Does the kind of anesthesia used during knee replacement surgery increase the odds that the patient is at risk for a post-surgery fall? Research has shown that regional forms of anesthesia—spinal or epidural (neuraxial) anesthesia and peripheral nerve blocks (PNB)—provide better pain control, faster rehabilitation and fewer complications than does general anesthesia. But surgeons have been reluctant to use them out of a fear that motor weakness, brought on by the regional anesthetic, may cause patients to fall in the first days after surgery.
A study based on almost 200, 000 patient records, published in the March issue of Anesthesiology, debunks that belief. “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, ” said Stavros G. Memtsoudis, M.D., Ph.D., professor of anesthesiology and public health and director of critical care services, Hospital for Special Surgery, New York, and lead author. “This work suggests that fear of in-hospital falls is not a reason to avoid regional anesthesia for orthopedic surgery.”
Surgeons have been right to be concerned about falls. Patients who fall within 30 days of knee surgery are more likely to have worse outcomes, including more heart and lung problems and higher rates of death. As a result doctors have used spinal or epidural anesthesia and PNB far less often than general anesthesia because of concern that regional forms of anesthesia may increase muscle weakness and make patients more prone to falls.
When researchers analyzed the types of anesthesia used in 191, 570 knee replacement surgeries in the Premier Perspective database they found that 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 PNB.
When they examined the type of anesthesia used for those who suffered a fall in the hospital they found that, 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 received a PNB had a fall rate of 1.58%.
The data used in the study came from a wide range of hospital settings. The researchers found that the fear of patient falls, as related to the kind of anesthetic used, to be unfounded. They noted that hospitals and physicians performing joint replacement procedures use effective fall-prevention programs.
