Jump to comment:
- Page navigation anchor for Fast-Track Spinal Anesthesia Reduces Length Of Motor Blockade, Length Of Stay And Facilitates Earlier Discharge After Total Hip And Knee ArthroplastyFast-Track Spinal Anesthesia Reduces Length Of Motor Blockade, Length Of Stay And Facilitates Earlier Discharge After Total Hip And Knee Arthroplasty
We read with interest the article by Bourget-Murray et al. We would like to congratulate them on their research which has expanded our current knowledge of perioperative morbidity and mortality following total joint arthroplasty (TJA) at 30, 60 and 90 days. Their findings of reduced blood transfusion and more rapid home discharge for total knee arthroplasty (TKA) patients who received spinal anesthesia (SA) versus general anesthesia (GA) are well supported in the current literature.1 Contrary to previous data1, they found no difference in mortality between the GA and SA groups. In addition, the authors found that patients undergoing total hip arthroplasty (THA) under SA had a longer length of stay than those under GA (3.33 days vs 3.05 days), which is also not supported by previous robust studies.2 The authors theorize that this finding may be related to fast-track arthroplasty pathways where GA may enable faster ambulation.
In response to improved outcomes associated with earlier ambulation and the development of fast-track pathways for TJA, we want to highlight that SA has also evolved. There has been renewed interest in shorter acting local anesthetics (LA) other than the traditionally and commonly used bupivacaine. These shorter acting LA have been used extensively for fast-track and ambulatory surgery programs. Perhaps of greatest interest in the setting of SA for TJA is mepivacaine. Several recent studies using spinal mepivacaine for THA and TKA have shown a...
Show MoreCompeting Interests: None declared.References
- 1. Memtsoudis SG, Cozowicz C, Bekeris J, et al. Anaesthetic care of patients undergoing primary hip and knee arthroplasty: consensus recommendations from the ICAROS group based on a systematic review and meta-analysis. Br J Anaesth 2019;123:269-87.
- 2. Helwani MA, Avidan MS, Ben Abdallah A, et al. Effects of regional versus general anesthesia on outcomes after total hip arthroplasty: a retrospective propensity-matched cohort study. J Bone Joint Surg Am 2015;97:186-93.
- 3. Siddiqi A, Mahmoud Y, Secic M, et al. Mepivacaine Versus Bupivacaine Spinal Anesthesia for Primary Total Joint Arthroplasty: A Systematic Review and Meta-Analysis. J Arthroplasty 2022;37:1396-1404.e5.
- 4. Gonano C, Leitgeb U, Sitzwohl C, et al. Spinal versus general anesthesia for orthopedic surgery: anesthesia drug and supply costs. Anesth Analg 2006;102:524-9.
- 5. Kuvadia M, Cummis CE, Liguori G, et al. 'Green-gional' anesthesia: the non-polluting benefits of regional anesthesia to decrease greenhouse gases and attenuate climate change. Reg Anesth Pain Med 2020;45:744-5.