title: Perioperative nerve injury after total hip arthroplasty: regional anesthesia risk during a 20-year cohort study.
abstract: BACKGROUND
  Perioperative nerve injury (PNI) is a recognized complication of total hip arthroplasty (THA). Regional anesthesia (RA) techniques may increase the risk of neurologic injury. Using a retrospective cohort study, the authors tested the hypothesis that use of RA increases the risk for PNI after elective THA.
  
  
  METHODS
  All adult patients who underwent elective THA at Mayo Clinic during a 20-yr period were included. The primary outcome was the presence of a new PNI within 3 months of surgery. Multivariable logistic regression was used to evaluate patient, surgical, and anesthetic risk factors for PNI.
  
  
  RESULTS
  Of 12,998 patients undergoing THA, 93 experienced PNI (incidence = 0.72%; 95% CI 0.58-0.88%). PNI was not associated with type of anesthesia (OR = 0.72 for neuraxial-combined vs. general; 95% CI 0.46-1.14) or peripheral nerve blockade (OR = 0.65; 95% CI 0.34-1.21). The risk for PNI was associated with younger age (OR = 0.79 per 10-yr increase; 95% CI 0.69-0.90), female gender (OR = 1.72; 95% CI 1.12-2.64), longer operations (OR = 1.10 per 30-min increase; 95% CI 1.03-1.18) or posterior surgical approach (OR = 1.91 vs. anterior approach; 95% CI 1.22-2.99). Neurologic recovery was not influenced by the use of RA techniques in patients with PNI.
  
  
  CONCLUSIONS
  The risk for PNI after THA was not increased with the use of neuraxial anesthesia or peripheral nerve blockade. Neurologic recovery in patients who experienced PNI was not affected by the use of RA. These results support the use of RA techniques in patients undergoing elective THA given their known functional and clinical benefits.
authors.affiliation: Department of Anesthesiology, College of Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA. jacob.adam@mayo.edu
authors.forename: Adam K
authors.initials: AK
authors.lastname: Jacob
authors.forename: Carlos B
authors.initials: CB
authors.lastname: Mantilla
authors.forename: Hans P
authors.initials: HP
authors.lastname: Sviggum
authors.forename: Darrell R
authors.initials: DR
authors.lastname: Schroeder
authors.forename: Mark W
authors.initials: MW
authors.lastname: Pagnano
authors.forename: James R
authors.initials: JR
authors.lastname: Hebl
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000765:Anesthesia, Conduction / Q000706:statistics & numerical data*; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D015984:Causality; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D009407:Nerve Block / Q000706:statistics & numerical data; D016017:Odds Ratio; D059348:Peripheral Nerve Injuries / Q000453:epidemiology*; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D017678:Sex Distribution; D013997:Time Factors; D055815:Young Adult