Anne Arundel Medical Center, Annapolis, MD.
J Arthroplasty. 2021 Mar;36(3):1013-1017. doi: 10.1016/j.arth.2020.09.050. Epub 2020 Oct 6.
Recent literature has suggested some benefits for neuraxial anesthesia (NA) as an alternative for general anesthesia (GA) for primary total hip arthroplasty patients. We examined the impact of NA vs GA on outcomes for patients undergoing direct anterior (DA) approach total hip arthroplasty (THA) in an institution with established rapid recovery protocols.
A retrospective review was conducted for 500 consecutive THA patients from a single institution. Univariate analysis and multivariate linear regression were used to compare outcomes for THA patients receiving NA and GA.
There was a significant difference in length of stay with NA patients having a shorter length of stay (NA 32.7 hours vs GA 38.1 hours, P = .003). Patients receiving NA had significantly lower PACU morphine milligram equivalents (MME) (NA 10.2 MME vs GA 15.6 MME, P < .001) and reported a lower score on the PACU pain numeric rating scale (NA 2.1 vs GA 3.7, P < .001).
Neuraxial anesthesia is associated with decreased LOS, decreased PACU MME, and a lower PACU pain score for patients undergoing primary DA THA. These trends remained consistent when controlling for age, gender, BMI, and ASA.
近期文献表明，在具有既定快速康复方案的机构中，对行直接前入路全髋关节置换术（THA）的患者而言，与全身麻醉（GA）相比，神经轴索麻醉（NA）具有一些优势。我们研究了 NA 与 GA 对接受直接前入路（DA）THA 患者结局的影响。
对单机构的 500 例连续 THA 患者进行回顾性研究。采用单变量分析和多变量线性回归比较接受 NA 和 GA 的 THA 患者的结局。
NA 患者的住院时间明显较短（NA 32.7 小时 vs GA 38.1 小时，P =.003）。接受 NA 的患者在 PACU 吗啡毫克当量（MME）（NA 10.2 MME vs GA 15.6 MME，P <.001）和 PACU 疼痛数字评分量表（NA 2.1 vs GA 3.7，P <.001）上的评分明显更低。
对于行原发性 DA THA 的患者，神经轴索麻醉与 LOS 减少、PACU MME 减少和 PACU 疼痛评分降低相关。当控制年龄、性别、BMI 和 ASA 时，这些趋势仍然一致。
