Failed spinal anesthesia associated with poor clinical outcomes after TJA
Click Here to Manage Email Alerts
Key takeaways:
- Failed spinal anesthesia prior to arthroplasty was associated with inferior outcomes vs. successful anesthesia.
- Patients with failed spinal anesthesia had increased blood loss, IV opioids and time to ambulation.
Patients with failed spinal anesthesia prior to total hip or knee arthroplasty had inferior clinical outcomes compared with patients who had successful spinal anesthesia and similar outcomes vs. those who received general anesthesia.
Researchers analyzed data from a consecutive cohort of 4,482 patients who underwent primary THA (n = 2,003) or TKA (n = 2,479) at a single institution between January 2018 and April 2023. According to the study, 130 patients (12.4%) failed spinal anesthesia and were converted to general anesthesia, 1,046 patients (23.3%) successfully received spinal anesthesia and 3,306 patients (73.8%) initially received general anesthesia.
Outcomes included required rescue analgesia in the post-anesthesia care unit (PACU), time to ambulation, VAS pain scores, estimated blood loss and 90-day postoperative complications.
Researchers found patients with failed spinal anesthesia had increased blood loss, use of rescue IV opioids and time to ambulation compared with patients who successfully received spinal anesthesia. Researchers found no associations between pain scores in the PACU and anesthesia modality. However, they noted patients with failed spinal anesthesia had a higher incidence of postoperative pain requiring ED visits and thromboembolism compared with patients who successfully received spinal anesthesia.
Researchers also noted 90-day complication rates were similar between patients with failed spinal anesthesia and patients who initially received general anesthesia.
“This emphasizes the importance of success in the initial attempt at [spinal anesthesia] SA for optimizing outcomes following TJA,” the researchers wrote in the study.
Collapse
Read more about
Click Here to Manage Email Alerts