Could a study based on nearly 200,000 patient records topple the long-held belief that regional anesthesia makes patients more prone to falls in the first days after having knee replacement surgery?
The popular thinking is that regional anesthesia for knee replacement may cause motor weakness, making patients more likely to fall when they're walking in the first days after surgery. But the study in the March issue of Anesthesiology finds that the chance of falling after knee replacement does not increase with epidurals and peripheral nerve blocks.
The study goes so far as to suggest that neuraxial anesthesia and blocks provide better pain control and lead to faster rehabilitation and fewer complications than general anesthesia.
"We found that not only do these types of anesthesia not increase the risk of falls, but also spinal or epidural anesthesia may even decrease the risk compared to general anesthesia," says Stavros G. Memtsoudis, MD, PhD, professor of anesthesiology and public health and director of critical care services at the Hospital for Special Surgery in New York, N.Y., and lead author of the study. "This work suggests that fear of in-hospital falls is not a reason to avoid regional anesthesia for orthopedic surgery."
Researchers analyzed the types of anesthesia used in 191,570 knee replacement surgeries: 76.2% of patients had general anesthesia, 10.9% had spinal or epidural anesthesia, and 12.9% had a combination of neuraxial and general anesthesia. In addition, 12.1% of all patients had peripheral nerve block. When researchers then analyzed the type of anesthesia used for those who fell in the hospital, they found little variance. Of patients who had general anesthesia, 1.62% fell, compared to 1.3% of those who had neuraxial anesthesia, and 1.5% who had general and neuraxial anesthesia. Patients who also received a peripheral nerve block had a fall rate of 1.58%.