Regional anesthesia reduces transfusion risk in knee replacement surgery

By Piriya Mahendra, medwireNews Reporter

Regional anesthesia, compared with general anesthesia, reduces the need for blood transfusions in patients undergoing bilateral total knee replacement, research suggests.

Neuraxial anesthesia (a type of regional anesthesia) was administered to 6.8% of 15,687 patients who underwent bilateral total knee replacement. In addition, 80.1% of patients received general anesthesia, and 13.1% received a combination of regional and general anesthesia.

Stavros Memtsoudis (Hospital for Special Surgery, New York, USA) and team found that patients who received neuraxial anesthesia were significantly less likely to receive a blood transfusion than those who received general anesthesia or a combination of both, at 28.5% versus 44.7% and 38.0%, respectively.

They also identified a trend toward a reduction in major complications including pulmonary embolism and mechanical ventilation with the use of neuraxial anesthesia compared with general and combination anesthesia, but this was not statistically significant.

Neuraxial anesthesia involves an epidural or cerebrospinal technique. The majority of bilateral knee replacements and single knee replacements in the USA is performed under general anesthetic, but Memtsoudis et al believe that neuraxial anesthesia should be more widely used.

"The use of neuraxial anesthesia may not always be feasible in every patient, but it should be considered more frequently," recommended Memtsoudis in a press statement. "You shouldn't be asking doctors who don't use neuraxial anesthesia in their daily practice to suddenly switch over and start doing it, but there is a lot of education that needs to be done in terms of training residents and orthopedic surgeons to point out the impact of the choice of anesthetic technique on outcomes beyond the operating room."

As reported in Regional Anesthesia and Pain Medicine, the retrospective review included 22,253 bilateral knee replacements performed between 2006 and 2010 at around 400 acute care hospitals in the USA.

"Many patients don't like the idea of having an injection in their back and their legs being numb, and they are worried about paralysis," pointed out Memtsoudis. "There is a lot of misinformation out there."

He added: "You have to take into account comorbidities, patient preferences and other practice specific factors, such as the choice for anticoagulation, but neuraxial anesthesia should at the very least be considered in every patient."

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