Two high-quality studies (Nielsen PT 1990, Jorgensen 1991) and one low-quality (Sharrock 1991) study demonstrated significantly lower rates of deep venous thrombosis (DVT) compared to general anesthesia. Of note, the two high-quality studies did not utilize any form of perioperative prophylactic anticoagulation; and the low-quality study utilized postoperative aspirin therapy only. Neither study used warfarin or low-molecular weight heparin as part of their postoperative DVT prophylactic regimen. Four additional low- (Stundner 2012, Memtsoudis 2013) quality studies demonstrated significant reductions in overall postoperative complications with neuraxial anesthesia; including reductions in blood transfusion rates, pulmonary compromise, pulmonary embolism, pneumonia, mechanical ventilation rates, acute renal failure and composite infectious complications.
Two high-quality studies demonstrated improved short-term functional outcomes after neuraxial anesthesia. Specifically, Williams-Russo (1996) demonstrated improved short-term range-of-motion (flexion) and short-term ambulation (days until unassisted stair climbing) compared to general anesthesia. Nielson WR (1990) demonstrated improved short-term cognitive function (Wechsler Memory Scale; Controlled Oral Word Association) compared to general anesthesia.
One low-quality study (Memtsoudis) demonstrated a significant reduction in 30-day mortality in patients undergoing neuraxial anesthesia compared to general anesthesia.
- Jorgensen,L.N., Rasmussen,L.S., Nielsen,P.T., Leffers,A., Albrecht-Beste,E. Antithrombotic efficacy of continuous extradural analgesia after knee replacement. Br J Anaesth. 1991/1; 1: 8-12
- Memtsoudis,S.G., Sun,X., Chiu,Y.L., Stundner,O., Liu,S.S., Banerjee,S., Mazumdar,M., Sharrock,N.E. Perioperative comparative effectiveness of anesthetic technique in orthopedic patients. 2013/5; 5: 1046-1058
- Mitchell,D., Friedman,R.J., Baker,J.D.,III, Cooke,J.E., Darcy,M.D., Miller,M.C.,III Prevention of thromboembolic disease following total knee arthroplasty. Epidural versus general anesthesia. Clin Orthop Relat Res 1991/8; 269: 109-112
- Nielsen,P.T., Jorgensen,L.N., Albrecht-Beste,E., Leffers,A.M., Rasmussen,L.S. Lower thrombosis risk with epidural blockade in knee arthroplasty. Acta Orthop Scand. 1990/2; 1: 29-31
- Nielson,W.R., Gelb,A.W., Casey,J.E., Penny,F.J., Merchant,R.N., Manninen,P.H. Long-term cognitive and social sequelae of general versus regional anesthesia during arthroplasty in the elderly. 1990/12; 6: 1103-1109
- Sharrock,N.E., Haas,S.B., Hargett,M.J., Urquhart,B., Insall,J.N., Scuderi,G. Effects of epidural anesthesia on the incidence of deep-vein thrombosis after total knee arthroplasty. J Bone Joint Surg Am 1991/4; 4: 502-506
- Stundner,O., Chiu,Y.L., Sun,X., Mazumdar,M., Fleischut,P., Poultsides,L., Gerner,P., Fritsch,G., Memtsoudis,S.G. Comparative perioperative outcomes associated with neuraxial versus general anesthesia for simultaneous bilateral total knee arthroplasty. Reg Anesth.Pain Med 2012/11; 6: 638-644
- Williams-Russo,P., Sharrock,N.E., Haas,S.B., Insall,J., Windsor,R.E., Laskin,R.S., Ranawat,C.S., Go,G., Ganz,S.B. Randomized trial of epidural versus general anesthesia: outcomes after primary total knee replacement. Clin Orthop Relat Res 1996/10; 331: 199-208
- Williams-Russo,P., Sharrock,N.E., Mattis,S., Szatrowski,T.P., Charlson,M.E. Cognitive effects after epidural vs general anesthesia in older adults. A randomized trial. 1995/7/5; 1: 44-50