A talk by Andreas Harsten at the 2017 meeting of the Scandinavian Society of Anaestesiology and Intensive Care Medicine. All available content from SSAI2017: https://scanfoam.org/ssai2017/ Delivered in collaboration between scanFOAM, SSAI & SFAI.

1. General or regional anaesthesia
for othopaedic surgery
(THA/TKA)?
Andreas Harsten, M.D., PhD
Dept Anaesth
Hässleholm Hospital
SWEDEN

2. Introduction
• Different techniques of anaesthesia for the orthopaedic patient
• Regional anaesthesia
• Spinal
• Epidural
• FNB, Adductor chanel block, etc
• General anaesthesia
• LMA, endotracheal tub
• Gas (Sevoflurane), TIVA/TCI
• Combinations

6. 6
Review

11. PRO RA
Rodgers et al. BMJ 2000. Reduced mortality , DVT, PE och AMI. Retrospektive and > 20 years old data
Stundner et al. Reg Anesth Pain Med 2012. Reduced need for bloodtransfusions and shorter LOS. Retrospective
Katz. Anesth Analg 1973. Anesthesiologists prefer RA.
Yeager et al. Anesthesiol 1987. EDA reducerar hjärt- och infektions komplikationer. Old study
Macfarlane et al. Clin Ortop Relat Res 2009. Less pain with RA. No difference in mortality, cardivasc. event, DVT, PE, RA
vs. GA
Pugely et al. JBJ Surgery 2013. RA fewer complications. Retrospektive study. Differences (<1%).
”The large number of patients in the present study provided sufficient power to find very small differences. In many cases the
observed differences were < 1%, and the clinical importance of such a small gap is not clear…..General anesthesia remains a
reasonable choice for many patients undergoing TKA.”
Memtsoudis et al. Anesthesiology 2013. 1,0 ‰ vs 1,8 ‰ mortalitet. Retrospektive study with 500.000 pat
Hunt et al. Lancet 2013. Lägre mortalitet med spinal. Retrospectiv studie with 400 000 pat

12. PRO GA
Cook et al. Br J Anaesth 2009. Serious complications to CNB was 7//100 000.
Borendal Wodlin. BJOG 2010. GA resulted in less PONV.
Gupta et al. Br J Anaesth 2012. Mortality with GA 7/180 000. mortalitet eller paraplegia with
RA 1/55 000
Kettner et al. Br J Anaesth 2011. Probably no difference in mortality or serious morbidity.
Bay-Nielsen et al. Acta Anaesth Scand 2008. For patients > 65 years RA resulted in more
complikations and more mortality. Retrospective studie.
Fischer et al. Anaesthesia 2008. GA+ FNB is one of the first choises in TKA.
Retrospective, www.postoppain.org
Liu et al. Anest Analg 2007. The clinical significance of RA is unclear. Deals with pain.
Gerbershagen et al. Anesthesiology 2013. No difference in pain between RA and GA

18. 18
Discussion (TKA)
• GA results in shorter LOS
• GA results in less dizziness och PONV
• GA produces better ortostatic function
• Between 0-4 h the SA patients had less pain but from 6 h and onwards the GA
patients had lower pain scores.
• GA patients used less Morphine
• Discharge from PACU can be done early, tourniquet or indwelling urinary
catheters are not needed (?)

20. 76% received spinal
anaesthesia vs. 23%
general anaesthesia.
General anaesthesia has
increased 100% since
2011 (range 99% - 0%)

21. Discussion
• Concerning regional or general anaesthesia for THA/TKA no
overwhelming evidence is found in the literature pinpointing that
either technique is superior to the other.
• We have found that TCI is clinically ideal for TKA
• The current situation calls for large sized randomized controlled trials
of spinal versus general anaesthesia.