Peripheral nerve blocks versus general anesthesia for total knee replacement in elderly patients on the postoperative quality of recovery
JunLe Liu,1,* WeiXiu Yuan,1,* XiaoLin Wang,1,* Colin F Royse,2,3 MaoWei Gong,1 Ying Zhao,1 Hong Zhang1 1Anesthesia and Operation Center, Chinese People's Liberation Army General Hospital and Medical School of Chinese People's Liberation Army, Beijing, People's Republic of Chi...
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Dove Medical Press
2014
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oai:doaj.org-article:a4c1717b142d4e99882d1288b540b4ee2021-12-02T08:17:25ZPeripheral nerve blocks versus general anesthesia for total knee replacement in elderly patients on the postoperative quality of recovery1178-1998https://doaj.org/article/a4c1717b142d4e99882d1288b540b4ee2014-02-01T00:00:00Zhttps://www.dovepress.com/peripheral-nerve-blocks-versus-general-anesthesia-for-total-knee-repla-peer-reviewed-article-CIAhttps://doaj.org/toc/1178-1998JunLe Liu,1,* WeiXiu Yuan,1,* XiaoLin Wang,1,* Colin F Royse,2,3 MaoWei Gong,1 Ying Zhao,1 Hong Zhang1 1Anesthesia 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; 2Anesthesia and Pain Management Unit, Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia; 3Department of Anesthesia and Pain Management, The Royal Melbourne Hospital, Melbourne, Victoria, Australia *These authors contributed equally to this work Background: Both peripheral nerve blocks with sedation or general anesthesia can be used for total knee replacement surgery. Objectives: We compared these anesthetic techniques on the postoperative quality of recovery early in elderly patients. Materials and 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). Conclusion: 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). Keywords: nerve block, general anesthesia, knee replacement, perioperative careLiu JLYuan WXWang XLRoyse CFGong MWZhao YZhang HDove Medical Pressarticlenerve blockgeneral anesthesiaknee replacementPerioperative care.GeriatricsRC952-954.6ENClinical Interventions in Aging, Vol Volume 9, Pp 341-350 (2014) |
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nerve block general anesthesia knee replacement Perioperative care. Geriatrics RC952-954.6 |
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nerve block general anesthesia knee replacement Perioperative care. Geriatrics RC952-954.6 Liu JL Yuan WX Wang XL Royse CF Gong MW Zhao Y Zhang H Peripheral nerve blocks versus general anesthesia for total knee replacement in elderly patients on the postoperative quality of recovery |
| description |
JunLe Liu,1,* WeiXiu Yuan,1,* XiaoLin Wang,1,* Colin F Royse,2,3 MaoWei Gong,1 Ying Zhao,1 Hong Zhang1 1Anesthesia 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; 2Anesthesia and Pain Management Unit, Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia; 3Department of Anesthesia and Pain Management, The Royal Melbourne Hospital, Melbourne, Victoria, Australia *These authors contributed equally to this work Background: Both peripheral nerve blocks with sedation or general anesthesia can be used for total knee replacement surgery. Objectives: We compared these anesthetic techniques on the postoperative quality of recovery early in elderly patients. Materials and 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). Conclusion: 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). Keywords: nerve block, general anesthesia, knee replacement, perioperative care |
| format |
article |
| author |
Liu JL Yuan WX Wang XL Royse CF Gong MW Zhao Y Zhang H |
| author_facet |
Liu JL Yuan WX Wang XL Royse CF Gong MW Zhao Y Zhang H |
| author_sort |
Liu JL |
| title |
Peripheral nerve blocks versus general anesthesia for total knee replacement in elderly patients on the postoperative quality of recovery |
| title_short |
Peripheral nerve blocks versus general anesthesia for total knee replacement in elderly patients on the postoperative quality of recovery |
| title_full |
Peripheral nerve blocks versus general anesthesia for total knee replacement in elderly patients on the postoperative quality of recovery |
| title_fullStr |
Peripheral nerve blocks versus general anesthesia for total knee replacement in elderly patients on the postoperative quality of recovery |
| title_full_unstemmed |
Peripheral nerve blocks versus general anesthesia for total knee replacement in elderly patients on the postoperative quality of recovery |
| title_sort |
peripheral nerve blocks versus general anesthesia for total knee replacement in elderly patients on the postoperative quality of recovery |
| publisher |
Dove Medical Press |
| publishDate |
2014 |
| url |
https://doaj.org/article/a4c1717b142d4e99882d1288b540b4ee |
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