Postoperative outcome in Chinese patients having primary total knee arthroplasty under general anaesthesia/intravenous patient-controlled analgesia compared to spinal-epidural anaesthesia/analgesia.
OBJECTIVE
To compare postoperative outcomes in patients having primary total knee arthroplasty receiving general or regional anaesthesia.


METHODS
Randomised prospective study.


METHODS
Regional hospital, Hong Kong.


METHODS
Patients having primary total knee replacement were randomised to either general anaesthesia followed by postoperative intravenous patient-controlled analgesia with morphine, or combined spinal-epidural anaesthesia followed by postoperative epidural infusion of bupivacaine 0.1% with fentanyl 2 microg/mL.


METHODS
Visual analogue scale pain scores, perioperative blood loss, time to first meal and ambulation, and prevalence of postoperative complications.


RESULTS
Sixty consecutive patients were enrolled in this study. Postoperative median pain scores were consistently lower at 1 (P<0.0001), 6 (P=0.08), 12 (P=0.003), 24 (P=0.14), and 48 hours (P=0.007) in those given regional anaesthesia. Although there was a trend towards fewer complications in the latter group, there were no statistically significant differences between the two groups with respect to the incidence of postoperative blood loss, haemodynamic instability, pruritus, nausea, vomiting, urinary retention, or other surgical/medical complications. Postoperatively, patients given regional anaesthesia also resumed meals earlier (P<0.0001), and showed a trend towards earlier ambulation and hospital discharge.


CONCLUSIONS
Chinese patients undergoing total knee arthroplasty with regional anaesthesia/regionally delivered analgesia enjoyed better postoperative pain relief and resumed meals earlier than those receiving general anaesthesia/intravenous patient-controlled analgesia. The former also showed trends towards less adverse effects, postoperative complications, earlier ambulation, and earlier hospital discharge.
Chu
C P W
CP
Alice Ho Miu Ling Nethersole Hospital, 11 Chuen On Road, Tai Po, Hong Kong: Department of Anaesthesia and Operating Services. cpwchu@hotmail.com
Yap
J C C M
JC
Chen
P P
PP
Hung
H H
HH
D015360:Analgesia, Epidural; D016058:Analgesia, Patient-Controlled; D000767:Anesthesia, Epidural; D000768:Anesthesia, General; D000775:Anesthesia, Spinal; D019645:Arthroplasty, Replacement, Knee; D006801:Humans; D010149:Postoperative Pain / Q000188:drug therapy*; D011446:Prospective Studies