Zhu Meng, Chen Jerry Yongqiang, Tan Yan Ru, Yew Andy Khye Soon, Chong Hwei Chi, Chia Shi-Lu, Lo Ngai Nung, Yeo Seng Jin
Duke-NUS Graduate Medical School, 8 College Road, Singapore, 169857, Singapore,
Arch Orthop Trauma Surg. 2015 Apr;135(4):565-71. doi: 10.1007/s00402-015-2188-8. Epub 2015 Mar 10.
Anesthetic technique affects perioperative outcomes, but less was known in simultaneous bilateral total knee arthroplasty (BTKA). A single center, retrospective analysis was carried out to prove the hypothesis that utilization of regional anesthesia would result in favorable perioperative outcomes.
Medical records of patients admitted for simultaneous BTKA between 2004 and 2013 were analyzed. Two groups, the general anesthesia (GA) and regional anesthesia (RA) group, were identified. Patient preoperative characteristics were compared. Perioperative outcomes measured included blood loss, transfusion requirement, length of hospitalization, operating time, and 30-day perioperative complications.
A total of 513 patients were identified, 54.6% were performed under GA, and 45.4% under RA. Patient characteristics were similar between the two groups, except that patients operated under GA were younger than those under RA. RA was associated with significantly less perioperative blood loss (981 vs. 1075 mL, p = 0.017) and 30-day complications (6.4 vs. 13.2%, p = 0.016). Systemic and organ specific infections were particularly lower in the RA group (0.4 vs. 3.9%, p = 0.009). Transfusion requirement, length of hospitalization, and operating time were similar between the two groups. After correcting for covariates, RA offered a 92 mL (p = 0.023) reduction in blood loss and 49% less overall complications (p = 0.047), compared to GA.
Patients who underwent simultaneous BTKA under RA had lesser blood loss and lower complication rate than GA. The impact of RA can be further exploited to improve perioperative outcomes of simultaneous BTKA in addition to various other interventions.
麻醉技术会影响围手术期结局，但在同期双侧全膝关节置换术（BTKA）中的相关情况了解较少。开展了一项单中心回顾性分析，以验证区域麻醉的应用会带来良好围手术期结局这一假设。
分析了2004年至2013年间因同期BTKA入院患者的病历。确定了两组，即全身麻醉（GA）组和区域麻醉（RA）组。比较了患者的术前特征。测量的围手术期结局包括失血量、输血需求、住院时间、手术时间和30天围手术期并发症。
共确定了513例患者，54.6%在GA下进行手术，45.4%在RA下进行手术。两组患者特征相似，只是GA下手术的患者比RA下手术的患者年轻。RA与围手术期失血量显著减少（981 vs. 1075 mL，p = 0.017）和30天并发症显著减少（6.4% vs. 13.2%，p = 0.016）相关。RA组的全身和器官特异性感染尤其更低（0.4% vs. 3.9%，p = 0.009）。两组之间的输血需求、住院时间和手术时间相似。校正协变量后，与GA相比，RA使失血量减少92 mL（p = 0.023），总体并发症减少49%（p = 0.047）。
在RA下进行同期BTKA的患者比GA下手术的患者失血量更少，并发症发生率更低。除了各种其他干预措施外，RA的影响可进一步用于改善同期BTKA的围手术期结局。
