Kieran Lafferty
Introduction
Enhanced recovery pathways for primary hip and knee arthroplasty aim to reduce length of hospital stay (LOS) and promote early mobilisation . The influence of anaesthetic technique, including choice of spinal agent, on these outcomes remains unclear. This study examined whether anaesthetic type affects LOS and time to first mobilisation following primary hip and knee arthroplasty.
Methods
A retrospective analysis of ARISE data was conducted over three months. All patients undergoing primary hip or knee arthroplasty were included. Anaesthetic techniques were grouped into general anaesthesia (GA) and spinal anaesthesia, with spinal agents subdivided into heavy bupivacaine, plain levobupivacaine, and prilocaine. Outcomes were LOS and mobilisation on the day of surgery (DOS).
Results
A total of 481 patients were analysed: 169 received GA and 312 spinal anaesthesia. Mean LOS was shortest in the GA group (2.0 days), compared with heavy bupivacaine (2.22 days), levobupivacaine (2.31 days), and prilocaine (2.22 days). DOS mobilisation occurred in 44.4% of GA patients, 40.8% with heavy bupivacaine, and 42.9% with levobupivacaine. The highest rate of DOS mobilisation was observed with prilocaine (56.3%), although numbers were small. Conversion from spinal to GA was uncommon.
Conclusions
Anaesthetic technique was not associated with clinically significant differences in LOS. Prilocaine spinal anaesthesia showed a higher proportion of same-day mobilisation, suggesting potential benefit within enhanced recovery pathways. We suggest that preoperative education and optimisation may exert greater influence on LOS and mobilisation. Larger prospective studies are needed to clarify the impact of spinal agent selection on early postoperative recovery.
Authors
Kieran Lafferty, Lorna McEwan
Victoria Hospital Kirkcaldy, Kirkcaldy, United Kingdom