title: Peripheral nerve blocks versus general anesthesia for total knee replacement in elderly patients on the postoperative quality of recovery.
abstract: BACKGROUND
  Both peripheral nerve blocks with sedation or general anesthesia can be used for total knee replacement surgery.
  
  
  OBJECTIVE
  We compared these anesthetic techniques on the postoperative quality of recovery early in elderly patients.
  
  
  METHODS
  In our study, 213 patients who were ≥65 years old and undergoing total knee replacement were randomized to peripheral nerve blocks (PNBs) - lumbar plexus and sciatic - with propofol sedation, or general anesthesia with combined propofol and remifentanil. Blocks were performed using nerve stimulation and 0.35% ropivacaine. All patients received postoperative multimodal analgesia. Postoperative recovery was assessed at 15 minutes, 40 minutes, 1 day, 3 days, and 7 days after surgery, with the Postoperative Quality of Recovery Scale, in physiological, nociceptive, emotive, modified activities of daily living, modified cognitive, and overall patient perspective domains.
  
  
  RESULTS
  Intraoperative blood pressure and heart rate were more stable with PNBs (P<0.001). The recovery was better with PNBs in physiological (P<0.001), emotive (depression and anxiety) (P<0.001), nociceptive (pain and nausea) (P<0.001), modified cognitive (P<0.001), and all domains recovery (P<0.001), but not in activities of daily living (P=0.181). Intraoperative drugs and the postoperative sulfentanil requirement of the PNBs group were lower (all P<0.001). Differences were greatest early after surgery with equivalence by 1 week. Satisfaction was high and not different between groups (P=0.059).
  
  
  CONCLUSIONS
  Lumbar plexus and sciatic blocks with sedation facilitates faster postoperative recovery than general anesthesia, but not at 1 week after total knee replacement in patients who were 65 years or older. The trial has been registered at ClinicalTrials.gov. (NCT01871012).
authors.affiliation: Anesthesia and Operation Center, Chinese People's Liberation Army General Hospital and Medical School of Chinese People's Liberation Army, Beijing, People's Republic of China.
authors.forename: JunLe
authors.initials: J
authors.lastname: Liu
authors.affiliation: Anesthesia and Operation Center, Chinese People's Liberation Army General Hospital and Medical School of Chinese People's Liberation Army, Beijing, People's Republic of China.
authors.forename: WeiXiu
authors.initials: W
authors.lastname: Yuan
authors.affiliation: Anesthesia and Operation Center, Chinese People's Liberation Army General Hospital and Medical School of Chinese People's Liberation Army, Beijing, People's Republic of China.
authors.forename: XiaoLin
authors.initials: X
authors.lastname: Wang
authors.affiliation: Anesthesia and Pain Management Unit, Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia ; Department of Anesthesia and Pain Management, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.
authors.forename: Colin F
authors.initials: CF
authors.lastname: Royse
authors.affiliation: Anesthesia and Operation Center, Chinese People's Liberation Army General Hospital and Medical School of Chinese People's Liberation Army, Beijing, People's Republic of China.
authors.forename: MaoWei
authors.initials: M
authors.lastname: Gong
authors.affiliation: Anesthesia and Operation Center, Chinese People's Liberation Army General Hospital and Medical School of Chinese People's Liberation Army, Beijing, People's Republic of China.
authors.forename: Ying
authors.initials: Y
authors.lastname: Zhao
authors.affiliation: Anesthesia and Operation Center, Chinese People's Liberation Army General Hospital and Medical School of Chinese People's Liberation Army, Beijing, People's Republic of China.
authors.forename: Hong
authors.initials: H
authors.lastname: Zhang
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D000768:Anesthesia, General / Q000379:methods; D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D009407:Nerve Block / Q000379:methods; D009483:Neuropsychological Tests; D017060:Patient Satisfaction; D011184:Postoperative Period; D020127:Recovery of Function
keywords: general anesthesia; knee replacement; nerve block; perioperative care