Anesthesiology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Reg Anesth Pain Med. 2020 Nov;45(11):934-936. doi: 10.1136/rapm-2020-101578. Epub 2020 Jun 18.
Total joint arthroplasty (TJA) is transitioning to be an outpatient rather than an inpatient procedure under national and institutional pressures to increase volumes while reducing hospital costs and length of stay. Innovative surgical and anesthesia techniques have allowed for earlier ambulation and physical therapy participation, maximizing the chance that an appropriately selected patient may be discharged within a day of surgery. The choice of anesthesia type is a modifiable factor that has a major impact on both surgical outcomes and discharge readiness. Recent large database studies have provided evidence for improved outcomes, including decreased mortality, with the use of spinal anesthesia. However, few randomized, controlled trials exist and database studies have limitations. Modern general anesthesia techniques, including total intravenous anesthesia and infusions targeted to anesthetic depth, may make some of these differences insignificant, especially when newer regional anesthesia and local infiltration analgesia techniques are incorporated into TJA enhanced recovery protocols. Multimodal analgesia for all TJA patients may also help minimize differences in pain. Perhaps even more important than anesthesia technique is the proper selection of patients likely to meet the necessary milestones for early discharge. In this article, we provide two contrasting viewpoints on the optimal primary anesthetic for outpatient TJA.
全关节置换术（TJA）正在转变为门诊手术，而不是住院手术，这是国家和机构的压力，旨在增加手术量，同时降低医院成本和住院时间。创新的手术和麻醉技术允许更早地进行活动和物理治疗，最大限度地提高适当选择的患者在手术后一天内出院的机会。麻醉类型的选择是一个可改变的因素，对手术结果和出院准备有重大影响。最近的大型数据库研究提供了证据，表明使用椎管内麻醉可以改善预后，包括降低死亡率。然而，随机对照试验很少，数据库研究也存在局限性。现代全身麻醉技术，包括全静脉麻醉和以麻醉深度为目标的输注，可能会使其中一些差异变得不那么重要，尤其是当将更新的区域麻醉和局部浸润镇痛技术纳入 TJA 增强恢复方案时。所有 TJA 患者的多模式镇痛也有助于最大限度地减少疼痛差异。也许比麻醉技术更重要的是正确选择可能达到早期出院所需里程碑的患者。在本文中，我们提供了两种关于门诊 TJA 最佳主要麻醉的对比观点。
