Using epidural or spinal anesthesia instead of general anesthesia for total joint replacement surgery may reduce the risk of surgical site infection, according to a new study published in the journal Anesthesiology.
An analysis of 3,081 patients in Taiwan who underwent total knee and total hip replacement procedures between 2002 and 2006 found the risk of getting an SSI within 30 days of surgery was 2.2 times greater for patients who had general anesthesia than it was for those who had regional anesthesia. Of the 56 patients who had infections, 33 had general anesthesia and 23 had spinal or epidural anesthesia.
The researchers, led by Chuen-Chau Chang, MD, MPH, PhD, say theirs is the first study to compare the SSI risk associated with general vs. regional anesthesia for total knee and total hip replacement surgery. They conclude that the findings "lend support to the evolving concept of long-term consequences of anesthesia" and the anesthesiologist's role in preventing SSIs.
But why does regional carry a lower risk of infection? In an accompanying editorial, Daniel I. Sessler, MD, of the Cleveland Clinic Anesthesiology Institute's Department of Outcomes Research, explains 3 reasons why spinal anesthesia may better equip patients to fight off SSIs:
"Neuraxial anesthesia moderates the inflammatory response to surgery," and "reducing nonspecific generalized responses may allow the immune system to focus better on the critical task of fighting bacteria."
Studies have shown neuraxial anesthesia to allow for better vasodilation and therefore improve tissue oxygenation.
Epidural anesthesia provides "excellent post-operative analgesia," which also assists tissue oxygenation.
He concludes that, in addition to antibiotic prophylaxis and other well-established ways of preventing post-op infections, Dr. Chang's study provides "compelling epidemiologic evidence that the use of neuraxial anesthesia also reduces risk" the risk of SSIs.
Irene Tsikitas
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