一般、脊椎、および区域神経ブロック：異なる麻酔法は一次股関節および膝関節全置換術における同日退院に影響しますか？

The purpose of this study was to compare the effect of spinal anesthesia (SA) versus general anesthesia (GA) on acute 90-day outcomes in same-day discharge (SDD) total hip (THA) and total knee arthroplasty (TKA) patients, including subgroup analysis of peripheral nerve block usage.

A retrospective review of 1,002 SDD patients (402 THAs, 600 TKAs) was performed, including 868 and 134 undergoing SA and GA, respectively. All patients received periarticular injections and multimodal analgesia; 80% of THAs received a paravertebral block (PVB), and 58% of TKAs received an adductor canal block (ACB). Intraoperative and postoperative narcotic usage (morphine milligram equivalents, MME) through SDD, numerical pain scores, first ambulation distance, length-of-stay (LOS), and 90-day complications (readmissions or reoperations) were compared.

The SA performed in SDD THA resulted in decreased intraoperative MME (0.1 versus 8.7, P < 0.01), postoperative MME (12.3 versus 16.1, P < 0.02), and pain scores (1.6 versus 3.8, P < 0.01). A similar result was found in TKA, as SA patients had decreased intraoperative MME (0.1 vs. 13.1, respectively, P < 0.01), postoperative MME (9.7 versus 15.5, P < 0.01), and pain scores (1.5 versus 3.2, P < 0.01). There was no difference in LOS between groups, but THA patients undergoing GA showed an increased 90-day readmission rate (4.8 versus 0.3%, P < 0.01). For SA, the use of PVBs in THA reduced postoperative MMEs and pain scores, while there were minimal effects with ACBs in TKA.

For SDD THA and TKA patients, SA improved intraoperative and immediate postoperative pain control compared to GA without affecting acute recovery. The use of PVBs modestly improved acute pain for THA, while ACBs for TKA did not demonstrate the same effect in the setting of contemporary multimodal analgesia.