Luo Nanbo, Luo Li, Yang Lei, Li Zhi, Yu Qingmin, Jian Wenling, Sun Wei, Chen Pac-Soo, Chen Qian, Ma Daqing, Xue Qingsheng, Luo Yan, Yu Buwei, Wang Hao, Liu Zhiheng
Department of Anesthesiology, The First Affiliated Hospital, Jinan University, Guangzhou, China.
Department of Anesthesiology, Institute of Translational Medicine, Shenzhen Second People's Hospital/The First Affiliated Hospital of Shenzhen University, Shenzhen, China.
Can J Anaesth. 2025 May 28. doi: 10.1007/s12630-025-02957-9.
General anesthesia combined with peripheral nerve blocks has become a common anesthesia regimen for knee replacement surgery. Its association with high-risk isolated distal deep venous thrombosis (IDDVT) remains uncertain.
In this cohort study, we obtained consecutive data from the electronic inpatient records of Shenzhen Second People's Hospital, including adults who underwent knee arthroplasty from 1 September 2019 to 31 August 2021. The primary outcome was the incidence of high-risk IDDVT. We compared the outcomes in patients who received general anesthesia combined with nerve blocks with those in patients who received neuraxial anesthesia without nerve blocks, using a multivariable regression model with inverse probability weighting according to the propensity score.
Of the 848 patients who underwent knee arthroplasty, 330 were excluded because they lacked thrombus testing or had received other types of anesthesia. Of the remaining 518 patients, 267/518 (52%) received general anesthesia combined with nerve blocks and 251/518 (48%) received neuraxial anesthesia with no nerve blocks. A total of 99 patients developed high-risk IDDVT. In the primary multivariable analysis with inverse probability weighting according to the propensity score, general anesthesia combined with nerve blocks was associated with a significantly reduced high-risk IDDVT compared with neuraxial anesthesia without nerve blocks (odds ratio, 0.50; 95% confidence interval, 0.31 to 0.81; P = 0.005). The results of multiple sensitivity analyses were similar between the two cohorts. E-value analysis suggested robustness to unmeasured confounding.
Compared with neuraxial anesthesia without peripheral nerve blocks, general anesthesia combined with peripheral nerve blocks in patients undergoing knee arthroplasty was associated with a reduced incidence of high-risk IDDVT in our retrospective study. A large multicentre prospective clinical trial is needed to validate our findings.
ChiCTR.org.cn ( ChiCTR2200057006 ), first submitted 25 February 2022.
全身麻醉联合外周神经阻滞已成为膝关节置换手术的常用麻醉方案。其与高危孤立性远端深静脉血栓形成（IDDVT）的关联仍不确定。
在这项队列研究中，我们从深圳市第二人民医院的电子住院记录中获取了连续数据，包括2019年9月1日至2021年8月31日接受膝关节置换术的成年人。主要结局是高危IDDVT的发生率。我们使用倾向评分逆概率加权多变量回归模型，比较了接受全身麻醉联合神经阻滞的患者与接受无神经阻滞的椎管内麻醉的患者的结局。
在848例接受膝关节置换术的患者中，330例因缺乏血栓检测或接受了其他类型的麻醉而被排除。在其余518例患者中，267/518（52%）接受全身麻醉联合神经阻滞，251/518（48%）接受无神经阻滞的椎管内麻醉。共有99例患者发生高危IDDVT。在根据倾向评分进行逆概率加权的主要多变量分析中，与无神经阻滞的椎管内麻醉相比，全身麻醉联合神经阻滞与高危IDDVT显著降低相关（比值比，0.50；95%置信区间，0.31至0.81；P = 0.005）。两个队列的多重敏感性分析结果相似。E值分析表明对未测量的混杂因素具有稳健性。
在我们的回顾性研究中，与无外周神经阻滞的椎管内麻醉相比，膝关节置换术患者接受全身麻醉联合外周神经阻滞与高危IDDVT发生率降低相关。需要进行大型多中心前瞻性临床试验来验证我们的发现。
中国临床试验注册中心（ChiCTR.org.cn，ChiCTR2200057006），于2022年2月25日首次提交。
