asurgeryАмбулаторная хирургияAmbulatornaya khirurgiya = Ambulatory Surgery (Russia)2712-87412782-2591ООО «ГРУППА РЕМЕДИУМ»10.21518/akh2023-033asurgery-394Research ArticleАНЕСТЕЗИЯANESTHESIAОсложнения спинальной и общей анестезии при тотальном эндопротезировании коленного суставаComplications of spinal and general anesthesia for total knee arthroplastyhttps://orcid.org/0009-0004-4046-1036АбдулахадС. А.AbdulahadS. A.

Самар А. Абдулахад, профильный врач отделения анестезиологии 

Багдад, ул. Мутанна Аль-Шайбани 

Samar A. Abdulahad, Specialist Doctor, Department of Anesthesiology 

Muthanna Alshaibani St., Baghdad

Samarantoine1@gmail.comhttps://orcid.org/0009-0001-4961-7402МохаммедХ. М.MohammadH. M.

Хусам М. Мохаммед, профильный врач отделения анестезиологии 

Багдад, ул. Мутанна Аль-Шайбани 

Husam M. Mohammad, Specialist Doctor, Department of Anesthesiology 

Muthanna Alshaibani St., Baghdad

husamanesthesia@gmail.comhttps://orcid.org/0009-0007-3555-3106Абд-Аль-КадирБ. К.Abd-Al-QaderB. K.

Бан К. Абд-Аль-Кадир, профильный врач отделения анестезиологии 

Багдад, ул. Мутанна Аль-Шайбани 

Ban K. Abd-Al-Qader, Specialist Doctor, Department of Anesthesiology 

Muthanna Alshaibani St., Baghdad

Bankhalid405@gmail.comБольница Аль-Уозити ТичингИракAlwasity Teaching HospitalIraq202324112023202110114Copyright © Абдулахад С.А., Мохаммед Х.М., Абд-Аль-Кадир Б.К., 20232023Абдулахад С.А., Мохаммед Х.М., Абд-Аль-Кадир Б.К.Abdulahad S.A., Mohammad H.M., Abd-Al-Qader B.K.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.a-surgeon.ru/jour/article/view/394

Введение. Общая анестезия (ОА) и спинальная анестезия (СА) являются основными методами, применяемыми при тотальном эндопротезировании коленного сустава (ТЭПКС). СА относится к категории нейроаксиальной анестезии (НА). В ходе многочисленных исследований были выявлены преимущества НА, выражающиеся в снижении частоты осложнений, среди которых тромбоэмболия легочной артерии (ЛЭ), инфекция мочевыводящих путей (ИМП) и тромбоз глубоких вен (ТГВ). Цель. Сравнить частоту осложнений спинальной анестезии и общей анестезии при ТЭПКС. Материалы и методы. В ретроспективное групповое исследование было включено 190 пациентов, которые наблюдались в больнице аль-Уозити Тичинг (Багдад) и перенесли ТЭПКС. Возраст пациентов колебался от 41 до 75 лет, 69% пациентов составляли женщины. Пациенты были распределены между группами СА (80 пациентов) и ОА (110 пациентов). Нами изучены истории болезней пациентов, проведен их опрос и медицинское обследование, в результате чего были получены данные о возрасте, поле, индексе массы тела (ИМТ), сочетанных заболеваниях, включая сахарный диабет (СД), артериальная гипертензия (АГ) и др. Результаты: В группе СА были выявлены пациенты более старшего возраста и с более высоким ИМТ. Частота осложнений в группе СА по сравнению с группой ОА составила ТЭЛА – 0,03 vs 0,09, ТГВ – 0,04 vs 0,10, пневмония – 0,04 vs 0,08, ИМП – 0,06 vs 0,23, а также ОПН – 0,03 vs 0,33, достоверных различий между ними не выявлено. Заключение. При ТЭПКС СА является оптимальным вариантом анестезии, так как она не связана с более высокой частотой осложнений по сравнению с ОА.

Introduction. General anesthesia (GA) and spinal anesthesia (SA) are the main techniques applied during total knee arthroplasty (TKA). SA belongs to neuraxial anesthesia (NA) category. Numerous studies have explored benefits of NA in diminishing the complications, among which are pulmonary embolism (PE), urinary tract infection (UTI), and deep vein thrombosis (DVT). Aim. To compare rate of complications of SA and GA in TKA. Materials and methods. This is a retrospective cohort studie conducted on 190 patients who attended Alwasity teaching hospital in Baghdad and underwent TKA. The age ranged from 41 to 75 years and 69% of patients were females. The patients were enrolled into SA group (80 patients) and GA group (110 patients). We reviewed patients’ records and interviewed patients and medically examined them to obtain data on age, sex, body mass index (BMI), comorbidities including diabetes mellitus(DM), hypertension (HT) and other comorbidities. Results: Higher age and BMI were found in SA group. Complications’ incidence in SA group vs. GA group was PE 0.03 vs. 0.09, DVT 0.04 vs. 0.10, Pneumonia 0.04 vs. 0.08, UTI 0.06 vs. 0.23, and ARF 0.03 vs. 0.33, they didn’t differ significantly. Conclusion: SA is a good option for anesthesia in TKA because it wasn’t associated with higher complications rate compared to GA.

тотальное эндопротезирование коленного суставаобщая анестезияспинальная анестезиянейроаксиальная анестезияТЭЛАtotal knee arthroplastygeneral anesthesiaspinal anesthesianeuraxial anesthesiapulomonary embolismReferencesMemtsoudis SG, Cozowicz C, Bekeris J, Bekere D, Liu J, Soffin EM et al. Anaesthetic care of patients undergoing primary hip and knee arthroplasty: consensus recommendations from the International Consensus on Anaesthesia-Related Outcomes after Surgery group (ICAROS) based on a systematic review and meta-analysis. Br J Anaesth. 2019;123(3):269–287. https://doi.org/10.1016/j.bja.2019.05.042Memtsoudis SG, Cozowicz C, Bekeris J, Bekere D, Liu J, Soffin EM et al. Anaesthetic care of patients undergoing primary hip and knee arthroplasty: consensus recommendations from the International Consensus on Anaesthesia-Related Outcomes after Surgery group (ICAROS) based on a systematic review and meta-analysis. Br J Anaesth. 2019;123(3):269–287. https://doi.org/10.1016/j.bja.2019.05.042Turnbull ZA, Sastow D, Giambrone GP, Tedore T. Anesthesia for the patient undergoing total knee replacement: current status and future prospects. Local Reg Anesth. 2017;10:1–7. https://doi.org/10.2147/LRA.S101373Turnbull ZA, Sastow D, Giambrone GP, Tedore T. Anesthesia for the patient undergoing total knee replacement: current status and future prospects. Local Reg Anesth. 2017;10:1–7. https://doi.org/10.2147/LRA.S101373Park YB, Chae WS, Park SH, Yu JS, Lee SG, Yim SJ. Comparison of Short-Term Complications of General and Spinal Anesthesia for Primary Unilateral Total Knee Arthroplasty. Knee Surg Relat Res. 2017;29(2):96–103. https://doi.org/10.5792/ksrr.16.009Park YB, Chae WS, Park SH, Yu JS, Lee SG, Yim SJ. Comparison of Short-Term Complications of General and Spinal Anesthesia for Primary Unilateral Total Knee Arthroplasty. Knee Surg Relat Res. 2017;29(2):96–103. https://doi.org/10.5792/ksrr.16.009Wong PB, McVicar J, Nelligan K, Bleackley JC, McCartney CJ. Factors influencing the choice of anesthetic technique for primary hip and knee arthroplasty. Pain Manag. 2016;6(3):297–311. https://doi.org/10.2217/pmt.16.6.Wong PB, McVicar J, Nelligan K, Bleackley JC, McCartney CJ. Factors influencing the choice of anesthetic technique for primary hip and knee arthroplasty. Pain Manag. 2016;6(3):297–311. https://doi.org/10.2217/pmt.16.6.Kopp SL, Børglum J, Buvanendran A, Horlocker TT, Ilfeld BM, Memtsoudis SG et al. Anesthesia and Analgesia Practice Pathway Options for Total Knee Arthroplasty: An Evidence-Based Review by the American and European Societies of Regional Anesthesia and Pain Medicine. Reg Anesth Pain Med. 2017;42(6):683–697. https://doi.org/10.1097/AAP.0000000000000673.Kopp SL, Børglum J, Buvanendran A, Horlocker TT, Ilfeld BM, Memtsoudis SG et al. Anesthesia and Analgesia Practice Pathway Options for Total Knee Arthroplasty: An Evidence-Based Review by the American and European Societies of Regional Anesthesia and Pain Medicine. Reg Anesth Pain Med. 2017;42(6):683–697. https://doi.org/10.1097/AAP.0000000000000673.Chandler K, Jacob R, Kuntz Iv GE, Sowers M, McGwin G, Naranje S, Kukreja P. Operating room time comparison between spinal and general anesthesia in total knee arthroplasty: an institutional review. Orthop Rev (Pavia). 2021;13(2):28330. https://doi.org/10.52965/001c.28330Chandler K, Jacob R, Kuntz Iv GE, Sowers M, McGwin G, Naranje S, Kukreja P. Operating room time comparison between spinal and general anesthesia in total knee arthroplasty: an institutional review. Orthop Rev (Pavia). 2021;13(2):28330. https://doi.org/10.52965/001c.28330Wei C, Gu A, Muthiah A, Fassihi SC, Sculco PK, Nunley RM et al. Neuraxial anaesthesia is associated with improved outcomes and reduced postoperative complications in patients undergoing aseptic revision total hip arthroplasty. Hip Int. 2022;32(2):221–230. https://doi.org/10.1177/1120700020975749.Wei C, Gu A, Muthiah A, Fassihi SC, Sculco PK, Nunley RM et al. Neuraxial anaesthesia is associated with improved outcomes and reduced postoperative complications in patients undergoing aseptic revision total hip arthroplasty. Hip Int. 2022;32(2):221–230. https://doi.org/10.1177/1120700020975749.Olawin AM, M Das J. Spinal Anesthesia. Treasure Island (FL): StatPearls Publishing; 2022. Available at: https://www.ncbi.nlm.nih.gov/books/NBK537299/.Olawin AM, M Das J. Spinal Anesthesia. Treasure Island (FL): StatPearls Publishing; 2022. Available at: https://www.ncbi.nlm.nih.gov/books/NBK537299/.Warren J, Sundaram K, Anis H, Kamath AF, Mont MA, Higuera CA, Piuzzi NS. Spinal Anesthesia Is Associated With Decreased Complications After Total Knee and Hip Arthroplasty. J Am Acad Orthop Surg. 2020;28(5):e213–e221. https://doi.org/10.5435/JAAOS-D-19-00156.Warren J, Sundaram K, Anis H, Kamath AF, Mont MA, Higuera CA, Piuzzi NS. Spinal Anesthesia Is Associated With Decreased Complications After Total Knee and Hip Arthroplasty. J Am Acad Orthop Surg. 2020;28(5):e213–e221. https://doi.org/10.5435/JAAOS-D-19-00156.Turky JH, Imran MK. Effect of regional anesthesia in the knee arthroplasty surgery. Kerbala J Pharm Sci. 2022;1(20):116–122. Available at: https://www.iasj.net/iasj/article/235053.Turky JH, Imran MK. Effect of regional anesthesia in the knee arthroplasty surgery. Kerbala J Pharm Sci. 2022;1(20):116–122. Available at: https://www.iasj.net/iasj/article/235053.Yasir HO, Zamil AJ, Jasim HS. Effect of Type of Anesthesia on total Knee Arthroplasty for Iraqi women. Sarcouncil J Med Sci. 2023;2(2):17–23. Available at: https://zenodo.org/record/7616750.Yasir HO, Zamil AJ, Jasim HS. Effect of Type of Anesthesia on total Knee Arthroplasty for Iraqi women. Sarcouncil J Med Sci. 2023;2(2):17–23. Available at: https://zenodo.org/record/7616750.Wilson JM, Farley KX, Erens GA, Guild GN 3rd. General vs Spinal Anesthesia for Revision Total Knee Arthroplasty: Do Complication Rates Differ?. J Arthroplasty. 2019;34(7):1417–1422. https://doi.org/10.1016/j.arth.2019.03.048Wilson JM, Farley KX, Erens GA, Guild GN 3rd. General vs Spinal Anesthesia for Revision Total Knee Arthroplasty: Do Complication Rates Differ?. J Arthroplasty. 2019;34(7):1417–1422. https://doi.org/10.1016/j.arth.2019.03.048Kendall MC, Cohen AD, Principe-Marrero S, Sidhom P, Apruzzese P, De Oliveira G. Spinal versus general anesthesia for patients undergoing outpatient total knee arthroplasty: a national propensity matched analysis of early postoperative outcomes. BMC Anesthesiol. 2021;21(1):226. https://doi.org/10.1186/s12871-021-01442-2.Kendall MC, Cohen AD, Principe-Marrero S, Sidhom P, Apruzzese P, De Oliveira G. Spinal versus general anesthesia for patients undergoing outpatient total knee arthroplasty: a national propensity matched analysis of early postoperative outcomes. BMC Anesthesiol. 2021;21(1):226. https://doi.org/10.1186/s12871-021-01442-2.Lee S, Kim MK, Ahn E, Jung Y. Comparison of general and regional anesthesia on short-term complications in patients undergoing total knee arthroplasty: A retrospective study using national health insurance service-national sample cohort. Medicine (Baltimore). 2023;102(8):e33032. https://doi.org/10.1097/MD.0000000000033032.Lee S, Kim MK, Ahn E, Jung Y. Comparison of general and regional anesthesia on short-term complications in patients undergoing total knee arthroplasty: A retrospective study using national health insurance service-national sample cohort. Medicine (Baltimore). 2023;102(8):e33032. https://doi.org/10.1097/MD.0000000000033032.O’Connor MI. Sex differences in osteoarthritis of the hip and knee. J Am Acad Orthop Surg. 2007;15(Suppl. 1):S22–S25. Available at: https://pubmed.ncbi.nlm.nih.gov/17766785/O’Connor MI. Sex differences in osteoarthritis of the hip and knee. J Am Acad Orthop Surg. 2007;15(Suppl. 1):S22–S25. Available at: https://pubmed.ncbi.nlm.nih.gov/17766785/Hame SL, Alexander RA. Knee osteoarthritis in women. Curr Rev Musculoskelet Med. 2013;6(2):182–187. https://doi.org/10.1007/s12178-013-9164-0.Hame SL, Alexander RA. Knee osteoarthritis in women. Curr Rev Musculoskelet Med. 2013;6(2):182–187. https://doi.org/10.1007/s12178-013-9164-0.Yap E, Wei J, Webb C, Ng K, Behrends M. Neuraxial and general anesthesia for outpatient total joint arthroplasty result in similarly low rates of major perioperative complications: a multicentered cohort study. Reg Anesth Pain Med. 2022;47(5):294–300. https://doi.org/10.1136/rapm-2021-103189.Yap E, Wei J, Webb C, Ng K, Behrends M. Neuraxial and general anesthesia for outpatient total joint arthroplasty result in similarly low rates of major perioperative complications: a multicentered cohort study. Reg Anesth Pain Med. 2022;47(5):294–300. https://doi.org/10.1136/rapm-2021-103189.Matharu GS, Garriga C, Rangan A, Judge A. Does Regional Anesthesia Reduce Complications Following Total Hip and Knee Replacement Compared With General Anesthesia? An Analysis From the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man. J Arthroplasty. 2020;35(6):1521–1528.e5. https://doi.org/10.1016/j.arth.2020.02.003.Matharu GS, Garriga C, Rangan A, Judge A. Does Regional Anesthesia Reduce Complications Following Total Hip and Knee Replacement Compared With General Anesthesia? An Analysis From the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man. J Arthroplasty. 2020;35(6):1521–1528.e5. https://doi.org/10.1016/j.arth.2020.02.003.Kim HJ, Roychoudhury P, Lohia S, Kim JS, Kim HT, Ro YJ, Koh WU. Comparison of General and Spinal Anaesthesia on Systemic Inflammatory Response in Patients Undergoing Total Knee Arthroplasty: A Propensity Score Matching Analysis. Medicina (Kaunas). 2021;57(11):1250. https://doi.org/10.3390/medicina57111250.Kim HJ, Roychoudhury P, Lohia S, Kim JS, Kim HT, Ro YJ, Koh WU. Comparison of General and Spinal Anaesthesia on Systemic Inflammatory Response in Patients Undergoing Total Knee Arthroplasty: A Propensity Score Matching Analysis. Medicina (Kaunas). 2021;57(11):1250. https://doi.org/10.3390/medicina57111250.Rodriguez-Patarroyo FA, Cuello N, Molloy R, Krebs V, Turan A, Piuzzi NS. A guide to regional analgesia for Total Knee Arthroplasty. EFORT Open Rev. 2021;6(12):1181–1192. https://doi.org/10.1302/2058-5241.6.210045.Rodriguez-Patarroyo FA, Cuello N, Molloy R, Krebs V, Turan A, Piuzzi NS. A guide to regional analgesia for Total Knee Arthroplasty. EFORT Open Rev. 2021;6(12):1181–1192. https://doi.org/10.1302/2058-5241.6.210045.Perlas A, Chan VW, Beattie S. Anesthesia Technique and Mortality after Total Hip or Knee Arthroplasty: A Retrospective, Propensity Score-matched Cohort Study. Anesthesiology. 2016;125(4):724–731. https://doi.org/10.1097/ALN.0000000000001248.Perlas A, Chan VW, Beattie S. Anesthesia Technique and Mortality after Total Hip or Knee Arthroplasty: A Retrospective, Propensity Score-matched Cohort Study. Anesthesiology. 2016;125(4):724–731. https://doi.org/10.1097/ALN.0000000000001248.Liu D, Sun C, Zhang X, Zhao Z. Influence of epidural anesthesia and general anesthesia on thromboembolism in patients undergoing total knee arthroplasty. Am J Transl Res. 2021;13(9):10933–10941. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8507049/Liu D, Sun C, Zhang X, Zhao Z. Influence of epidural anesthesia and general anesthesia on thromboembolism in patients undergoing total knee arthroplasty. Am J Transl Res. 2021;13(9):10933–10941. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8507049/Choi PT, Bhandari M, Scott J, Douketis J. Epidural analgesia for pain relief following hip or knee replacement. Cochrane Database Syst Rev. 2003;(3):CD003071. https://doi.org/10.1002/14651858.CD003071.Choi PT, Bhandari M, Scott J, Douketis J. Epidural analgesia for pain relief following hip or knee replacement. Cochrane Database Syst Rev. 2003;(3):CD003071. https://doi.org/10.1002/14651858.CD003071.

The authors declare that there are no conflicts of interest present.