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Total Diz Artroplastisi Ameliyatlarında Uygulanan Anestezi Yöntemlerinin Retrospektif Olarak İncelenmesi

Year 2021, Volume: 43 Issue: 6, 633 - 639, 24.09.2021
https://doi.org/10.20515/otd.942350

Abstract

Total diz artroplastisi ameliyatı geçiren hastalarda uygulanan anestezi metodlarının perioperatif ve postoperatif etkilerinin retrospektif değerlendirilmesi üzerine Türkiye’de yapılan çalışmalar az sayıdadır. Bu çalışmada amacımız total diz protezi ameliyatı geçiren hastalarda uygulanan rejyonel anestezi tekniklerinin genel anesteziye göre daha iyi sonuçlar sağladığı hipotezini test etmektir. Ankara Numune Eğitim ve Araştırma Hastanesi Bilimsel Araştırma Değerlendirme Komisyonu onayı alındı. 01 Ocak 2012 ile 31 Aralık 2012 tarihleri arasında total diz artroplasti ameliyatı geçiren 247 hastanın tıbbi arşivleri ve anestezi kayıtları geriye dönük olarak incelendi. Hastaların preoperatif, intraoperatif ve postoperatif kayıtlar tutuldu. Çalışılan gruplar arasında cinsiyet, yaş, sigara içme durumu, ASA düzeyi, ameliyat şekli, eşlik eden hastalıklar, ortalama arteriyel kan basıncı, kan verilme durumu, komplikasyonlar, postoperatif yoğun bakım ihtiyacı, ameliyat ve taburculuk süreleri, peroperatif morbidite ve mortalite açısından istatistiksel olarak anlamlı bir fark olmadığı bulundu (p> 0.05). Çalışılan gruplar arasında verilen kan miktarı, verilen sıvı miktarı ve kalp hızı açısından istatistiksel olarak anlamlı fark vardı (p <0.05). Çalışmamızda total diz artroplastisi operasyonu geçiren 247 hastanın verileri retrospektif olarak incelendi. Benzer yaş grupları ve yandaş hastalıklara sahip hastalarda rejyonel anestezi uygulamaları ve genel anestezi uygulamaları arasında peroperatif morbidite ve mortalite açısından anlamlı bir fark olmadığını gözlemledik. Bu konuda daha kapsamlı meta analizlere ve çalışmalara ihtiyaç olduğu kanısındayız.

Thanks

Değerli hocalarımız Prof. Dr. Nermin GÖĞÜŞ ve Prof. Dr. Işıl ÖZKOÇAK TURAN'a desteklerinden ötürü çok teşekkür ederiz.

References

  • 1. Greimel F, Maderbacher G, Zeman F, at al. No clinical difference comparing general, regional, and combination anesthesia in hip arthroplasty: A multicenter cohort-study regarding perioperative pain management and patient satisfaction. J Arthroplasty. 2017 Nov;32(11):3429-3433. doi: 10.1016/j.arth.2017.05.038. Epub 2017 May 26. PMID: 28641966.
  • 2. Kopp SL, Børglum J, Buvanendran A, at al. Anesthesia and analgesia practice pathway options for total knee arthroplasty: an evidence-based review by the american and european societies of regional anesthesia and pain medicine. Reg Anesth Pain Med. 2017 Nov/Dec;42(6):683-697. doi: 10.1097/AAP.0000000000000673. PMID: 29053504.
  • 3. Wilson JM, Farley KX, Erens GA, at al. General vs spinal anesthesia for revision total knee arthroplasty: do complication rates differ? J Arthroplasty. 2019 Jul;34(7):1417-1422. doi: 10.1016/j.arth.2019.03.048. Epub 2019 Mar 28. PMID: 31005435.
  • 4. Donauer K, Bomberg H, Wagenpfeil S, at al. Regional vs. General anesthesia for total knee and hip replacement: An analysis of postoperative pain perception from the ınternational paın out registry. Pain Pract. 2018 Nov;18(8):1036-1047. doi: 10.1111/papr.12708. Epub 2018 Jun 25. PMID: 29758587.
  • 5. Memtsoudis SG, Sun X, Chiu YL, at al. Perioperative comparative effectiveness of anesthetic technique in orthopedic patients. Anesthesiology. 2013 May;118(5):1046-58. doi: 10.1097/ALN.0b013e318286061d. Erratum in: Anesthesiology. 2016 Sep;125(3):610. PMID: 23612126; PMCID: PMC3956038.
  • 6. McIsaac DI, Wijeysundera DN, Huang A, at al. Association of hospital-level neuraxial anesthesia use for hip fracture surgery with outcomes: A population-based cohort study. Anesthesiology. 2018 Mar;128(3):480-491. doi: 10.1097/ALN.0000000000001899. Erratum in: Anesthesiology. 2018 May;128(5):1049. PMID: 28968275.
  • 7. Nakamura M, Kamei M, Bito S, at al. Spinal anesthesia increases the risk of venous thromboembolism in total arthroplasty: Secondary analysis of a J-PSVT cohort study on anesthesia. Medicine (Baltimore). 2017 May;96(18):e6748. doi: 10.1097/MD.0000000000006748. PMID: 28471968; PMCID: PMC5419914.
  • 8. Warren J, Sundaram K, Anis H, at al. Spinal anesthesia ıs associated with decreased complications after total knee and hip arthroplasty. J Am Acad Orthop Surg. 2020 Mar 1;28(5):e213-e221. doi: 10.5435/JAAOS-D-19-00156. PMID: 31478916
  • 9. Memtsoudis SG, Sun X, Chiu YL, at al. Utilization of critical care services among patients undergoing total hip and knee arthroplasty: Epidemiology and risk factors. Anesthesiology. 2012 Jul;117(1):107-16. doi: 10.1097/ALN.0b013e31825afd36. PMID: 22634871; PMCID: PMC3662478.
  • 10. Labraca NS, Castro-Sánchez AM, Matarán-Peñarrocha GA, at al. Benefits of starting rehabilitation within 24 hours of primary total knee arthroplasty: Randomized clinical trial. Clin Rehabil. 2011 Jun;25(6):557-66. doi: 10.1177/0269215510393759. Epub 2011 Mar 7. PMID: 21382863.
  • 11. Rodgers A, Walker N, Schug S, at al. Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: Results from overview of randomised trials. BMJ. 2000 Dec 16;321(7275):1493. doi: 10.1136/bmj.321.7275.1493. PMID: 11118174; PMCID: PMC27550.
  • 12. Van Waesberghe J, Stevanovic A, Rossaint R, at al. General vs. neuraxial anaesthesia in hip fracture patients: a systematic review and meta-analysis. BMC Anesthesiol. 2017 Jun 28;17(1):87. doi: 10.1186/s12871-017-0380-9. PMID: 28659127; PMCID: PMC5490182.
  • 13. Sharrock NE, Go G, Harpel PC, at al. The john charnley award. Thrombogenesis during total hip arthroplasty. Clin Orthop Relat Res. 1995 Oct;(319):16-27. PMID: 7554626.
  • 14. Modig J, Borg T, Karlström G, at al. Thromboembolism after total hip replacement: Role of epidural and general anesthesia. Anesth Analg. 1983 Feb;62(2):174-80. PMID: 6829920.
  • 15. Sharrock NE, Haas SB, Hargett MJ, at al. Effects of epidural anesthesia on the incidence of deep-vein thrombosis after total knee arthroplasty. J Bone Joint Surg Am. 1991 Apr;73(4):502-6. Erratum in: J Bone Joint Surg Am 1991 Jul;73(6):952. PMID: 2013588.
  • 16. Kahn RL, Marino V, Urquhart B, at al. Hemodynamic changes associated with tourniquet use under epidural anesthesia for total knee arthroplasty. Reg Anesth. 1992 Jul-Aug;17(4):228-32. PMID: 1515391.
  • 17. Valli H, Rosenberg PH. Effects of three anaesthesia methods on haemodynamic responses connected with the use of thigh tourniquet in orthopaedic patients. Acta Anaesthesiol Scand. 1985 Jan;29(1):142-7. doi: 10.1111/j.1399-6576.1985.tb02175.x. PMID: 3976320.
  • 18. Kohro S, Yamakage M, Arakawa J, at al. Surgical/tourniquet pain accelerates blood coagulability but not fibrinolysis. Br J Anaesth. 1998 Apr;80(4):460-3. doi: 10.1093/bja/80.4.460. PMID: 9640150.
  • 19. Williams-Russo P, Sharrock NE, Mattis S, at al. Cognitive effects after epidural vs general anesthesia in older adults. A randomized trial. JAMA. 1995 Jul 5;274(1):44-50. PMID: 7791257.
  • 20. Sharrock NE, Salvati EA. Hypotensive epidural anesthesia for total hip arthroplasty: A review. Acta Orthop Scand. 1996 Feb;67(1):91-107. doi: 10.3109/17453679608995620. PMID: 8615115.
  • 21. Planès A, Vochelle N, Fagola M, at al. Prevention of deep vein thrombosis after total hip replacement. The effect of low-molecular-weight heparin with spinal and general anaesthesia. J Bone Joint Surg Br. 1991 May;73(3):418-22. doi: 10.1302/0301-620X.73B3.1670442. PMID: 1670442.
  • 22. Sharrock NE, Ranawat CS, Urquhart B, at al. Factors influencing deep vein thrombosis following total hip arthroplasty under epidural anesthesia. Anesth Analg. 1993 Apr;76(4):765-71. doi: 10.1213/00000539-199304000-00014. PMID: 8466014.
  • 23. Sharrock NE, Mineo R, Urquhart B. Hemodynamic response to low-dose epinephrine infusion during hypotensive epidural anesthesia for total hip replacement. Reg Anesth. 1990 Nov-Dec;15(6):295-9. PMID: 2291884.

Retrospective Review of Anesthesia Methods in Total Knee Arthroplasty Surgeries

Year 2021, Volume: 43 Issue: 6, 633 - 639, 24.09.2021
https://doi.org/10.20515/otd.942350

Abstract

In Turkey, there are few studies conducted on the retrospective evaluation of the perioperative and postoperative effects of anesthesia methods applied in patients undergoing total knee arthroplasty surgery. In this study, our aim is to test the hypothesis that regional anesthesia techniques applied in patients undergoing total knee replacement surgery provide better results than general anesthesia. Ankara Numune Training and Research Hospital Scientific Research Evaluation Commission approved this study. Medical archives and anesthesia records of 247 patients who underwent total knee arthroplasty surgery between January 01, 2012 and December 31, 2012 were retrospectively analyzed. Preoperative, intraoperative and postoperative records were kept. In terms of gender, age, smoking status, ASA level, surgery type, accompanying diseases, mean arterial blood pressure, blood donation status, complications, postoperative intensive care need, operation and discharge times, perioperative morbidity and mortality, it was found that there is no statistically significant difference between the groups studied (p> 0.05). There was a statistically significant difference between groups in terms of the amount of blood given, amount of fluid administered and heart rate (p <0.05). In our study, 247 patients who underwent total knee arthroplasty were analyzed retrospectively. We concluded that there was no significant difference in terms of perioperative morbidity and mortality between regional anesthesia applications and general anesthesia applications in patients with similar age groups and concomitant diseases. We think that more comprehensive meta-analyzes and studies are needed on this subject.

References

  • 1. Greimel F, Maderbacher G, Zeman F, at al. No clinical difference comparing general, regional, and combination anesthesia in hip arthroplasty: A multicenter cohort-study regarding perioperative pain management and patient satisfaction. J Arthroplasty. 2017 Nov;32(11):3429-3433. doi: 10.1016/j.arth.2017.05.038. Epub 2017 May 26. PMID: 28641966.
  • 2. Kopp SL, Børglum J, Buvanendran A, at al. Anesthesia and analgesia practice pathway options for total knee arthroplasty: an evidence-based review by the american and european societies of regional anesthesia and pain medicine. Reg Anesth Pain Med. 2017 Nov/Dec;42(6):683-697. doi: 10.1097/AAP.0000000000000673. PMID: 29053504.
  • 3. Wilson JM, Farley KX, Erens GA, at al. General vs spinal anesthesia for revision total knee arthroplasty: do complication rates differ? J Arthroplasty. 2019 Jul;34(7):1417-1422. doi: 10.1016/j.arth.2019.03.048. Epub 2019 Mar 28. PMID: 31005435.
  • 4. Donauer K, Bomberg H, Wagenpfeil S, at al. Regional vs. General anesthesia for total knee and hip replacement: An analysis of postoperative pain perception from the ınternational paın out registry. Pain Pract. 2018 Nov;18(8):1036-1047. doi: 10.1111/papr.12708. Epub 2018 Jun 25. PMID: 29758587.
  • 5. Memtsoudis SG, Sun X, Chiu YL, at al. Perioperative comparative effectiveness of anesthetic technique in orthopedic patients. Anesthesiology. 2013 May;118(5):1046-58. doi: 10.1097/ALN.0b013e318286061d. Erratum in: Anesthesiology. 2016 Sep;125(3):610. PMID: 23612126; PMCID: PMC3956038.
  • 6. McIsaac DI, Wijeysundera DN, Huang A, at al. Association of hospital-level neuraxial anesthesia use for hip fracture surgery with outcomes: A population-based cohort study. Anesthesiology. 2018 Mar;128(3):480-491. doi: 10.1097/ALN.0000000000001899. Erratum in: Anesthesiology. 2018 May;128(5):1049. PMID: 28968275.
  • 7. Nakamura M, Kamei M, Bito S, at al. Spinal anesthesia increases the risk of venous thromboembolism in total arthroplasty: Secondary analysis of a J-PSVT cohort study on anesthesia. Medicine (Baltimore). 2017 May;96(18):e6748. doi: 10.1097/MD.0000000000006748. PMID: 28471968; PMCID: PMC5419914.
  • 8. Warren J, Sundaram K, Anis H, at al. Spinal anesthesia ıs associated with decreased complications after total knee and hip arthroplasty. J Am Acad Orthop Surg. 2020 Mar 1;28(5):e213-e221. doi: 10.5435/JAAOS-D-19-00156. PMID: 31478916
  • 9. Memtsoudis SG, Sun X, Chiu YL, at al. Utilization of critical care services among patients undergoing total hip and knee arthroplasty: Epidemiology and risk factors. Anesthesiology. 2012 Jul;117(1):107-16. doi: 10.1097/ALN.0b013e31825afd36. PMID: 22634871; PMCID: PMC3662478.
  • 10. Labraca NS, Castro-Sánchez AM, Matarán-Peñarrocha GA, at al. Benefits of starting rehabilitation within 24 hours of primary total knee arthroplasty: Randomized clinical trial. Clin Rehabil. 2011 Jun;25(6):557-66. doi: 10.1177/0269215510393759. Epub 2011 Mar 7. PMID: 21382863.
  • 11. Rodgers A, Walker N, Schug S, at al. Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: Results from overview of randomised trials. BMJ. 2000 Dec 16;321(7275):1493. doi: 10.1136/bmj.321.7275.1493. PMID: 11118174; PMCID: PMC27550.
  • 12. Van Waesberghe J, Stevanovic A, Rossaint R, at al. General vs. neuraxial anaesthesia in hip fracture patients: a systematic review and meta-analysis. BMC Anesthesiol. 2017 Jun 28;17(1):87. doi: 10.1186/s12871-017-0380-9. PMID: 28659127; PMCID: PMC5490182.
  • 13. Sharrock NE, Go G, Harpel PC, at al. The john charnley award. Thrombogenesis during total hip arthroplasty. Clin Orthop Relat Res. 1995 Oct;(319):16-27. PMID: 7554626.
  • 14. Modig J, Borg T, Karlström G, at al. Thromboembolism after total hip replacement: Role of epidural and general anesthesia. Anesth Analg. 1983 Feb;62(2):174-80. PMID: 6829920.
  • 15. Sharrock NE, Haas SB, Hargett MJ, at al. Effects of epidural anesthesia on the incidence of deep-vein thrombosis after total knee arthroplasty. J Bone Joint Surg Am. 1991 Apr;73(4):502-6. Erratum in: J Bone Joint Surg Am 1991 Jul;73(6):952. PMID: 2013588.
  • 16. Kahn RL, Marino V, Urquhart B, at al. Hemodynamic changes associated with tourniquet use under epidural anesthesia for total knee arthroplasty. Reg Anesth. 1992 Jul-Aug;17(4):228-32. PMID: 1515391.
  • 17. Valli H, Rosenberg PH. Effects of three anaesthesia methods on haemodynamic responses connected with the use of thigh tourniquet in orthopaedic patients. Acta Anaesthesiol Scand. 1985 Jan;29(1):142-7. doi: 10.1111/j.1399-6576.1985.tb02175.x. PMID: 3976320.
  • 18. Kohro S, Yamakage M, Arakawa J, at al. Surgical/tourniquet pain accelerates blood coagulability but not fibrinolysis. Br J Anaesth. 1998 Apr;80(4):460-3. doi: 10.1093/bja/80.4.460. PMID: 9640150.
  • 19. Williams-Russo P, Sharrock NE, Mattis S, at al. Cognitive effects after epidural vs general anesthesia in older adults. A randomized trial. JAMA. 1995 Jul 5;274(1):44-50. PMID: 7791257.
  • 20. Sharrock NE, Salvati EA. Hypotensive epidural anesthesia for total hip arthroplasty: A review. Acta Orthop Scand. 1996 Feb;67(1):91-107. doi: 10.3109/17453679608995620. PMID: 8615115.
  • 21. Planès A, Vochelle N, Fagola M, at al. Prevention of deep vein thrombosis after total hip replacement. The effect of low-molecular-weight heparin with spinal and general anaesthesia. J Bone Joint Surg Br. 1991 May;73(3):418-22. doi: 10.1302/0301-620X.73B3.1670442. PMID: 1670442.
  • 22. Sharrock NE, Ranawat CS, Urquhart B, at al. Factors influencing deep vein thrombosis following total hip arthroplasty under epidural anesthesia. Anesth Analg. 1993 Apr;76(4):765-71. doi: 10.1213/00000539-199304000-00014. PMID: 8466014.
  • 23. Sharrock NE, Mineo R, Urquhart B. Hemodynamic response to low-dose epinephrine infusion during hypotensive epidural anesthesia for total hip replacement. Reg Anesth. 1990 Nov-Dec;15(6):295-9. PMID: 2291884.
There are 23 citations in total.

Details

Primary Language Turkish
Subjects Health Care Administration
Journal Section ORİJİNAL MAKALE
Authors

Musa Zengin 0000-0003-2249-6521

Güvenç Doğan 0000-0001-7351-8968

Onur Karaca 0000-0002-3339-4195

Derya Gokcinar 0000-0002-0870-2168

Necati Erdoğmuş This is me 0000-0001-5960-2880

Özgür Aldemir This is me 0000-0001-9519-9179

Mustafa Baydar This is me 0000-0002-9333-7213

Publication Date September 24, 2021
Published in Issue Year 2021 Volume: 43 Issue: 6

Cite

Vancouver Zengin M, Doğan G, Karaca O, Gokcinar D, Erdoğmuş N, Aldemir Ö, Baydar M. Total Diz Artroplastisi Ameliyatlarında Uygulanan Anestezi Yöntemlerinin Retrospektif Olarak İncelenmesi. Osmangazi Tıp Dergisi. 2021;43(6):633-9.


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