Rasouli Mohammad R, Cavanaugh Priscilla K, Restrepo Camilo, Ceylan Hasan Huseyin, Maltenfort Mitchell G, Viscusi Eugene R, Parvizi Javad
Rothman Institute of Orthopaedics, Thomas Jefferson Hospital, Philadelphia, PA, USA.
Clin Orthop Relat Res. 2015 Apr;473(4):1472-7. doi: 10.1007/s11999-015-4175-3. Epub 2015 Feb 11.
There is concern that neuraxial anesthesia in patients undergoing surgery for treatment of a periprosthetic joint infection (PJI) may increase the risk of having a central nervous system infection develop. However, the available data on this topic are limited and contradictory.
QUESTIONS/PURPOSES: We wished to determine whether neuraxial anesthesia (1) is associated with central nervous system infections in patients undergoing surgery for a PJI, and (2) increases the likelihood of systemic infection in these patients.
All 539 patients who received neuraxial or general anesthesia during 1499 surgeries for PJI from October 2000 to May 2013 were included in this study; of these, 51% (n = 764) of the surgeries were performed in 134 patients receiving neuraxial anesthesia and 49% were performed in 143 patients receiving general anesthesia. Two hundred sixty-two patients received general and neuraxial anesthesia during different surgeries. We used the International Classification of Diseases, 9(th) Revision codes and the medical records to identify patients who had an intraspinal abscess or meningitis develop after surgery for a PJI. Multivariate analysis was used to assess the effect of type of anesthesia (neuraxial versus general) on postoperative complications.
There were no cases of meningitis, but one epidural abscess developed in a patient after neuraxial anesthesia. This patient underwent six revision surgeries during a 42-day period. Patients who received neuraxial anesthesia had lower odds of systemic infections (4% versus 12%; odds ratio, 0.35; 95% CI, 023-054; p < 0.001).
Central nervous system infections after neuraxial anesthesia in patients with a PJI appear to be exceedingly rare. Based on the findings of this study, it may be time for the anesthesiology community to reevaluate the risk of sepsis as a relative contraindication to the use of neuraxial anesthesia.
人们担心，接受人工关节周围感染（PJI）手术治疗的患者进行椎管内麻醉可能会增加发生中枢神经系统感染的风险。然而，关于这一主题的现有数据有限且相互矛盾。
问题/目的：我们希望确定椎管内麻醉（1）是否与接受PJI手术的患者发生中枢神经系统感染有关，以及（2）是否会增加这些患者发生全身感染的可能性。
纳入2000年10月至2013年5月期间在1499例PJI手术中接受椎管内或全身麻醉的所有539例患者；其中，764例（51%）手术由134例接受椎管内麻醉的患者进行，49%由143例接受全身麻醉的患者进行。262例患者在不同手术中接受了全身麻醉和椎管内麻醉。我们使用国际疾病分类第9版编码和病历识别PJI手术后发生脊髓内脓肿或脑膜炎的患者。采用多变量分析评估麻醉类型（椎管内麻醉与全身麻醉）对术后并发症的影响。
没有脑膜炎病例，但1例接受椎管内麻醉的患者术后发生了硬膜外脓肿。该患者在42天内接受了6次翻修手术。接受椎管内麻醉的患者发生全身感染的几率较低（4%对12%；比值比，0.35；95%CI，0.23 - 0.54；p < 0.001）。
PJI患者椎管内麻醉后发生中枢神经系统感染似乎极为罕见。基于本研究结果，麻醉学界可能是时候重新评估将败血症风险作为椎管内麻醉相对禁忌证的情况了。
