD: - 1.77; 95% CI - 2.79, - 0.74), length of stay (WMD: - 0.10; 95% CI - 0.18, - 0.02), and risk of acute kidney injury (AKI) (OR 0.56; 95% CI 0.36, 0.87). No significant difference was observed in the other perioperative outcomes. CONCLUSIONS For older patients undergoing hip fracture surgery, RA did not significantly reduce the incidence of postoperative delirium and mortality compared to GA. Due to the limitations of this study, the evidence on delirium and mortality was still inconclusive and further high-quality studies are needed.
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Affiliation(s)
- Sheng-Liang Zhou
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guoxue Road, Sichuan Province, 610041, Chengdu, People's Republic of China
| | - Shao-Yun Zhang
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guoxue Road, Sichuan Province, 610041, Chengdu, People's Republic of China
- Department of Orthopedics, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, Sichuan Province, People's Republic of China
| | - Hai-Bo Si
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guoxue Road, Sichuan Province, 610041, Chengdu, People's Republic of China
| | - Bin Shen
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guoxue Road, Sichuan Province, 610041, Chengdu, People's Republic of China.
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Kumar V. Current indications for spinal anesthesia-a narrative review. Best Pract Res Clin Anaesthesiol 2023; 37:89-99. [PMID: 37321771 DOI: 10.1016/j.bpa.2023.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 03/14/2023] [Accepted: 04/05/2023] [Indexed: 06/17/2023]
Abstract
Spinal anesthesia is a commonly performed regional anesthesia technique by most anesthesiologists worldwide. This technique is learned early during training and is relatively easy to master. Despite being an old technique, spinal anesthesia has evolved and developed in various aspects. This review attempts to highlight the current indications of this technique. Understanding the finer aspects and knowledge gaps will help postgraduates and practicing anesthesiologists in designing patient-specific techniques and interventions.
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Affiliation(s)
- Vinoth Kumar
- Department of Anaesthesiology, Ganga Medical Centre and Hospitals Pvt Ltd, 313, Mettupalayam Road, Coimbatore, 641043, India.
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Long H, Zeng C, Xiong Y, Shi Y, Wang H, Lei G. Neuraxial versus general anesthesia for perioperative outcomes and resource utilization following knee arthroplasty: experience from a large national database. Arch Orthop Trauma Surg 2023; 143:2153-2163. [PMID: 35695925 DOI: 10.1007/s00402-022-04483-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 05/15/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Attentions have been paid to the optimal anesthesia for knee arthroplasty (KA). We sought to investigate whether neuraxial anesthesia (NA) is superior to general anesthesia (GA) in terms of perioperative outcomes and resource utilization following KA. METHODS Patients undergoing primary KA registered in the Hospital Quality Monitoring System (HQMS) in China during 2013-2019 were identified. By utilizing a time-stratified propensity score matching, every patient receiving NA was matched by propensity score to a patient receiving GA. Then, we conducted Poisson, logistic, and linear regression to compare NA with GA in terms of perioperative outcomes and resource utilization. RESULTS Of 109,132 included participants, 75,945 (69.59%) underwent KA with GA and 33,187 (30.41%) with NA. After propensity score matching (26,425 participants per group), NA was associated with lower incidence of blood transfusion (OR: 0.82, 95% CI 0.77-0.87; p < 0.0001), 30-day readmission (OR: 0.76, 95% CI 0.68-0.84; p < 0.0001), and 90-day readmission (OR: 0.83, 95% CI 0.77-0.90; p < 0.0001). No statistically significant difference in in-hospital mortality, incidence of pulmonary embolism, deep vein thrombosis, and surgical site infection was found. In addition, NA was associated with a 1% decrease in length of stay (95% CI 0-2%; p = 0.0070) and a 3% lower total hospital charge (95% CI 2-4%; p < 0.0001) when compared with GA. CONCLUSION Compared with GA, NA was associated with decreased incidence of blood transfusion, readmission, reduced length of stay, and total hospital charge following KA, suggesting the favorable role of NA for perioperative outcomes and resource utilization in KA.
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Affiliation(s)
- Huizhong Long
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Chao Zeng
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
- Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, China
- Hunan Engineering Research Center for Osteoarthritis, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Yunchuan Xiong
- Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, China
| | - Ying Shi
- China Standard Medical Information Research Center, Shenzhen, China
| | - Haibo Wang
- China Standard Medical Information Research Center, Shenzhen, China
- Clinical Trial Unit, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Guanghua Lei
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China.
- Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, China.
- Hunan Engineering Research Center for Osteoarthritis, Changsha, China.
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.
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12
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Bailey JG, Miller A, Richardson G, Hogg T, Uppal V. Cost comparison between spinal versus general anesthesia for hip and knee arthroplasty: an incremental cost study. Can J Anaesth 2022; 69:1349-1359. [PMID: 35982355 PMCID: PMC9387885 DOI: 10.1007/s12630-022-02303-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 03/17/2022] [Accepted: 05/19/2022] [Indexed: 11/10/2022] Open
Abstract
PURPOSE Wait list times for total joint arthroplasties have been growing, particularly in the aftermath of the COVID-19 pandemic. Increasing operating room (OR) efficiency by reducing OR time and associated costs while maintaining quality allows the greatest number of patients to receive care. METHODS We used propensity score matching to compare parallel processing with spinal anesthesia in a block room vs general anesthesia in a retrospective cohort of adult patients undergoing primary total hip arthroplasty (THA) and total knee arthroplasty (TKA). We compared perioperative costs, hospital costs, OR time intervals, and complications between the groups with nonparametric tests using an intention-to-treat approach. RESULTS After matching, we included 636 patients (315 TKA; 321 THA). Median [interquartile range (IQR)] perioperative costs were CAD 7,417 [6,521-8,109], and hospital costs were CAD 10,293 [9,344-11,304]. Perioperative costs were not significantly different between groups (pseudo-median difference [MD], CAD -47 (95% confidence interval [CI], -214 to -130; P = 0.60); nor were total hospital costs (MD, CAD -78; 95% CI, -340 to 178; P = 0.57). Anesthesia-controlled time and total intraoperative time were significantly shorter for spinal anesthesia (MD, 14.6 min; 95% CI, 13.4 to 15.9; P < 0.001; MD, 15.9; 95% CI, 11.0 to 20.9; P < 0.001, respectively). There were no significant differences in complications. CONCLUSION Spinal anesthesia in the context of a dedicated block room reduced both anesthesia-controlled time and total OR time. This did not translate into a reduction in incremental cost in the spinal anesthesia group.
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Affiliation(s)
- Jonathan G Bailey
- Department of Anesthesia, Pain Management & Perioperative Medicine, Dalhousie University, Halifax, NS, Canada.
| | - Ashley Miller
- Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Glen Richardson
- Division of Orthopedic Surgery, Dalhousie University, Halifax, NS, Canada
| | - Tyler Hogg
- Case Costing, Nova Scotia Health, Halifax, NS, Canada
| | - Vishal Uppal
- Department of Anesthesia, Pain Management & Perioperative Medicine, Dalhousie University, Halifax, NS, Canada
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13
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Quan T, Malyavko A, Ifarraguerri AM, Kim Y, Mcdaniel L, Manzi JE, Agarwal AR, Chen FR, Gu A, Tabaie S. Evaluating the Association of Anesthesia Type With Postoperative Complications in Patients Undergoing Ankle Fracture Repair. J Foot Ankle Surg 2022; 61:1086-1090. [PMID: 35183454 DOI: 10.1053/j.jfas.2022.01.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 01/05/2022] [Accepted: 01/15/2022] [Indexed: 02/03/2023]
Abstract
General and neuraxial anesthesia are both successful anesthesia techniques used in many orthopedic procedures. The purpose of this study was to compare the complications and length of hospital stay between patients who underwent general anesthesia versus neuraxial anesthesia during the repair of ankle fractures. Patients undergoing open reduction and internal fixation for ankle fracture from 2014 to 2018 were identified in the National Surgical Quality Improvement Program database. Patients were stratified into 2 cohorts: general anesthesia and neuraxial anesthesia. In this analysis, demographics data, comorbidities, and postoperative complications were collected and compared between the two cohorts. Bivariate analyses and multivariable logistical regression were performed. Of 3585 patients who underwent operative treatment for ankle fracture, 3315 patients (92.5%) had general anesthesia and 270 (7.5%) had neuraxial anesthesia. On bivariate analyses, patients who had neuraxial anesthesia were more likely to develop pulmonary complications (p = .173) or extended length of stay more than 5 days (p = .342) compared to the general anesthesia group. Following adjustment on multivariate analyses, the neuraxial anesthesia cohort no longer had increased likelihood of pulmonary complications or extended length of stay compared to the general anesthesia group. Healthy ankle fracture patients could also benefit from neuraxial anesthetic methods, and they should be considered for this anesthetic type regardless of their lack of comorbidities.
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Affiliation(s)
- Theodore Quan
- Department of Orthopaedic Surgery, George Washington University School of Medicine and Health Sciences, Washington, DC.
| | - Alisa Malyavko
- Department of Orthopaedic Surgery, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Anna M Ifarraguerri
- Department of Orthopaedic Surgery, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Yumin Kim
- Department of Orthopaedic Surgery, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Lea Mcdaniel
- Department of Orthopaedic Surgery, George Washington University School of Medicine and Health Sciences, Washington, DC
| | | | - Amil R Agarwal
- Department of Orthopaedic Surgery, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Frank R Chen
- Department of Anesthesiology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Alex Gu
- Department of Orthopaedic Surgery, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Sean Tabaie
- Department of Orthopaedic Surgery, Children's National Health System, Washington, DC
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Della Corte L, Mercorio A, Morra I, Riemma G, De Franciscis P, Palumbo M, Viciglione F, Borrelli D, Laganà AS, Vizzielli G, Bifulco G, Giampaolino P. Spinal anesthesia vs general anesthesia in gynecological laparoscopic surgery: a systematic review and meta-analysis. Gynecol Obstet Invest 2021; 87:1-11. [PMID: 34915508 DOI: 10.1159/000521364] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 12/06/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION In the last years, spinal anesthesia (SA) has emerging as alternative to general anesthesia (GA) for the laparoscopic treatment of gynecological diseases, for better control of postoperative pain. The aim of the review is to compare the advantages of SA compared to GA. METHODS MEDLINE, Scopus, ClinicalTrials.gov, EMBASE, Cochrane Library, and CINAHL were searched from inception until March 2021. Randomized controlled trials (RCTs) and non-randomized studies (NRSs) about women who underwent SA and GA for gynecological laparoscopic surgery. Relevant data were extracted and tabulated. RESULTS The primary outcomes included the evaluation of postoperative pain (described as shoulder pain), postoperative nausea and vomiting, and operative times. One hundred and eight patients were included in RCTs, 58 in NRSs. The qualitative analysis had conflicting results and for the most of parameters (hemodynamic variables, nausea and postoperative analgesic administration) no statistically significant differences were observed: in the NRSs studies, contradictory results regarding the postoperative pain in SA and GA groups were reported. Regarding the quantitative analysis, in the RCT studies, women who received SA had not significantly lower operative times (RR -4.40, 95% CI -9.32 to 0.53) and a lower incidence of vomiting (RR 0.51, 95% CI 0.17 to 1.55); on the other hand, in the NRS studies, women who received SA had longer operative times (RR 5.05, 95% CI -0.03 to 10.14) and more episodes of vomiting (RR 0.56, 95% CI 0.10 to 2.97) compared to those with GA: anyway, the outcomes proved to be insignificant. CONCLUSIONS Current evidence suggests no significant advantages to using SA over GA for laparoscopic treatment of gynecological diseases.
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Affiliation(s)
- Luigi Della Corte
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Antonio Mercorio
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Ilaria Morra
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Gaetano Riemma
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Pasquale De Franciscis
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Mario Palumbo
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Francesco Viciglione
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Danilo Borrelli
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Antonio Simone Laganà
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
| | - Giuseppe Vizzielli
- Department of Women's and Children's Health, Fondazione Policlinico Universitario A, Gemelli - IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giuseppe Bifulco
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
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15
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Chuaychoosakoon C, Parinyakhup W, Wiwatboworn A, Purngpiputtrakul P, Wanasitchaiwat P, Boonriong T. Comparing the Efficacy of Postoperative Pain Control Between Intravenous Parecoxib and Oral Diclofenac in ACL Reconstruction. Orthop J Sports Med 2021; 9:23259671211041660. [PMID: 34692879 PMCID: PMC8532231 DOI: 10.1177/23259671211041660] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 06/08/2021] [Indexed: 11/19/2022] Open
Abstract
Background: A nonsteroidal anti-inflammatory drug such as oral diclofenac is normally used to relieve postoperative pain after anterior cruciate ligament reconstruction (ACLR), but most patients continue to have moderate-to-severe pain that disturbs their rehabilitation. Some orthopaedists prefer to use intravenous (IV) parecoxib for postoperative pain control. Purpose: To compare the efficacy of IV parecoxib and oral diclofenac for postoperative pain control in ACLR. Study Design: Cohort study; Level of evidence, 3. Methods: We retrospectively collected and analyzed postoperative pain in patients who underwent both single- and double-bundle ACLR; pain was reported on a 10-point visual analog scale (VAS; 10 = worst pain). After the operation, each patient was given either IV parecoxib twice a day or oral diclofenac 3 times a day, and all patients received paracetamol 6 times per day for 24 hours postoperatively. If the patient complained of moderate or severe pain (VAS >3) after surgery, 3 mg of morphine would be given intravenously every 3 hours and 1 mg of morphine as a rescue analgesic every 1 hour for 24 hours postoperatively. Postoperative VAS and morphine consumption were recorded every 4 hours for 24 hours. Data were analyzed using paired t test, analysis of variance, and chi-square test. Results: Overall, 161 patients were included in this study, of whom 47 received IV parecoxib and 114 received oral diclofenac. The mean VAS scores at 4 and 8 hours postoperatively were 3.5 and 3.4, respectively, in the parecoxib group, and 4.4 and 4.7, respectively, in the diclofenac group. The parecoxib group had significantly lower mean VAS than the diclofenac group at 4 hours (P = .047) and 8 hours (P = .005), and the mean cumulative morphine consumption in the parecoxib group was significantly lower than in the diclofenac group at all time points (P < .05) except 4 hours postoperatively. Conclusion: This study found that IV parecoxib was more effective than oral diclofenac in controlling postoperative pain and resulted in lower postoperative morphine consumption within the first 24 hours after ACLR.
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Affiliation(s)
- Chaiwat Chuaychoosakoon
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Wachiraphan Parinyakhup
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Arnan Wiwatboworn
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | | | - Pawin Wanasitchaiwat
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Tanarat Boonriong
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
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16
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Chandler K, Jacob R, Kuntz Iv GE, Sowers M, McGwin G, Naranje S, Kukreja P. Operating room time comparison between spinal and general anesthesia in total knee arthroplasty: an institutional review. Orthop Rev (Pavia) 2021; 13:28330. [PMID: 35478702 PMCID: PMC9037657 DOI: 10.52965/001c.28330] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 09/17/2021] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND The type of anesthesia used in total knee arthroplasty is one modifiable factor that could save hospital systems time and money. With spinal and general anesthesia having similar outcomes, more weight can be placed on these anesthesia methods' time or money-saving aspects. OBJECTIVE This study aims to determine the differences in time expenditure between spinal and general anesthesia for total knee arthroplasty to optimize OR efficiency and reduce costs. METHODS A retrospective analysis of 200 unilateral total knee arthroplasty procedures (CPT Code 27447) was performed from Jan 2017 - July 2019 at one institution. 100 of these received spinal anesthesia, and 100 received general anesthesia. Patient charts were reviewed to obtain demographic, surgical, and anesthetic data. RESULTS Time to prepare the patient for surgery and total preoperative time was significantly decreased in the general anesthesia group (24.4 minutes vs. 18.5 minutes; p=<0.0001 and 25.4 minutes vs. 20.4 minutes; p=0.012). After surgery, the time to remove the patient from the operating room was significantly decreased in the spinal group (4.8 minutes vs. 7.0 minutes; p= <0.0001). Nonoperative total time was not significantly different between the two groups (49.3 minutes vs. 46.6 minutes; p=0.1127). CONCLUSION While there are significant differences in certain operating room time periods between spinal and general anesthesia, these differences are effectively canceled out when considering total operating room time.
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Affiliation(s)
- Kelly Chandler
- Department of Orthopaedic Surgery, University of Alabama at Birmingham
| | - Roshan Jacob
- Department of Orthopaedic Surgery, University of Alabama at Birmingham
| | - George E Kuntz Iv
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham
| | - Mackenzie Sowers
- Department of Orthopaedic Surgery, University of Alabama at Birmingham
| | - Gerald McGwin
- Department of Epidemiology, University of Alabama at Birmingham
| | - Sameer Naranje
- Department of Orthopaedic Surgery, University of Alabama at Birmingham
| | - Promil Kukreja
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham
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17
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Ganjifard M, Kouzegaran S, Abdi R, Naseri M, Allahyari E, Sabertanha A, Zeinali B. The Comparison of Inflammatory Cytokines between Spinal and General Anesthesia following Changes in Ischemic Reperfusion due to Tourniquet during Lower Limb Surgery. Adv Orthop 2021; 2021:2027421. [PMID: 34631170 PMCID: PMC8500770 DOI: 10.1155/2021/2027421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 08/12/2021] [Indexed: 11/17/2022] Open
Abstract
METHODS In this randomized controlled clinical trial, 34 patients with lower limb surgery admitted at the orthopedic ward of Imam Reza Hospital, Birjand, Iran, were selected by the available sampling method. They were randomly divided into two groups as follows: general anesthesia (n = 17) and spinal anesthesia (n = 17). Venous blood samples were taken from the patients of both groups at baseline (before the use of tourniquet) and 12 and 24 hours after reperfusion. Interleukin-6 (IL-6), tumor necrotizing factor-α (TNF-α), high-sensitivity C-reactive protein (hs-CRP), and ferritin were measured and recorded. The data were analyzed using independent t-test, chi-square, and repeated measure at the significant level of 0.05. RESULTS The results showed that hs-CRP and IL-6 significantly increased during the study (p < 0.001); however, the mean changes of TNF-α and ferritin were not significant during the study. Moreover, none of the inflammatory cytokines indicated significant differences between these two study groups (p < 0.05). CONCLUSION According to the results, the use of tourniquet can lead to inflammation, and the inflammation is similar in both groups.
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Affiliation(s)
- Mahmoud Ganjifard
- Department of Anesthesia, Faculty of Medicine, Birjand University of Medical Sciences, Birjand, Iran
| | - Samaneh Kouzegaran
- Clinical Immunology and Allergy, Faculty of Medicine, Birjand University of Medical Sciences, Birjand, Iran
| | - Reza Abdi
- Department of Orthopedics, School of Medicine, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohsen Naseri
- Cellular and Molecular Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Elahe Allahyari
- Social Determinants of Health Research Center, Department of Epidemiology and Biostatistics, Faculty of Health, Birjand University of Medical Sciences, Birjand, Iran
| | - Amir Sabertanha
- Department of Anesthesia, Faculty of Medicine, Birjand University of Medical Sciences, Birjand, Iran
| | - Batool Zeinali
- Department of Anesthesia, Faculty of Medicine, Birjand University of Medical Sciences, Birjand, Iran
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Peloza JH, Millgram MA, Jacobian E, Kolsky DE, Guyer RD, Le Huec JC, Ashkenazi E. Economic Analysis of Transforaminal Lumbar Interbody Fusion Surgery Utilizing a Curved Bone Removal Device. PHARMACOECONOMICS - OPEN 2021; 5:519-531. [PMID: 33462767 PMCID: PMC8333172 DOI: 10.1007/s41669-020-00256-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/31/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Transforaminal lumbar interbody fusion (TLIF) represents a commonly performed spinal procedure that poses a significant financial burden on patients, hospitals and insurers. Reducing these costs, while maintaining efficacy, may be assisted by a new powered endplate preparation device, designed to shorten procedural time while offering positive impacts on other elements that contribute to the cost of care. OBJECTIVE The aim of the study was to assess and compare the individual cost elements of TLIF procedures with and without the use of the device, to determine whether application of this technology translated into any material procedural savings. METHODS The records of 208 single-level TLIF procedures in a single hospital were reviewed. Surgical time, length of hospital stay, blood loss, infection rate, and other parameters were compared for the cases where the device was used (device group; n = 143) and cases which used standard tools (control group; n = 65). The cost per unit of each element was derived from the literature, online resources, and the hospital's financial department. RESULTS The analysis revealed a shorter surgery duration in the device group (23 min, after controlling for procedure year and patient characteristics; statistically significant at p < 0.001) and lower complication and readmission rates (p = 0.67 and p = 0.21, respectively) associated with the use of the device, leading to a statistically significant cost reduction of approximately 2060 US dollars (US$) (p < 0.01). CONCLUSION The study suggests that use of the device may lead to a cost reduction and shorter procedure without deteriorating the clinical outcome.
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Affiliation(s)
| | - Michael A Millgram
- Israel Spine Center, Assuta Hospital, Assuta Medical Centers, 69710, Tel Aviv, Israel.
| | - Erel Jacobian
- Israel Spine Center, Assuta Hospital, Assuta Medical Centers, 69710, Tel Aviv, Israel
| | - Daniel E Kolsky
- Israel Spine Center, Assuta Hospital, Assuta Medical Centers, 69710, Tel Aviv, Israel
| | | | | | - Ely Ashkenazi
- Israel Spine Center, Assuta Hospital, Assuta Medical Centers, 69710, Tel Aviv, Israel
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19
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Yu H, Gild P, Pompe RS, Vetterlein MW, Ludwig TA, Soave A, Kölker M, Maurer V, Marks P, Becker A, Punke MA, Fisch M, Rink M, Dahlem R, Meyer CP. Anesthetic Technique (Spinal vs. General Anesthesia) in Holmium Laser Enucleation of the Prostate: Retrospective Analysis of Procedural and Functional Outcomes among 1,159 Patients. Urol Int 2021; 107:336-343. [PMID: 34404060 DOI: 10.1159/000517542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 03/29/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim of the study was to compare procedural efficacy, early and late functional outcomes in holmium laser enucleation of the prostate (HoLEP) under spinal anesthesia (SA) versus general anesthesia (GA). METHODS We retrospectively reviewed patients undergoing HoLEP at our institution between 2012 and 2017. Standard pre-, peri-, and postoperative characteristics were compared according to anesthetic technique. Multivariable logistic regression analyses (MVAs) were employed to study the impact of SA on procedural efficacy and postoperative complications. RESULTS Our study cohort consisted of 1,159 patients, of whom 374 (32%) underwent HoLEP under SA. While a medical history of any anticoagulation/antiplatelet therapy except low-dose acetylsalicylic acid was significantly more common among patients undergoing GA (16% vs. 10%, p = 0.001), no other significant differences in preoperative characteristics were noted including age, body mass index, American Society of Anesthesiologists Classification (ASA), prostate size, or International Prostate Symptom Score (IPSS), and quality of life scores. Patients under SA exhibited shorter times of enucleation 42 min (interquartile range [IQR]:27-59 vs. 45 min [IQR: 31-68], p = 0.002), and combined time of enucleation/morcellation/coagulation (57 min [IQR: 38-85] vs. 64 min [IQR: 43-93], p = 0.002), as well as fewer complications (Clavien-Dindo ≥3) (12 [3.2%] vs. 55 [7%], p = 0.013). These associations were confirmed in MVA. Patients did not differ significantly with regard to early micturition including post-void residual volume and maximum flow-rate improvement. At a median follow-up of 33 months (IQR: 32-44), patients with SA had a lower IPSS score (median 3 [IQR: 1-6] vs. 4 [IQR: 2-7], p = 0.039). However, no significant differences were observed with respect to any urinary incontinence, urge symptoms, and postoperative pain. CONCLUSION In this large retrospective series, HoLEP under SA was a safe and efficacious procedure with comparable early and long-term functional outcomes.
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Affiliation(s)
- Hang Yu
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Philipp Gild
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Raisa S Pompe
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Malte W Vetterlein
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tim A Ludwig
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Armin Soave
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Mara Kölker
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Valentin Maurer
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Phillip Marks
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Andreas Becker
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Urology, University Medical Center Frankfurt, Frankfurt, Germany
| | - Mark-Andree Punke
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Margit Fisch
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Rink
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Roland Dahlem
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian P Meyer
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Outcome of Spinal Versus General Anesthesia in Revision Total Hip Arthroplasty: A Propensity Score-Matched Cohort Analysis. J Am Acad Orthop Surg 2021; 29:e656-e666. [PMID: 32947347 DOI: 10.5435/jaaos-d-20-00797] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 08/18/2020] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Spinal anesthesia has been previously shown to offer improved patient outcomes compared with general anesthesia in revision total knee arthroplasty. This study aimed to evaluate the potential differences in perioperartive and postoperative outcomes in revision total hip arthroplasty (THA) between spinal or general anesthesia. METHODS A total of 2,656 consecutive patients who underwent revision THA were evaluated. Propensity-score-adjusted multivariate logistic regression analyses were applied to control for intergroup variability and evaluate the differences in outcomes and complications with anesthesia type. RESULTS Propensity score matching resulted in 1:1 matching with 265 patients in each anesthesia cohort. Multivariate analyses demonstrated that patients administered general anesthesia had a significantly longer procedure time (174.8 versus 161.3, P < 0.01), higher intraoperative (402.6 versus 305.5 mL, P < 0.01), and total perioperative blood loss (1802.2 versus 1,684.2 mL,P < 0.01). In addition, patients administered general anesthesia were found to have higher odds for two or more inhospital complications (odds ratio, 4.51, P < 0.01) and extended length of stay (odds ratio, 2.45, P = 0.02). DISCUSSION Our study shows that propensity-matched patients who received spinal anesthesia for revision THA exhibited notable reduction in surgical time, perioperative blood loss, and complications compared with patients who received general anesthesia, suggesting that spinal anesthesia is a viable alternative to general anesthesia in revision THA.
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Ritz ML, Rosenfeld DM, Spangehl M, Misra L, Khurmi N, Butterfield RJ, Buras MR, Gorlin AW. Evaluation of the use of spinal anesthesia administered prior to proceeding to the operating room in patients undergoing total joint arthroplasty. ACTA ACUST UNITED AC 2021. [DOI: 10.1016/j.pcorm.2020.100154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Eklund SE, Vodonos A, Ryan-Barnett SM. Changing practice to increase rates of spinal anaesthesia for total joint replacement. J Perioper Pract 2021; 32:83-89. [PMID: 33611968 DOI: 10.1177/1750458920970145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Neuraxial anaesthesia for lower extremity total joint replacement surgery has several advantages over general anaesthesia; however, we encountered resistance to routine use of spinal anaesthesia and standardised analgesic regimens at our large, tertiary hospital. Our Perioperative Surgical Home led to multidisciplinary education and enhanced communication to change practice, with the purpose of increasing rates of neuraxial anaesthetics for these surgeries. METHODS Team members from anaesthesia, nursing and surgery participated in the development and adoption of the care pathway. After implementation, we performed a retrospective analysis to examine the impact of the pathway on primary anaesthetic choice. Data were analysed using Student's t-test and interrupted time series analysis. RESULTS The rate of neuraxial anaesthetics increased following implementation of the total joint pathway. CONCLUSION With multidisciplinary collaboration, we were able to change practice towards spinal anaesthesia, despite a large and diverse group of practitioners.
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Affiliation(s)
- Susan E Eklund
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital & Harvard Medical School, Boston, MA, USA
| | - Alina Vodonos
- Clinical Research Center Soroka University Medical Center, Beersheva, Israel
| | - Sheila M Ryan-Barnett
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center & Harvard Medical School, Boston, MA, USA
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GÜRBÜZ T, TANRIDAN OKÇU N. Charecteristics of postcesarean section pain. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2021. [DOI: 10.32322/jhsm.719225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Ahmed Jonayed S, Alam MS, Al Mamun Choudhury A, Akter S, Chakraborty S. Efficacy, safety, and reliability of surgery on the lumbar spine under general versus spinal anesthesia- an analysis of 64 cases. J Clin Orthop Trauma 2021; 16:176-181. [PMID: 33717954 PMCID: PMC7920005 DOI: 10.1016/j.jcot.2020.12.032] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 12/06/2020] [Accepted: 12/29/2020] [Indexed: 01/17/2023] Open
Abstract
QUASI-EXPERIMENTAL DESIGN PURPOSE Compare intra and postoperative parameters, surgeons' satisfaction, and cost-effectiveness between general anesthesia (GA) and spinal anesthesia (SA) on patients undergoing surgery in the lumbar spine surgery. OVERVIEW OF LITERATURE Surgery on the lumbar spine is the commonest surgical procedure among all spinal surgical practices. Both the GA and SA are shown to be suitable techniques for performing the surgery safely. GA is used most frequently. But, SA became increasingly more popular because it allows the patient to self-position thereby reducing various complications associated with GA in a prone position. METHODS A total of 64 patients from June 2016 to July 2019 who underwent either discectomy, laminectomy, or lamino-foraminotomy for herniated lumbar disc or canal stenosis in 1 or 2 levels were included. During the study period, 32 patients were non-randomly selected for each of the GA and SA groups. The heart rate (HR), mean arterial pressure (MAP), blood loss, total anesthetic time, surgeons' satisfaction, analgesic requirements, cost of the procedure, and hospital stay were recorded and compared. RESULTS In the context of demographic characteristics, baseline HR, or MAP, no significant differences were noted between SA and GA groups. Mean anesthetic time, mean PACU time, mean doses of analgesic requirement, cost of anesthesia, and the surgeon's satisfaction was significantly lower in the SA Group (P < 0.05). The blood loss, duration of operation, and hospital stay were not significant too. No major Intra and postoperative complications were reported nor were significant differences found in either series. CONCLUSION Safety and efficacy of SA in comparison to GA were similar for the patients undergoing surgery on the lumbar spine. Notable advantages of SA include shorter anesthesia duration, fewer drug requirements, relative cost-effectiveness, and fewer complications rate. Successful surgery can be performed using either anesthesia type.
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Affiliation(s)
- Sharif Ahmed Jonayed
- National Institute of Traumatology & Orthopaedic Rehabilitation, (NITOR), Dhaka, Bangladesh,Corresponding author. National Institute of Traumatology & orthopaedic rehabilitation, (NITOR), House#23, Road#06, Dhanmondi Residential Area, Dhaka, 1209, Bangladesh.
| | - Md Shah Alam
- Dhaka Medical College Hospital, Dhaka, Bangladesh
| | | | - Sohely Akter
- Dhaka Medical College Hospital, Dhaka, Bangladesh
| | - Shubhendu Chakraborty
- National Institute of Traumatology & Orthopaedic Rehabilitation, (NITOR), Dhaka, Bangladesh
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Sharma A, Chaudhary S, Kumar M, Kapoor R. Comparison of nalbuphine versus fentanyl as intrathecal adjuvant to bupivacaine for orthopedic surgeries: A randomized controlled double-blind trial. J Anaesthesiol Clin Pharmacol 2021; 37:529-536. [PMID: 35340949 PMCID: PMC8944353 DOI: 10.4103/joacp.joacp_270_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 08/31/2019] [Accepted: 03/06/2020] [Indexed: 11/16/2022] Open
Abstract
Background and Aims: Intrathecal adjuvants are used with local anesthetics to prolong the duration and provide postoperative pain relief while minimizing the dose of local anesthetic. Nalbuphine is an agonist-antagonist opioid and provides prolonged duration of analgesia with fewer side effects of fentanyl such as pruritus, nausea, and vomiting. The aim of this study was to evaluate and compare the onset and duration of sensory and motor blockade, hemodynamic effects, duration of postoperative analgesia, and adverse effects of nalbuphine and fentanyl given intrathecally with hyperbaric 0.5% bupivacaine in orthopedic lower limb surgeries. Material and Methods: Sixty six patients classified in American Society of Anesthesiology (ASA) classes I and II scheduled for orthopedic lower limb surgeries were enrolled. Patients were randomly allocated to receive 15 mg of hyperbaric bupivacaine with either 1 mg nalbuphine (group N), 25 μg fentanyl (group F) or 0.9% normal saline (group C) intrathecally. Results: Patients who received intrathecal nalbuphine (group N) had a significantly delayed onset of sensory and motor block as compared to patients who received fentanyl (group F). The time to two segment regression was significantly prolonged in group F (122.05 ± 10.65 minutes) as compared to group N (114.55 ± 10.90 minutes) [P < 0.05]. The mean duration of motor blockade was significantly prolonged in group F (197.73 ± 15.09 minutes) as compared to group N (180.68 ± 15.68 minutes) [P < 0.05]. Duration of spinal analgesia was comparable in group N (323.18 ± 57.39 minutes) and group F (287.05 ± 78.87 minutes), both significantly more than group C (224.32 ± 42.54 minutes). Hemodynamic effects, 24-h rescue analgesic requirements, and incidence of side effects were comparable among group N and F. Conclusion: Intrathecal nalbuphine in a dose of 1 mg is an equally useful alternative to fentanyl in a dose 25 μg when used as an intrathecal adjuvant to bupivacaine for lower limb surgeries. The prolonged duration of analgesia and no adverse effects makes it a good choice for the orthopedic procedures of lower limb.
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Sekerak R, Mostafa E, Morris MT, Nessim A, Vira A, Sharan A. Comparative outcome analysis of spinal anesthesia versus general anesthesia in lumbar fusion surgery. J Clin Orthop Trauma 2020; 13:122-126. [PMID: 33680810 PMCID: PMC7919949 DOI: 10.1016/j.jcot.2020.11.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 11/23/2020] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Spinal anesthesia (SA) has been shown in several studies to be a viable alternative to general anesthesia (GA) in laminectomies, discectomies, and microdiscectomies. However, the use of SA in spinal fusion surgery has been very scarcely documented in the current literature. Here we present a comparison of SA to GA in lumbar fusion surgery in terms of perioperative outcomes and cost. METHODS The authors retrospectively reviewed the charts of all patients who underwent 1- or 2-level minimally invasive transforaminal lumbar interbody fusion (TLIF) surgery by a single surgeon, at a single institution, from 2015 to 2018. Data collected included demographics, operative and recovery times, nausea/vomiting, postoperative pain, and opioid requirement. Costs were included in the analysis if they were: 1) non-fixed; 2) incurred in the operating room (OR); and 3) directly related to patient care. All cost data represents net costs and was obtained from the hospital revenue cycle team. Patients were grouped for statistical analysis based on anesthetic modality. RESULTS A total of 29 patients received SA and 46 received GA. Both groups were similar in terms of age, gender, BMI, number of levels operated upon, preoperative diagnosis, and medical comorbidities. The SA group spent less time in the OR (163.86 ± 9.02 vs. 195.63 ± 11.27 min, p < 0.05), PACU (82.00 ± 7.17 vs. 102.98 ± 8.46 min, p < 0.05), and under anesthesia (175.03 ± 9.31 vs. 204.98 ± 10.15 min, p < 0.05) than the GA group. Post-surgery OR time was significantly less with SA than with GA (6.00 ± 1.09 vs. 17.26 ± 3.05 min, p < 0.05); however, pre-surgery OR time was similar between groups (50.17 ± 3.08 vs. 56.17 ± 5.34 min, p = 0.061). The SA group also experienced less maximum postoperative pain (3.31 ± 1.41 out of 10 vs. 5.96 ± 0.84/10, p < 0.05) and required less opioid analgesics (2.38 ± 1.37 vs. 5.39 ± 0.84 doses, p < 0.05). Both groups experienced similar nausea or vomiting rates and adverse events postoperatively. Net operative cost was found to be $812.31 (5.6%) less with SA than with GA, although this difference was not significant (p = 0.225). DISCUSSION/CONCLUSION To our knowledge, SA is almost never used in lumbar fusion, and a cost-effectiveness comparison with GA has not been recorded. In this retrospective study, we demonstrate that the use of SA in lumbar fusion surgery leads to significantly shorter operative and recovery times, less postoperative pain and opioid usage, and slight cost savings over GA. Thus, we conclude that this anesthetic modality represents a safe and cost-effective alternative to GA in lumbar fusion.
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Affiliation(s)
| | - Evan Mostafa
- Albert Einstein College of Medicine, Bronx, NY, USA,Corresponding author. Albert Einstein College of Medicine, 1400 Morris Park Ave, Bronx, NY, 10461, United States.
| | - Matthew T. Morris
- Northwell Health, North Shore University Hospital, Manhasset, NY, USA
| | - Adam Nessim
- Albert Einstein College of Medicine, Bronx, NY, USA
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Cost-Effectiveness of Arthroplasty Management in Hip and Knee Osteoarthritis: a Quality Review of the Literature. CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2020. [DOI: 10.1007/s40674-020-00157-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Elsharkawy RA, Messeha MM, Elgeidi AA. The Influence of Different Degrees of Temperature of Intrathecal Levobupivacaine on Spinal Block Characteristics in Orthopedic Surgeries: A Prospective Randomized Study. Anesth Essays Res 2019; 13:509-514. [PMID: 31602070 PMCID: PMC6775827 DOI: 10.4103/aer.aer_76_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background and Aims: The temperature of the local anesthetics may affect the distribution of spinal anesthesia. The aim of the current study is to compare the effects of different degrees of intrathecal levobupivacaine 0.5% on the spinal anesthesia characteristics and shivering in orthopedic surgery. Materials and Methods: A randomized, prospective, and controlled trial was conducted on 120 patients aged 40–70 years with American Society of Anesthesiologists Classes I and II and who scheduled for orthopedic surgery; they were randomly distributed into three groups: Group 1 (L 24°C) – levobupivacaine 0.5% warmed to 24°C; Group 2 (L 30°C) – levobupivacaine 0.5% warmed to 30°C; and Group 3 (L 37°C) – levobupivacaine 0.5% warmed to 37°C. Every patient had received 3 mL of 0.5% levobupivacaine intrathecally. Sensory blockade was tested using the loss of pinprick sensation, whereas the motor block was tested using the modified Bromage scale. The onset and grading of shivering after spinal anesthesia were recorded. Results: The use of intrathecal levobupivacaine 0.5% warmed to either 30°C or 37°C resulted in a significant acceleration of the onset of either sensory or motor blockade with a significant prolongation in the duration in addition to significant delay in the onset of shivering and the time of the first analgesia requirement in comparison to those of spinal anesthesia with levobupivacaine at room temperature (24°C). Notably, a nonsignificant difference in the spinal block characteristics and shivering was observed between Group L 30°C and Group L 37°C. Conclusion: The increasing the temperature of levobupivacaine 0.5% to 30 °C attains more rapid onset of sensory and motor blocks , with prolongation of the onset of shivering. It could be considered as effective equivalent to warming levobupivacaine 0.5%to 37°C in spinal anesthesia.
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Affiliation(s)
- Reem Abdelraouf Elsharkawy
- Department of Anesthesia and Surgical Intensive Care, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Medhat Mikhail Messeha
- Department of Anesthesia and Surgical Intensive Care, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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Kim HJ, Park HS, Go YJ, Koh WU, Kim H, Song JG, Ro YJ. Effect of Anesthetic Technique on the Occurrence of Acute Kidney Injury after Total Knee Arthroplasty. J Clin Med 2019; 8:jcm8060778. [PMID: 31159309 PMCID: PMC6616515 DOI: 10.3390/jcm8060778] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 05/29/2019] [Accepted: 05/30/2019] [Indexed: 12/21/2022] Open
Abstract
Recent studies have reported the advantages of spinal anesthesia over general anesthesia in orthopedic patients. However, little is known about the relationship between acute kidney injury (AKI) after total knee arthroplasty (TKA) and anesthetic technique. This study aimed to identify the influence of anesthetic technique on AKI in TKA patients. We also evaluated whether the choice of anesthetic technique affected other clinical outcomes. We retrospectively reviewed medical records of patients who underwent TKA between January 2008 and August 2016. Perioperative data were obtained and analyzed. To reduce the influence of potential confounding factors, propensity score (PS) analysis was performed. A total of 2809 patients and 2987 cases of TKA were included in this study. A crude analysis of the total set demonstrated a significantly lower risk of AKI in the spinal anesthesia group. After PS matching, the spinal anesthesia group showed a tendency for reduced AKI, without statistical significance. Furthermore, the spinal anesthesia group showed a lower risk of pulmonary and vascular complications, and shortened hospital stay after PS matching. In TKA patients, spinal anesthesia had a tendency to reduce AKI. Moreover, spinal anesthesia not only reduced vascular and pulmonary complications, but also shortened hospital stay.
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Affiliation(s)
- Ha-Jung Kim
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan, College of Medicine, Seoul 05505, Korea.
| | - Hee-Sun Park
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan, College of Medicine, Seoul 05505, Korea.
| | - Yon-Ji Go
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan, College of Medicine, Seoul 05505, Korea.
| | - Won Uk Koh
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan, College of Medicine, Seoul 05505, Korea.
| | - Hyungtae Kim
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan, College of Medicine, Seoul 05505, Korea.
| | - Jun-Gol Song
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan, College of Medicine, Seoul 05505, Korea.
| | - Young-Jin Ro
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan, College of Medicine, Seoul 05505, Korea.
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Abstract
BACKGROUND The optimal anesthetic technique remains debated in patients undergoing total-hip arthroplasty (THA). The purpose of this meta-analysis was to test the efficacy of general and spinal anesthesia for patients undergoing THA. METHODS In January 2018, we searched PubMed, Embase, Web of Science, Cochrane Database of Systematic Reviews, and the Google database. Data from randomized controlled trials (RCTs) that compared the use of general and spinal anesthesia for patients undergoing THA were retrieved. The primary outcome was to compare the total blood loss. The secondary outcomes were the occurrence of deep venous thrombosis (DVT), the occurrence of nausea, and the length of hospital stay. Software Stata 12.0 was used for meta-analysis. RESULTS Five RCTs with 487 THAs were finally included for meta-analysis. There was no significant difference between the general anesthesia and spinal anesthesia in terms of the total blood loss (weighted mean difference [WMD] = -20.72, 95% confidence interval [CI] -84.50 to 43.05, P = .524; I = 87.8%) and the occurrence of DVT (risk ratio (RR) = 0.85, 95% CI 0.24-3.01, P = .805; I = 70.5%). Compared with general anesthesia, spinal anesthesia was a significant reduction in the occurrence of nausea (RR = 3.04, 95% CI 1.69-5.50, P = .000; I = 0.0%) and the length of hospital stay (WMD = 1.00, 95% CI 0.59-1.41, P = .000; I = 94.7%). CONCLUSION Spinal anesthesia was superior than general anesthesia in terms of the occurrence of nausea and shorten the length of hospital stay. The quality and number of included studies was limited; thus, a greater number of high-quality RCTs is still needed to further identify the effects of spinal anesthesia on reducing the blood loss after THA.
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Do Hospitals Performing Frequent Neuraxial Anesthesia for Hip and Knee Replacements Have Better Outcomes? Anesthesiology 2019; 129:428-439. [PMID: 29878899 DOI: 10.1097/aln.0000000000002299] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Neuraxial anesthesia is increasingly recommended for hip/knee replacements as some studies show improved outcomes on the individual level. With hospital-level studies lacking, we assessed the relationship between hospital-level neuraxial anesthesia utilization and outcomes. METHODS National data on 808,237 total knee and 371,607 hip replacements were included (Premier Healthcare 2006 to 2014; 550 hospitals). Multivariable associations were measured between hospital-level neuraxial anesthesia volume (subgrouped into quartiles) and outcomes (respiratory/cardiac complications, blood transfusion/intensive care unit need, opioid utilization, and length/cost of hospitalization). Odds ratios (or percent change) and 95% CI are reported. Volume-outcome relationships were additionally assessed by plotting hospital-level neuraxial anesthesia volume against predicted hospital-specific outcomes; trend tests were applied with trendlines' R statistics reported. RESULTS Annual hospital-specific neuraxial anesthesia volume varied greatly: interquartile range, 3 to 78 for hips and 6 to 163 for knees. Increasing frequency of neuraxial anesthesia was not associated with reliable improvements in any of the study's clinical outcomes. However, significant reductions of up to -14.1% (95% CI, -20.9% to -6.6%) and -15.6% (95% CI, -22.8% to -7.7%) were seen for hospitalization cost in knee and hip replacements, respectively, both in the third quartile of neuraxial volume. This coincided with significant volume effects for hospitalization cost; test for trend P < 0.001 for both procedures, R 0.13 and 0.41 for hip and knee replacements, respectively. CONCLUSIONS Increased hospital-level use of neuraxial anesthesia is associated with lower hospitalization cost for lower joint replacements. However, additional studies are needed to elucidate all drivers of differences found before considering hospital-level neuraxial anesthesia use as a potential marker of quality.
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Lin FH, Chen HC, Lin C, Chiu YL, Lee HS, Chang H, Huang GS, Chang HL, Yeh SJ, Su W, Wang CC, Su SL. The increase in total knee replacement surgery in Taiwan: A 15-year retrospective study. Medicine (Baltimore) 2018; 97:e11749. [PMID: 30075592 PMCID: PMC6081077 DOI: 10.1097/md.0000000000011749] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Total knee replacement (TKR) is considered as one of the most success among clinical interventions for patients with who suffering from knee osteoarthritis (OA). We sought to estimate the incidence of TKR using demographics, incidence rates, lengths of hospital stay, and costs from 1996 to 2010 by analyzing Taiwan's National Health Insurance Research Database. A total of 154,553 patients obtained primary TKR surgery between 1996 and 2010. The diagnosis code for knee OA and the procedure code for TKR were selected from the records. To compare the rate of TKR between covariables, we calculated the TKR risk ratios and 95% confidence interval (CI) of these variables (gender, age, age group, and primary diagnoses). A 2-tailed P-value of .05 was considered statistically significant. The statistical package SPSS version 20.0 (SPSS, Chicago, IL) was used to conduct all the statistical analyzes. We analyzed 154,553 TKRs performed by surgeons in Taiwan from 1996 to 2010. The overall crude incidence increased from 26.4 to 74.55 TKR per 100,000 inhabitants from 1996 to 2010. TKR incidence for the 70 to 79 years age group increased from 227 to 505 per 100,000 people from 1996 to 2010. The age-standardized rate ratios for TKR of women to men ranged from 2.5 to 3.0. The mean average length of stay in hospital was 15 days in 1996 and decreased to 8 days in 2010. During the study period, the adjusted mean cost per patient decreased from US$7485 to US$4827. Health expenditures for TKR were 5% of total National Health Insurance expenditure every year. Over the 15-year period, Taiwan's TKR incidence tripled, which is consistent with population ageing. Arthritis will be a major public health issue in the ageing population in the future.
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Affiliation(s)
| | - Hsiang-Cheng Chen
- Division of Rheumatology/Immunology/Allergy, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei
| | | | | | - Herng-Sheng Lee
- Department of Pathology and Laboratory Medicine, Kaohsiung Veterans General Hospital, Kaohsiung
| | - Hung Chang
- Department of Physiology and Biophysics
- Division of Thoracic Surgery
| | - Guo-Shu Huang
- Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei
| | | | - Shih-Jen Yeh
- Department of Research and Development, Da-Yeh University, Changhua
| | | | - Chih-Chien Wang
- Department of Orthopedics, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
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Optimal dose of intrathecal isobaric bupivacaine in total knee arthroplasty. Can J Anaesth 2018; 65:1004-1011. [DOI: 10.1007/s12630-018-1165-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 04/11/2018] [Accepted: 04/18/2018] [Indexed: 10/14/2022] Open
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Weinstein SM, Poultsides L, Baaklini LR, Mörwald EE, Cozowicz C, Saleh JN, Arrington MB, Poeran J, Zubizarreta N, Memtsoudis SG. Postoperative delirium in total knee and hip arthroplasty patients: a study of perioperative modifiable risk factors. Br J Anaesth 2018; 120:999-1008. [PMID: 29661417 DOI: 10.1016/j.bja.2017.12.046] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 12/08/2017] [Accepted: 02/02/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Postoperative delirium continues to pose major clinical difficulties. While unmodifiable factors (e.g. age and comorbidity burden) are commonly studied risk factors for delirium, the role of modifiable factors, such as anaesthesia type and commonly used perioperative medications, remains understudied. This study aims to evaluate the role of modifiable factors for delirium after hip and knee arthroplasties. METHODS We performed a retrospective study of 41 766 patients who underwent hip or knee arthroplasties between 2005 and 2014 at a single institution. Data were collected as part of routine patient care. Multivariable logistic regression models assessed associations between anaesthesia type and commonly used perioperative medications (opioids, benzodiazepines, and ketamine) and postoperative delirium. Odds ratios (OR) and 95% confidence intervals (CI) are reported. Various sensitivity analyses are also considered, including multiple imputation methods to address missing data. RESULTS Postoperative delirium occurred in 2.21% (n=922) of all patients. While patients who received neuraxial anaesthesia were at lower risk for postoperative delirium (compared with general anaesthesia; epidural OR 0.59 CI 0.38-0.93; spinal OR 0.55 CI 0.37-0.83; combined spinal/epidural OR 0.56 CI 0.40-0.80), those given intraoperative ketamine (OR 1.27 CI 1.01-1.59), opioids (OR 1.25 CI 1.09-1.44), postoperative benzodiazepines (OR 2.47 CI 2.04-2.97), and ketamine infusion (OR 10.59 CI 5.26-19.91) were at a higher risk. CONCLUSIONS In this cohort of hip and knee arthroplasty patients, anaesthesia type and perioperative medications were associated with increased odds for postoperative delirium. Our results support the notion that modifiable risk factors may exacerbate or attenuate risk for postoperative delirium.
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Affiliation(s)
- S M Weinstein
- Department of Anesthesiology, Hospital for Special Surgery, New York, NY, USA
| | - L Poultsides
- Department of Orthopedic Surgery, New York University Langone Orthopedic Hospital, New York, NY, USA
| | - L R Baaklini
- Department of Anesthesiology, Hospital for Special Surgery, New York, NY, USA; Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA
| | - E E Mörwald
- Department of Anesthesiology, Hospital for Special Surgery, New York, NY, USA; Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University, Salzburg, Austria
| | - C Cozowicz
- Department of Anesthesiology, Hospital for Special Surgery, New York, NY, USA; Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University, Salzburg, Austria
| | - J N Saleh
- Pharmacy Department, Hospital for Special Surgery, New York, NY, USA
| | - M B Arrington
- Pharmacy Department, Hospital for Special Surgery, New York, NY, USA
| | - J Poeran
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - N Zubizarreta
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - S G Memtsoudis
- Department of Anesthesiology, Hospital for Special Surgery, New York, NY, USA; Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA; Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University, Salzburg, Austria.
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Greimel F, Maderbacher G, Baier C, Keshmiri A, Schwarz T, Zeman F, Meissner W, Grifka J, Benditz A. Multicenter cohort-study of 15326 cases analyzing patient satisfaction and perioperative pain management: general, regional and combination anesthesia in knee arthroplasty. Sci Rep 2018; 8:3723. [PMID: 29487361 PMCID: PMC5829078 DOI: 10.1038/s41598-018-22146-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 02/19/2018] [Indexed: 12/21/2022] Open
Abstract
Numbers of knee replacement surgeries have been rising over the past years. After having ameliorated operation techniques and material, pain management and anesthetic methods have come into focus. All 15326 patients included had undergone primary knee arthroplasty within this multicenter cohort-study, conducted in 46 orthopedic departments. Parameters were evaluated on first postoperative day. Primary outcome values were pain levels (activity, minimum and maximum pain, and pain management satisfaction). Pain medication necessity was analyzed. Parameters were compared between the types of anesthesia used: general, regional and combination anesthesia. Pain scores and pain management satisfaction were significantly better in the groups of either spinal or peripheral anesthesia combined with general anesthesia (p < 0.001, respectively). Patients who received the combination of general and spinal anesthesia were associated with the lowest need for opioids (p < 0.001). The use of a combined general and spinal anesthesia as well as using a combination of general and peripheral anesthesia in knee arthroplasty was associated with a highly significant advantage to other anesthetic techniques regarding perioperative pain management in daily clinical practice, but maybe below clinical relevance. Furthermore they were associated with positive tendency considering side effects and subjective well-being parameters.
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Affiliation(s)
- Felix Greimel
- Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Germany.
| | - Guenther Maderbacher
- Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Germany
| | - Clemens Baier
- Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Germany
| | - Armin Keshmiri
- Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Germany
| | - Timo Schwarz
- Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Germany
| | - Florian Zeman
- Center for Clinical Studies, University Medical Center of Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Winfried Meissner
- Department of Anesthesiology and Intensive Care, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - Joachim Grifka
- Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Germany
| | - Achim Benditz
- Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Germany
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Greimel F, Maderbacher G, Zeman F, Grifka J, Meissner W, Benditz A. No Clinical Difference Comparing General, Regional, and Combination Anesthesia in Hip Arthroplasty: A Multicenter Cohort-Study Regarding Perioperative Pain Management and Patient Satisfaction. J Arthroplasty 2017. [PMID: 28641966 DOI: 10.1016/j.arth.2017.05.038] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Steadily increasing numbers of hip arthroplasties are reported in the past years. Different types of anesthetic methods for surgery itself as well as pain management programs have been established. It is one of the main goals to reduce postoperative pain levels and guarantee better and faster mobilization in the postoperative period. The present study aims to compare the use of general and regional spinal anesthesia and their combination regarding perioperative pain management and patient satisfaction. METHODS All patients included in the present study had undergone primary hip arthroplasty. Parameters were analyzed on the first postoperative day within the scope of the "Quality Improvement in Postoperative Pain Management" project, which is conducted nationwide in 49 orthopedic departments at the time of data evaluation. RESULTS From 2009-2015, 18,118 patients underwent primary hip arthroplasty and have been evaluated. Demographic and general patient data were homogenous. The need for opioids was significantly higher in patients where general and combination anesthesia was applied (P < .001, respectively). Pain scores and pain management satisfaction were significantly better in regional and combination anesthesia (P < .001, respectively). CONCLUSION We were able to show a highly significant advantage in the use of regional or the combination of regional and general anesthesia in comparison with general anesthesia alone in hip arthroplasty regarding patients' satisfaction and the requirement of opioid pain medication, although maybe below clinical relevance.
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Affiliation(s)
- Felix Greimel
- Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Bad Abbach, Germany
| | - Guenther Maderbacher
- Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Bad Abbach, Germany
| | - Florian Zeman
- Center for Clinical Studies, University Medical Center of Regensburg, Regensburg, Germany
| | - Joachim Grifka
- Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Bad Abbach, Germany
| | - Winfried Meissner
- Department of Anesthesiology and Intensive Care, Jena University Hospital, Jena, Germany
| | - Achim Benditz
- Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Bad Abbach, Germany
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Jasim HH, Sulaiman SABS, Khan AH, S Rajah UA. Factors Affecting Post Caesarean Pain Intensity among Women in the Northern Peninsular of Malaysia. J Clin Diagn Res 2017; 11:IC07-IC11. [PMID: 29207737 DOI: 10.7860/jcdr/2017/25364.10630] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 05/27/2017] [Indexed: 11/24/2022]
Abstract
Introduction Caesarean section (CS) rate has increased considerably during the past years, accounting for 15% to 25% of births. During post-CS period, moderate to severe postoperative pain is a regularly reported problem. Ideally, the intensity of postoperative pain should be predicted so as to customize analgesia. Aim To document the CS rate, assess the pain intensity and preoperative factors that may predict post caesarean pain among women in the Obstetric unit of a Hospital Pulau Pinang in Malaysia. Materials and Methods A retrospective chart review of 400 caesarean deliveries was conducted between January 2013 and June 2014. The study encompassed patient's demographic data and obstetrics data. The overall pain scores since the time of surgery (2, 4, 8, 12, 24 and 48 hours postoperatively at rest and while moving) were assessed by visual analogue scale (VAS). The data were analyzed by using SPSS software (version 21.0 for Windows). Results The results demonstrate that within a 48 hours postoperative period, the average pain at rest and while moving was 0.40±0.013 and 0.83±0.017 (VAS score), respectively. Logistic regression identified that a higher BMI (≥30) (OR 1.056; 95% CI=1.003 to 1.113, p=0.04), an increase in operation time (> 60 minutes) (OR 1.009; 95% CI=1.000 to 1.018, p=0.049), Single women (OR 11.597; 95% CI=1.382 to 97.320, p=0.024), blood group type O (OR 1.857; 95% CI=0.543 to 2.040, p = 0.001) and general anesthesia (OR 3.689; 95% CI=1.653 to 8.232, p=0.001) were found to be independent predictors for postcaesarean pain intensity. Conclusion This study concluded that CS rate is 28% among women in the obstetric unit of a Hospital Pulau Pinang and the pain experienced by the study participants was mild. Moreover, the predictive factors for pain intensity may aid in identifying patients at greater risk for postoperative pain. This study concluded that the predictive methods proposed may aid in identifying patients at greater risk for postoperative pain.
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Affiliation(s)
- Hanan Hussein Jasim
- Student, Department of Clinical Pharmacy, School of Pharmaceutical Sciences, University Science, Penang, Pulau Pinang, Malaysia
| | - Syed Azhar Bin Syed Sulaiman
- Professor, Department of Clinical Pharmacy, School of Pharmaceutical Sciences, University Science, Penang, Pulau Pinang, Malaysia
| | - Amer Hayat Khan
- Lecturer, Department of Clinical Pharmacy, School of Pharmaceutical Sciences, University Science, Penang, Pulau Pinang, Malaysia
| | - Usha A/P S Rajah
- Pain Management Specialist, Department of Anesthesia, Hospital Pulau Pinang, Penang, Pulau Pinang, Malaysia
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Mayer S, Kiss N, Łaszewska A, Simon J. Costing evidence for health care decision-making in Austria: A systematic review. PLoS One 2017; 12:e0183116. [PMID: 28806728 PMCID: PMC5555669 DOI: 10.1371/journal.pone.0183116] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 07/28/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND With rising healthcare costs comes an increasing demand for evidence-informed resource allocation using economic evaluations worldwide. Furthermore, standardization of costing and reporting methods both at international and national levels are imperative to make economic evaluations a valid tool for decision-making. The aim of this review is to assess the availability and consistency of costing evidence that could be used for decision-making in Austria. It describes systematically the current economic evaluation and costing studies landscape focusing on the applied costing methods and their reporting standards. Findings are discussed in terms of their likely impacts on evidence-based decision-making and potential suggestions for areas of development. METHODS A systematic literature review of English and German language peer-reviewed as well as grey literature (2004-2015) was conducted to identify Austrian economic analyses. The databases MEDLINE, EMBASE, SSCI, EconLit, NHS EED and Scopus were searched. Publication and study characteristics, costing methods, reporting standards and valuation sources were systematically synthesised and assessed. RESULTS A total of 93 studies were included. 87% were journal articles, 13% were reports. 41% of all studies were full economic evaluations, mostly cost-effectiveness analyses. Based on relevant standards the most commonly observed limitations were that 60% of the studies did not clearly state an analytical perspective, 25% of the studies did not provide the year of costing, 27% did not comprehensively list all valuation sources, and 38% did not report all applied unit costs. CONCLUSION There are substantial inconsistencies in the costing methods and reporting standards in economic analyses in Austria, which may contribute to a low acceptance and lack of interest in economic evaluation-informed decision making. To improve comparability and quality of future studies, national costing guidelines should be updated with more specific methodological guidance and a national reference cost library should be set up to allow harmonisation of valuation methods.
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Affiliation(s)
- Susanne Mayer
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Noemi Kiss
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Agata Łaszewska
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Judit Simon
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute Applied Diagnostics, General Hospital Vienna, Vienna, Austria
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Pre- or postoperative interscalene block and/or general anesthesia for arthroscopic shoulder surgery: a retrospective observational study. Can J Anaesth 2017; 64:1048-1058. [PMID: 28721690 DOI: 10.1007/s12630-017-0937-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 06/12/2017] [Accepted: 07/06/2017] [Indexed: 10/19/2022] Open
Abstract
PURPOSE Arthroscopic shoulder surgery can be performed with an interscalene brachial plexus block (ISBPB) alone, ISBPB combined with general anesthesia (GA), or GA alone. Postoperative pain is typically managed with opioids; however, both GA and opioids have adverse effects which can delay discharge. This retrospective study compares the efficacy of four methods of anesthesia management for arthroscopic shoulder surgery. METHODS Charts of all patients who underwent shoulder surgery by a single surgeon from 2012-2015 were categorized by analgesic regimen: GA only (n = 177), single-shot ISBPB only (n = 124), or pre- vs postoperative ISBPB combined with GA (ISBPB + GA [n = 72] vs GA + ISBPB [n = 52], respectively). The primary outcome measure was the time to discharge from the postanesthesia care unit (PACU). RESULTS Mean (SD) time in the PACU ranged from 70.5 (39.9) min for ISBPB only to 111.2 (56.9) min for GA only. Use of ISBPB in any combination and regardless of timing resulted in significantly reduced PACU time, with a mean drop of 27.2 min (95% confidence interval [CI], 17.3 to 37.2; P < 0.001). The largest mean pairwise difference was between GA only and ISBPB only, with a mean difference of 40.7 min (95% CI, 25.5 to 55.8; P < 0.001). Use of ISBPB also reduced pain upon arrival at the PACU and, in some cases, upon discharge from the PACU (i.e., ISBPB only but not ISBPB + GA compared with GA). An ISBPB (alone or prior to GA) also reduced analgesic requirements. CONCLUSION Previously reported benefits of an ISBPB for arthroscopic shoulder surgery are confirmed. Postoperative ISBPBs may also be beneficial for reducing pain and opioid requirements and could be targeted for patients in severe pain upon emergence. A sufficiently powered randomized-controlled trial could determine the relative efficacy, safety, and associated financial implications associated with each method.
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Combination Therapy with Continuous Three-in-One Femoral Nerve Block and Periarticular Multimodal Drug Infiltration after Total Hip Arthroplasty. Pain Res Manag 2016; 2016:1425201. [PMID: 28070159 PMCID: PMC5192331 DOI: 10.1155/2016/1425201] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Accepted: 11/23/2016] [Indexed: 11/18/2022]
Abstract
Background. Various postoperative pain relief modalities, including continuous femoral nerve block (CFNB), local infiltration analgesia (LIA), and combination therapy, have been reported for total knee arthroplasty. However, no studies have compared CFNB with LIA for total hip arthroplasty (THA). The aim of this study was to compare the efficacy of CFNB versus LIA after THA. Methods. We retrospectively reviewed the postoperative outcomes of 93 THA patients (20 men, 73 women; mean age 69.2 years). Patients were divided into three groups according to postoperative analgesic technique: CFNB, LIA, or combined CFNB+LIA. We measured the following postoperative outcome parameters: visual analog scale (VAS) for pain at rest, supplemental analgesia, side effects, mobilization, length of hospital stay, and Harris Hip Score (HHS). Results. The CFNB+LIA group had significantly lower VAS pain scores than the CFNB and LIA groups on postoperative day 1. There were no significant differences among the three groups in use of supplemental analgesia, side effects, mobilization, length of hospital stay, or HHS at 3 months after THA. Conclusions. Although there were no clinically significant differences in outcomes among the three groups, combination therapy with CFNB and LIA provided better pain relief after THA than CFNB or LIA alone, with few side effects.
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Ohsfeldt RL, Miller TR, Schneider JE, Scheibling CM. Cost impact of unexpected disposition after orthopedic ambulatory surgery associated with category of anesthesia provider. J Clin Anesth 2016; 35:157-162. [PMID: 27871514 DOI: 10.1016/j.jclinane.2016.06.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Revised: 05/18/2016] [Accepted: 06/15/2016] [Indexed: 11/26/2022]
Abstract
STUDY OBJECTIVE To provide estimates of the costs and health outcomes implications of the excess risk of unexpected disposition for nurse anesthetist (NA) procedures. DESIGN A projection model was used to apply estimates of costs and health outcomes associated with the excess risk of unexpected disposition for NAs reported in a recent study. SETTING Ambulatory and inpatient surgery. PATIENTS Base-case model parameters were based on estimates taken from peer-reviewed publications when available, or from other sources including data for all hospital stays in the United States in 2013 from the Healthcare Cost and Utilization Project Web site. The impact of parameter uncertainty was assessed using 1-way and 2-way sensitivity analyses. INTERVENTIONS Not applicable. MEASUREMENTS Major complication rates, relative risks of complications, anesthesia costs, costs of complications, and cost-effectiveness ratios. MAIN RESULTS In the base-case model, there were on average 2.3 fewer unexpected dispositions for physician anesthesiologists compared with NAs. Overall, anesthesia-related costs (including the cost of managing unexpected dispositions) were estimated to be about $31 higher per procedure for physician anesthesiologists compared with NAs. Alternative model scenarios in the sensitivity analysis produced estimates of smaller additional costs associated with physician anesthesia administration, to the point of cost savings in some scenarios. CONCLUSIONS Provision of anesthesia for ambulatory knee and shoulder procedures by physician anesthesiologists results in better health outcomes, at a reasonable additional cost, compared with procedures with NA-administered anesthesia, at least when using updated cost-effectiveness willingness-to-pay benchmarks.
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Affiliation(s)
- Robert L Ohsfeldt
- Avalon Health Economics LLC, 26 Washington St., Floor 3, Morristown, NJ 07960, USA; Texas A&M University, 212 Adriance Lab Rd 1266 TAMU, College Station, TX 77843, USA.
| | - Thomas R Miller
- American Society of Anesthesiologists, 1061 American Lane, Schaumburg, IL 60173, USA.
| | - John E Schneider
- Avalon Health Economics LLC, 26 Washington St., Floor 3, Morristown, NJ 07960, USA.
| | - Cara M Scheibling
- Avalon Health Economics LLC, 26 Washington St., Floor 3, Morristown, NJ 07960, USA.
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Jo YY, Lee D, Jung WS, Cho NR, Kwak HJ. Comparison of Intravenous Dexmedetomidine and Midazolam for Bispectral Index-Guided Sedation During Spinal Anesthesia. Med Sci Monit 2016; 22:3544-3551. [PMID: 27701366 PMCID: PMC5053123 DOI: 10.12659/msm.896461] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Despite the high frequency of hypotension during spinal anesthesia with proper sedation, no previous report has compared the hemodynamic effects of dexmedetomidine and midazolam sedation during spinal anesthesia. We compared the effects of bispectral index (BIS)-guided intravenous sedation using midazolam or dexmedetomidine on hemodynamics and recovery profiles in patients who underwent spinal anesthesia. Material/Methods One hundred and sixteen adult patients were randomly assigned to receive either midazolam (midazolam group; n=58) or dexmedetomidine (dexmedetomidine group; n=58) during spinal anesthesia. Systolic, diastolic, and mean arterial pressures; heart rates; peripheral oxygen saturations; and bispectral index scores were recorded during surgery, and Ramsay sedation scores and postanesthesia care unit (PACU) stay were monitored. Results Hypotension occurred more frequently in the midazolam group (P<0.001) and bradycardia occurred more frequently in the dexmedetomidine group (P<0.001). Mean Ramsay sedation score was significantly lower in the dexmedetomidine group after arrival in the PACU (P=0.025) and PACU stay was significantly longer in the dexmedetomidine group (P=0.003). Conclusions BIS-guided dexmedetomidine sedation can attenuate intraoperative hypotension, but induces more bradycardia, prolongs PACU stay, and delays recovery from sedation in patients during and after spinal anesthesia as compared with midazolam sedation.
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Affiliation(s)
- Youn Yi Jo
- Department of Anesthesiology and Pain Medicine, Gachon University Gil Medical Center, Incheon, South Korea
| | - Dongchul Lee
- Department of Anesthesiology and Pain Medicine, Gachon University Gil Medical Center, Incheon, South Korea
| | - Wol Seon Jung
- Department of Anesthesiology and Pain Medicine, Gachon University Gil Medical Center, Incheon, South Korea
| | - Noo Ree Cho
- Department of Anesthesiology and Pain Medicine, Gachon University Gil Medical Center, Incheon, South Korea
| | - Hyun Jeong Kwak
- Department of Anesthesiology and Pain Medicine, Gachon University Gil Medical Center, Incheon, South Korea
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Health Care Costs and Utilization in Patients Receiving Prescriptions for Long-acting Opioids for Acute Postsurgical Pain. Clin J Pain 2016; 32:747-54. [DOI: 10.1097/ajp.0000000000000322] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Blom AW, Artz N, Beswick AD, Burston A, Dieppe P, Elvers KT, Gooberman-Hill R, Horwood J, Jepson P, Johnson E, Lenguerrand E, Marques E, Noble S, Pyke M, Sackley C, Sands G, Sayers A, Wells V, Wylde V. Improving patients’ experience and outcome of total joint replacement: the RESTORE programme. PROGRAMME GRANTS FOR APPLIED RESEARCH 2016. [DOI: 10.3310/pgfar04120] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BackgroundTotal hip replacements (THRs) and total knee replacements (TKRs) are common elective procedures. In the REsearch STudies into the ORthopaedic Experience (RESTORE) programme, we explored the care and experiences of patients with osteoarthritis after being listed for THR and TKR up to the time when an optimal outcome should be expected.ObjectiveTo undertake a programme of research studies to work towards improving patient outcomes after THR and TKR.MethodsWe used methodologies appropriate to research questions: systematic reviews, qualitative studies, randomised controlled trials (RCTs), feasibility studies, cohort studies and a survey. Research was supported by patient and public involvement.ResultsSystematic review of longitudinal studies showed that moderate to severe long-term pain affects about 7–23% of patients after THR and 10–34% after TKR. In our cohort study, 10% of patients with hip replacement and 30% with knee replacement showed no clinically or statistically significant functional improvement. In our review of pain assessment few research studies used measures to capture the incidence, character and impact of long-term pain. Qualitative studies highlighted the importance of support by health and social professionals for patients at different stages of the joint replacement pathway. Our review of longitudinal studies suggested that patients with poorer psychological health, physical function or pain before surgery had poorer long-term outcomes and may benefit from pre-surgical interventions. However, uptake of a pre-operative pain management intervention was low. Although evidence relating to patient outcomes was limited, comorbidities are common and may lead to an increased risk of adverse events, suggesting the possible value of optimising pre-operative management. The evidence base on clinical effectiveness of pre-surgical interventions, occupational therapy and physiotherapy-based rehabilitation relied on small RCTs but suggested short-term benefit. Our feasibility studies showed that definitive trials of occupational therapy before surgery and post-discharge group-based physiotherapy exercise are feasible and acceptable to patients. Randomised trial results and systematic review suggest that patients with THR should receive local anaesthetic infiltration for the management of long-term pain, but in patients receiving TKR it may not provide additional benefit to femoral nerve block. From a NHS and Personal Social Services perspective, local anaesthetic infiltration was a cost-effective treatment in primary THR. In qualitative interviews, patients and health-care professionals recognised the importance of participating in the RCTs. To support future interventions and their evaluation, we conducted a study comparing outcome measures and analysed the RCTs as cohort studies. Analyses highlighted the importance of different methods in treating and assessing hip and knee osteoarthritis. There was an inverse association between radiographic severity of osteoarthritis and pain and function in patients waiting for TKR but no association in THR. Different pain characteristics predicted long-term pain in THR and TKR. Outcomes after joint replacement should be assessed with a patient-reported outcome and a functional test.ConclusionsThe RESTORE programme provides important information to guide the development of interventions to improve long-term outcomes for patients with osteoarthritis receiving THR and TKR. Issues relating to their evaluation and the assessment of patient outcomes are highlighted. Potential interventions at key times in the patient pathway were identified and deserve further study, ultimately in the context of a complex intervention.Study registrationCurrent Controlled Trials ISRCTN52305381.FundingThis project was funded by the NIHR Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 4, No. 12. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Ashley W Blom
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Neil Artz
- School of Health Professions, Faculty of Health and Human Sciences, Plymouth University, Plymouth, UK
| | - Andrew D Beswick
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Amanda Burston
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Paul Dieppe
- Medical School, University of Exeter, Exeter, UK
| | - Karen T Elvers
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Rachael Gooberman-Hill
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Jeremy Horwood
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Paul Jepson
- School of Sport, Exercise and Rehabilitation Sciences, Birmingham, UK
| | - Emma Johnson
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Erik Lenguerrand
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Elsa Marques
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Sian Noble
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Mark Pyke
- North Bristol NHS Trust, Bristol, UK
| | | | - Gina Sands
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Adrian Sayers
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Victoria Wells
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Vikki Wylde
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
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Copanitsanou P, Valkeapää K, Cabrera E, Katajisto J, Leino-Kilpi H, Sigurdardottir AK, Unosson M, Zabalegui A, Lemonidou C. Total Joint Arthroplasty Patients' Education on Financial Issues and Its Connection to Reported Out-of-Pocket Costs-A European Study. Nurs Forum 2016; 52:97-106. [PMID: 27441849 DOI: 10.1111/nuf.12171] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE Total joint arthroplasty is accompanied by significant costs. In nursing, patient education on financial issues is considered important. Our purpose was to examine the possible association between the arthroplasty patients' financial knowledge and their out-of-pocket costs. METHODS Descriptive correlational study in five European countries. Patient data were collected preoperatively and at 6 months postoperatively, with structured, self-administered instruments, regarding their expected and received financial knowledge and out-of-pocket costs. FINDINGS There were 1,288 patients preoperatively, and 352 at 6 months. Patients' financial knowledge expectations were higher than knowledge received. Patients with high financial knowledge expectations and lack of fulfillment of these expectations had lowest costs. CONCLUSION There is need to establish programs for improving the financial knowledge of patients. Patients with fulfilled expectations reported higher costs and may have followed and reported their costs in a more precise way. In the future, this association needs multimethod research.
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Affiliation(s)
| | - Kirsi Valkeapää
- Adjunct Professor, Department of Nursing Science, University of Turku, Turku, Finland and Lahti University of Applied Sciences, Lahti, Finland
| | - Esther Cabrera
- Director of Health Science School, Tecno Campus, Matarό-Maresme, Spain
| | - Jouko Katajisto
- Statistician, Department of Statistics, University of Turku, Turku, Finland
| | - Helena Leino-Kilpi
- Professor, Department of Nursing Science, University of Turku, Turku, Finland and Nurse Director, Turku University Hospital, Turku, Finland
| | | | - Mitra Unosson
- Professor, Department of Social and Welfare Studies, Faculty of Health Sciences, Linköping University, Norrköping, Sweden
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Wong PBY, McVicar J, Nelligan K, Bleackley JC, McCartney CJL. Factors influencing the choice of anesthetic technique for primary hip and knee arthroplasty. Pain Manag 2016; 6:297-311. [DOI: 10.2217/pmt.16.6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Despite evidence in the literature, continuing wide variation exists in anesthetic technique for primary joint arthroplasties. Recent evidence suggests that neuraxial anesthesia has advantages over general anesthesia in terms of mortality, major morbidity and healthcare utilization. Yet, despite the proposed benefits, utilization of these two techniques varies greatly across geographical locations, with general anesthesia being most common for total hip arthroplasty (THA) and total knee arthroplasty (TKA) in parts of the world. We uncover some factors that promote or hinder the use of neuraxial anesthesia in THA and TKA. Healthcare professionals should be familiarized with the evidence for neuraxial anesthesia, and unbiased educational material should be developed for patients regarding anesthetic options for THA and TKA in order to promote best practice.
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Affiliation(s)
- Patrick BY Wong
- Department of Anesthesiology, University of Ottawa, Ottawa, ON, Canada
- The Ottawa Hospital, General Campus, CCW 1401, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
| | - Jason McVicar
- Department of Anesthesiology, University of Ottawa, Ottawa, ON, Canada
- The Ottawa Hospital, General Campus, CCW 1401, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
| | - Kathleen Nelligan
- Schulich School of Medicine & Dentistry, Western University, ON, N6G 2M1, Canada
| | - Joanne C Bleackley
- Department of Anesthesiology, University of Ottawa, Ottawa, ON, Canada
- The Ottawa Hospital, General Campus, CCW 1401, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
| | - Colin JL McCartney
- Department of Anesthesiology, University of Ottawa, Ottawa, ON, Canada
- The Ottawa Hospital, General Campus, CCW 1401, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
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Pelt CE, Anderson MB, Pendleton R, Foulks M, Peters CL, Gililland JM. Improving value in primary total joint arthroplasty care pathways: changes in inpatient physical therapy staffing. Arthroplast Today 2016; 3:45-49. [PMID: 28378006 PMCID: PMC5365407 DOI: 10.1016/j.artd.2016.02.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 02/11/2016] [Accepted: 02/16/2016] [Indexed: 11/28/2022] Open
Abstract
Background An early physical therapy (PT) care pathway was implemented to provide same-day ambulation after total joint arthroplasty by changing PT staffing hours. Methods After receiving an exemption from our institutional review board, we performed a secondary data analysis on a cohort of patients that underwent primary TJA of the hip or knee 6 months before and 12 months after implementation of the change. Data on same-day ambulation rates, length of stay (LOS), and in-hospital costs were reviewed. Results Early evaluation and mobilization of patients by PT improved on postoperative day (POD) 0 from 64% to 85% after the change (P ≤ .001). The median LOS before the change was 3.27 days compared to 3.23 days after the change (P = .014). Patients with higher American Society of Anesthesiologists scores were less likely to ambulate on POD 0 (P = .038) and had longer hospital stays (P < .001). Early mobilization in the entire cohort was associated with a greater cost savings (P < .001). Conclusions A relatively simple change to staffing hours, using resources currently available to us, and little additional financial or institutional investment resulted in a significant improvement in the number of patients ambulating on POD 0, with a modest reduction in both LOS and inpatient costs.
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Affiliation(s)
- Christopher E. Pelt
- Department of Orthopaedic Surgery, The University of Utah, Salt Lake City, UT, USA
- Corresponding author. 590 Wakara Way, Salt Lake City, UT, 84106, USA. Tel.: +1 801 587 5448.590 Wakara WaySalt Lake CityUT84106USA
| | - Mike B. Anderson
- Department of Orthopaedic Surgery, The University of Utah, Salt Lake City, UT, USA
| | - Robert Pendleton
- Department of Internal Medicine, The University of Utah, Salt Lake City, UT, USA
| | - Matthew Foulks
- Department of Physical Therapy, The University of Utah, Salt Lake City, UT, USA
| | | | - Jeremy M. Gililland
- Department of Orthopaedic Surgery, The University of Utah, Salt Lake City, UT, USA
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Johnson RL, Kopp SL, Burkle CM, Duncan CM, Jacob AK, Erwin PJ, Murad MH, Mantilla CB. Neuraxial vs general anaesthesia for total hip and total knee arthroplasty: a systematic review of comparative-effectiveness research. Br J Anaesth 2016; 116:163-176. [PMID: 26787787 DOI: 10.1093/bja/aev455] [Citation(s) in RCA: 152] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2025] Open
Abstract
BACKGROUND This systematic review evaluated the evidence comparing patient-important outcomes in spinal or epidural vs general anaesthesia for total hip and total knee arthroplasty. METHODS MEDLINE, Ovid EMBASE, EBSCO CINAHL, Thomson Reuters Web of Science, and the Cochrane Central Register of Controlled Trials from inception until March 2015 were searched. Eligible randomized controlled trials or prospective comparative studies investigating mortality, major morbidity, and patient-experience outcomes directly comparing neuraxial (spinal or epidural) with general anaesthesia for total hip arthroplasty, total knee arthroplasty, or both were included. Independent reviewers working in duplicate extracted study characteristics, validity, and outcomes data. Meta-analysis was conducted using the random-effects model. RESULTS We included 29 studies involving 10 488 patients. Compared with general anaesthesia, neuraxial anaesthesia significantly reduced length of stay (weighted mean difference -0.40 days; 95% confidence interval -0.76 to -0.03; P=0.03; I2 73%; 12 studies). No statistically significant differences were found between neuraxial and general anaesthesia for mortality, surgical duration, surgical site or chest infections, nerve palsies, postoperative nausea and vomiting, or thromboembolic disease when antithrombotic prophylaxis was used. Subgroup analyses failed to find statistically significant interactions (P>0.05) based on risk of bias, type of surgery, or type of neuraxial anaesthesia. CONCLUSION Neuraxial anaesthesia for total hip or total knee arthroplasty, or both appears equally effective without increased morbidity when compared with general anaesthesia. There is limited quantitative evidence to suggest that neuraxial anaesthesia is associated with improved perioperative outcomes. Future investigations should compare intermediate and long-term outcome differences to better inform anaesthesiologists, surgeons, and patients on importance of anaesthetic selection.
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Affiliation(s)
- R L Johnson
- College of Medicine, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905, USA
| | - S L Kopp
- College of Medicine, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905, USA
| | - C M Burkle
- College of Medicine, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905, USA
| | - C M Duncan
- College of Medicine, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905, USA
| | - A K Jacob
- College of Medicine, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905, USA
| | - P J Erwin
- College of Medicine, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905, USA
| | - M H Murad
- College of Medicine, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905, USA
| | - C B Mantilla
- College of Medicine, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905, USA
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Vaishya R, Agarwal AK, Ingole S, Vijay V. Current practice variations in the management of anterior cruciate ligament injuries in Delhi. J Clin Orthop Trauma 2016; 7:193-9. [PMID: 27489416 PMCID: PMC4949409 DOI: 10.1016/j.jcot.2015.12.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Accepted: 12/27/2015] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The aim of this study was to determine the current practices and preferences of the arthroscopic surgeons of Delhi in the diagnosis, treatment and rehabilitation of patients with anterior cruciate ligament (ACL) injury. METHODS It was a cross-sectional descriptive study conducted among arthroscopic surgeons of Delhi. A survey was conducted using a questionnaire that was sent either by e-mail or by direct contact to all sixty arthroscopic surgeons of Delhi. RESULTS Forty-eight (80%) surgeons responded to our questionnaire. Maximum participants (83.3%) used semitendinosus/gracilis tendon autograft for ACL reconstruction (ACLR) and only 2.1% were using bone-patellar-tendon-bone (BPTB) autograft. Most preferred method of graft fixation was an 'interference screw' on the tibial side and an 'endobutton' on the femoral side, which was preferred by 95.83% and 93.75% surgeons, respectively. Almost all respondents (97%) used a bio-absorbable interference screw for tibial side graft fixation. Postoperative bracing was advised for <3 weeks by 47.9% surgeons and for 3-6 weeks by 31.3%. The results were analysed using statistical analysis. CONCLUSION Surgeon preferences in ACLR differ considerably among the arthroscopic surgeons of Delhi. There is majority consensus for using Hamstring autograft (single bundle) with a suspensory fixation on the femoral side and an aperture fixation on the tibial side. Transportal technique of making the femoral tunnel and preservation of amputation stump were the preferred methods. However, differences exist over the timing of surgery, rehab after surgery, pain management, etc.
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Affiliation(s)
- Raju Vaishya
- Professor, Senior Consultant Orthopaedics, Department of Orthopaedics and Joint Replacement Surgery, Indraprastha Apollo Hospitals, New Delhi 110076, India
| | - Amit Kumar Agarwal
- Consultant Orthopaedics, Department of Orthopaedics and Joint Replacement Surgery, Indraprastha Apollo Hospitals, New Delhi 110076, India
- Corresponding author. Tel.: +91 9968578514.
| | - Sachin Ingole
- Orthopaedic Registrar, Department of Orthopaedics and Joint Replacement Surgery, Indraprastha Apollo Hospitals, New Delhi 110076, India
| | - Vipul Vijay
- Consultant Orthopaedics, Department of Orthopaedics and Joint Replacement Surgery, Indraprastha Apollo Hospitals, New Delhi 110076, India
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Cost-effectiveness analysis of levobupivacaine 0.5 %, a local anesthetic, infusion in the surgical wound after modified radical mastectomy. Clin Drug Investig 2015; 35:575-82. [PMID: 26305021 DOI: 10.1007/s40261-015-0316-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND AND OBJECTIVE Effective treatment of postoperative pain contributes to decreasing the rate of complications as well as the total cost of the operated patients. The aim of this study was to analyze the costs and the efficiency of use of continuous infusion of levobupivacaine 0.5 % with the help of an infusion pump in modified radical mastectomy. METHODS A cost calculation of the analgesic procedures (continuous infusion of levobupivacaine 0.5 % [levobupivacaine group (LG)] or saline [saline group (SG)] (2 ml/h 48 h) has been carried out based on the data of a previous clinical trial (double-blind randomized study) of patients who underwent modified radical mastectomy surgery. The measure of the effectiveness was the point reduction of pain derived from the verbal numeric rating scale (VNRS). The usual incremental cost-effectiveness ratio (ICER) was performed. RESULTS Considering only the intravenous analgesia, overall costs were lower in LG, as less analgesia was used (EUR14.06 ± 7.89 vs. 27.47 ± 14.79; p < 0.001). In this study the costs of the infusion pump were not calculated as it was used by both groups and they offset each other. However, if the infusion pump costs were included, costs would be higher in the LG, (EUR91.89 ± 7.89 vs. 27.47 ± 14.79; p < 0.001) and then the ICER was -8.51, meaning that for every extra point of decrease in the pain verbal numerical rating score over the 2-day period, the cost increased by EUR8.51. CONCLUSION Infiltration of local anesthetics is an effective technique for controlling postoperative pain and the associated added costs are relatively low in relation to the total cost of mastectomy, therefore providing patients with a higher quality of care in the prevention of pain. CLINICAL TRIALS REGISTRATION clinicaltrials.gov: reference number NCT01389934. http://clinicaltrials.gov/show/NCT01389934
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