Effects or anaesthesia method and tourniquet use on recovery following total knee arthroplasty : a randomised controlled study

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Palanne , R , Rantasalo , M , Vakkuri , A , Madanat , R , Olkkola , K T , Lahtinen , K , Reponen , E , Linko , R , Vahlberg , T & Skants , N 2020 , ' Effects or anaesthesia method and tourniquet use on recovery following total knee arthroplasty : a randomised controlled study ' , British Journal of Anaesthesia , vol. 125 , no. 5 , pp. 762-772 . https://doi.org/10.1016/j.bja.2020.03.036

Title: Effects or anaesthesia method and tourniquet use on recovery following total knee arthroplasty : a randomised controlled study
Author: Palanne, Riku; Rantasalo, Mikko; Vakkuri, Anne; Madanat, Rami; Olkkola, Klaus T.; Lahtinen, Katarina; Reponen, Elina; Linko, Rita; Vahlberg, Tero; Skants, Noora
Contributor organization: Anestesiologian yksikkö
HUS Perioperative, Intensive Care and Pain Medicine
Helsinki University Hospital Area
I kirurgian klinikka (Töölö)
Department of Surgery
HUS Musculoskeletal and Plastic Surgery
Clinicum
Department of Diagnostics and Therapeutics
University of Helsinki
Date: 2020-11
Language: eng
Number of pages: 11
Belongs to series: British Journal of Anaesthesia
ISSN: 0007-0912
DOI: https://doi.org/10.1016/j.bja.2020.03.036
URI: http://hdl.handle.net/10138/331981
Abstract: Background: We investigated the effects of spinal and general anaesthesia and surgical tourniquet on acute pain and early recovery after total knee arthroplasty (TKA). Methods: Patients (n=413) were randomised to four parallel groups: spinal anaesthesia with or without tourniquet, and general anaesthesia with or without tourniquet. The primary outcome was patient-controlled i.v. oxycodone consumption over 24 postoperative hours. Results: Results from 395 subjects were analysed. Median i.v. oxycodone consumption did not differ between the four groups (spinal anaesthesia without [36.6 mg] and with tourniquet [38.0 mg], general anaesthesia without [42.3 mg] and with tourniquet [42.5 mg], P=0.42), between spinal (37.7 mg) and general anaesthesia (42.5 mg) groups (median difference -3.1, 95% confidence interval [CI] -7.4 to 1.2, P=0.15) and between tourniquet and no-tourniquet groups (40.0 vs 40.0 mg, median difference -0.8, CI -5.1 to 3.5, P=0.72). Vomiting incidence was higher with spinal than with general anaesthesia (21% [42/200] vs 13% [25/194], CI 1.05 to 3.1, P=0.034). The mean haemoglobin decrease was greater without than with tourniquet (-3.0 vs -2.5 g dl(-1), mean difference -0.48, CI -0.65 to -0.32, P Conclusions: For TKA, spinal and general anaesthesia with or without tourniquet did not differ in 24-h postoperative opioid consumption, pain management, blood transfusions, in-hospital complications, and length of hospital stay. Vomiting incidence was higher in the spinal than in the general anaesthesia group. Tourniquet use caused smaller decreases in haemoglobin levels.
Subject: acute pain
analgesia
general anaesthesia
knee arthroplasty
opioid
randomised study
spinal anaesthesia
tourniquet
TOTAL HIP
GENERAL-ANESTHESIA
JOINT ARTHROPLASTY
COST-EFFECTIVENESS
SPINAL-ANESTHESIA
OPIOID USE
BLOOD-LOSS
PAIN
OUTCOMES
COMPLICATION
3126 Surgery, anesthesiology, intensive care, radiology
Peer reviewed: Yes
Rights: cc_by_nc_nd
Usage restriction: openAccess
Self-archived version: draft


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