Neal-Smith Gregory, Hopley Erin, Gourbault Lysander, Watts Daniel T, Abrahams Harry, Wilson Katy, Athanassoglou Vassilis
Orthopaedics, Oxford University Hospitals NHS Foundation Trust, Oxford, GBR.
Anaesthetics, Oxford University Hospitals NHS Foundation Trust, Oxford, GBR.
Cureus. 2021 Aug 9;13(8):e17024. doi: 10.7759/cureus.17024. eCollection 2021 Aug.
Introduction Lower limb arthroplasty is performed under general anaesthesia (GA) or regional anaesthesia (RA). There is increasing evidence of the surgical and anaesthetic benefits of RA. National Institute for Health and Care Excellence (NICE) guidelines advise using either but highlight a lack of data comparing outcomes of RA and GA for these procedures. We conducted a service evaluation, prospectively analysing elective orthopaedic cases performed at the Nuffield Orthopaedic Centre, Oxford, UK from 19/11/2018 to 03/04/2019. We aimed to compare data on anaesthetic assessment, intra-operative parameters and patient satisfaction for RA and GA cases. Methods We selected elective patients, aged above 18, undergoing total hip, total knee or unilateral knee arthroplasties. Prospective quantitative and qualitative data were collected using two forms. Firstly, anaesthetists completed a case report recording demographic data, intra-operative details and reason for anaesthetic choice. Secondly a questionnaire gathered patient satisfaction data. This was analysed using descriptive statistics and presented in tables. Results Data for 132 patients were collected over the service evaluation period. After exclusion, 99 patients were included for final analysis; 59 underwent GA and 40 had RA. GA was used predominantly due to patient preference (74.6%). RA was used primarily due to anaesthetic preference (75%); most commonly due to speed of list and duration of operation. Overall patients had low pain scores (0.3/10) and high pre-operative anxiety levels (4.6/10) regardless of anaesthetic. Conclusion Our results show high patient satisfaction with GA and RA for lower limb arthroplasty; however, pre-operative anxiety was common for both. Patient preference and comfort influenced choice of anaesthesia, highlighting the importance of pre-operative counselling and education to facilitate shared decision making, leading to favourable post-operative outcomes.
引言 下肢关节置换术在全身麻醉（GA）或区域麻醉（RA）下进行。越来越多的证据表明RA在手术和麻醉方面具有益处。英国国家卫生与临床优化研究所（NICE）指南建议可使用其中任何一种麻醉方式，但强调缺乏比较这些手术中RA和GA效果的数据。我们进行了一项服务评估，前瞻性分析了2018年11月19日至2019年4月3日在英国牛津纳菲尔德骨科中心进行的择期骨科病例。我们旨在比较RA和GA病例在麻醉评估、术中参数和患者满意度方面的数据。
方法 我们选择了年龄在18岁以上、接受全髋关节置换术、全膝关节置换术或单侧膝关节置换术的择期患者。使用两种表格收集前瞻性定量和定性数据。首先，麻醉医生完成一份病例报告，记录人口统计学数据、术中细节和麻醉选择的原因。其次，通过一份问卷收集患者满意度数据。使用描述性统计方法对其进行分析，并以表格形式呈现。
结果 在服务评估期间收集了132例患者的数据。排除后，99例患者纳入最终分析；59例接受GA，40例接受RA。主要因患者偏好而使用GA（74.6%）。主要因麻醉偏好而使用RA（75%）；最常见的原因是手术安排速度和手术持续时间。无论采用何种麻醉方式，总体患者疼痛评分较低（0.3/10），术前焦虑水平较高（4.6/10）。
结论 我们的结果表明，患者对下肢关节置换术使用GA和RA的满意度较高；然而，两种麻醉方式下术前焦虑都很常见。患者偏好和舒适度影响麻醉选择，凸显了术前咨询和教育以促进共同决策从而实现良好术后结果的重要性。
