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

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<0.001). No differences were observed in pain, pain management, incidences of blood transfusions, in-hospital complications, or length of hospital stay. 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. CLINICAL TRIAL REGISTRATION:EudraCT 2016-002035-15.

journal_name

Br J Anaesth

journal_title

British journal of anaesthesia

authors

Palanne R,Rantasalo M,Vakkuri A,Madanat R,Olkkola KT,Lahtinen K,Reponen E,Linko R,Vahlberg T,Skants N

doi

10.1016/j.bja.2020.03.036

subject

Has Abstract

pub_date

2020-11-01 00:00:00

pages

762-772

issue

eissn

0007-0912

issn

1471-6771

pii

S0007-0912(20)30340-8

journal_volume

125

pub_type

杂志文章,随机对照试验

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