Effects of anaesthesia method and tourniquet use on recovery following total knee arthroplasty: a randomised controlled study

: Riku Palanne, Mikko Rantasalo, Anne Vakkuri, Rami Madanat, Klaus T. Olkkola, Katarina Lahtinen, Elina Reponen, Rita Linko, Tero Vahlberg, Noora Skants

Publisher: Elsevier Ltd

: 2020

: British Journal of Anaesthesia

: 125

: 5

: 762

: 772

: 1471-6771

DOI: https://doi.org/10.1016/j.bja.2020.03.036

: https://www.sciencedirect.com/science/article/pii/S0007091220303408?via%3Dihub

Background
We investigated the effects of spinal and general anaesthesia and surgical tourniquet on acute pain and early recovery after total knee arthroplasty (TKA).
Methods
Patients (n=413) were randomised to four parallel groups: spinal anaesthesia with or without tourniquet, and general anaesthesia with or without tourniquet. The primary outcome was patient-controlled i.v. oxycodone consumption over 24 postoperative hours.
Results
Results from 395 subjects were analysed. Median i.v. oxycodone consumption did not differ between the four groups (spinal anaesthesia without [36.6 mg] and with tourniquet [38.0 mg], general anaesthesia without [42.3 mg] and with tourniquet [42.5 mg], P=0.42), between spinal (37.7 mg) and general anaesthesia (42.5 mg) groups (median difference –3.1, 95% confidence interval [CI] –7.4 to 1.2, P=0.15) and between tourniquet and no-tourniquet groups (40.0 vs 40.0 mg, median difference –0.8, CI –5.1 to 3.5, P=0.72). Vomiting incidence was higher with spinal than with general anaesthesia (21% [42/200] vs 13% [25/194], CI 1.05 to 3.1, P=0.034). The mean haemoglobin decrease was greater without than with tourniquet (–3.0 vs –2.5 g dl⁻¹, mean difference –0.48, CI –0.65 to –0.32, P<0.001). No differences were observed in pain, pain management, incidences of blood transfusions, in-hospital complications, or length of hospital stay.
Conclusions
For TKA, spinal and general anaesthesia with or without tourniquet did not differ in 24-h postoperative opioid consumption, pain management, blood transfusions, in-hospital complications, and length of hospital stay. Vomiting incidence was higher in the spinal than in the general anaesthesia group. Tourniquet use caused smaller decreases in haemoglobin levels.
Clinical trial registration
EudraCT 2016-002035-15.