Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, Oregon, USA
School of Medicine, Oregon Health & Science University, Portland, Oregon, USA.
Reg Anesth Pain Med. 2020 Dec;45(12):975-978. doi: 10.1136/rapm-2020-101773. Epub 2020 Oct 1.
Creating highly efficient operating room (OR) protocols for total joint arthroplasty (TJA) is a challenging and multifactorial process. We evaluated whether spinal anesthesia in a designated block bay (BBSA) would reduce time to incision, improve first case start time and decrease conversion to general anesthesia (GA).
Retrospective cohort study on the first 86 TJA cases with BBSA from April to December 2018, compared with 344 TJA cases with spinal anesthesia performed in the OR (ORSA) during the same period. All TJA cases were included if the anesthetic plan was for spinal anesthesia. Patients were excluded if circumstances delayed start time or time to incision (advanced vascular access, pacemaker interrogation, surgeon availability). Data were extracted and analyzed via a linear mixed effects model to compare time to incision, via a Wilcoxon rank-sum test to compare first case start time, and via a Fisher's exact test to compare conversion to GA between the groups.
In the mixed effect model, the BBSA group time to incision was 5.37 min less than the ORSA group (p=0.018). The BBSA group had improved median first case start time (30.0 min) versus the ORSA group (40.5 min, p<0.0001). There was lower conversion to GA 2/86 (2.33%) in the BBSA group versus 36/344 (10.47%) in the ORSA group (p=0.018). No serious adverse events were noted in either group.
BBSA had limited impact on time to incision for TJA, with a small decrease for single OR days and no improvement on OR days with two rooms. BBSA was associated with improved first case start time and decreased rate of conversion to GA. Further research is needed to identify how BBSA affects the efficiency of TJA.
为全膝关节置换术（TJA）创建高效的手术室（OR）方案是一个具有挑战性的多因素过程。我们评估了指定阻滞区（BBSA）中的脊髓麻醉是否会缩短切口时间、改善第一例手术开始时间并降低全麻（GA）的转化率。
回顾性队列研究，纳入了 2018 年 4 月至 12 月期间在 BBSA 下进行的 86 例 TJA 病例，与同期在 OR 下进行的 344 例 TJA 病例进行比较。所有 TJA 病例均纳入研究，如果麻醉计划为脊髓麻醉。如果出现以下情况延迟了手术开始时间或切口时间（先进的血管通路、起搏器询问、外科医生的可用性），则排除患者。通过线性混合效应模型比较两组间的切口时间，通过 Wilcoxon 秩和检验比较第一例手术开始时间，通过 Fisher 精确检验比较两组间的 GA 转化率。
在混合效应模型中，BBSA 组的切口时间比 ORSA 组少 5.37 分钟（p=0.018）。BBSA 组的中位第一例手术开始时间（30.0 分钟）优于 ORSA 组（40.5 分钟，p<0.0001）。BBSA 组的 GA 转化率为 2/86（2.33%），低于 ORSA 组的 36/344（10.47%）（p=0.018）。两组均未发生严重不良事件。
BBSA 对 TJA 的切口时间影响有限，对于单间手术室的天数略有减少，而对于两间手术室的天数则没有改善。BBSA 与第一例手术开始时间的改善和全麻转化率的降低有关。需要进一步研究 BBSA 如何影响 TJA 的效率。
