Incidence and related factors for intraoperative failed spinal anaesthesia for lower limb arthroplasty

Incidence and related factors for intraoperative failed spinal anaesthesia for lower limb arthroplasty

Background Spinal anaesthesia is the preferred choice for total hip‐ and knee arthroplasty (THA/TKA), due to the claimed superior outcome profile, relative simple technique and without the need for advanced airway support. However, choosing and informing about spinal anaesthesia should also include...

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Bibliographic Details
Published in:Acta anaesthesiologica Scandinavica Vol. 62; no. 7; pp. 993 - 1000
Main Authors: Aasvang, E. K., Laursen, M. B., Madsen, J., Krøigaard, M., Solgaard, S., Kjærsgaard‐Andersen, P., Mandøe, H., Hansen, T. B., Nielsen, J. U., Krarup, N., Skøtt, A. E., Kehlet, H.
Format: Journal Article
Language:English
Published: England Wiley Subscription Services, Inc 01-08-2018
Subjects:
Anesthesia
Arthroplasty (hip)
Arthroplasty (knee)
Biomedical materials
Body mass
Bupivacaine
Data processing
Failure analysis
Health risk assessment
Hip
Incidence
Joint surgery
Knee
Pain
Patients
Respiratory tract
Surgery
Surgical implants
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Summary:Background Spinal anaesthesia is the preferred choice for total hip‐ and knee arthroplasty (THA/TKA), due to the claimed superior outcome profile, relative simple technique and without the need for advanced airway support. However, choosing and informing about spinal anaesthesia should also include the risk for intraoperative failed spinal anaesthesia with associated pain, discomfort and suboptimal settings for airway management. Small‐scale studies suggest incidences from 1 to 17%; however, no multi‐institutional large data exists on failed spinal incidence and related factors during THA/TKA, hindering evidence‐based information and potential anaesthesia stratification. Methods In a sub‐analysis, data from a prospective study on spinal anaesthesia for THA/TKA were examined for incidence of intraoperative conversion to general anaesthesia. Potential perioperative factors (age, gender, American Society of Anaesthesiologist (ASA) score, height, weight, BMI, procedure, bupivacaine dosage and duration of time from spinal administration until end of surgery) were analysed with logistic regression for relation to failed spinal anaesthesia. Results In all, 1451 patients were included for analysis, whereof 57 (3.9%) had failed spinal anaesthesia. Spinal failure patients were significantly younger (61 vs. 67 years, P = 0.003), and operation time longer in the failed spinal group vs no‐failure, respectively (133 vs. 89 min, P < 0.001). No significant differences were found with regard to bupivacaine volume, gender, ASA‐score, height, weight, BMI or THA vs. TKA. Conclusion Failed spinal anaesthesia for THA and TKA is a relatively frequent occurrence and identification of risk patients is not feasible. These results should be considered when choosing anaesthesia and included in the information to patients.
Bibliography:Conflicts on interests
No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article; thus, we declare no conflicts of interest.
This study was funded by the Lundbeck Centre for Fast‐track Hip and Knee Arthroplasty, Copenhagen, Denmark, which was supported by a grant from the Lundbeck Foundation, Hellerup Denmark. The foundation is independent of the pharmaceutical company Lundbeck a/s and was not involved in designing or conducting the study.
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ISSN:0001-5172
1399-6576
DOI:10.1111/aas.13118