• S M Weinstein, L R Baaklini, J Liu, L Poultsides, C Cozowicz, J Poeran, J N Saleh, and S G Memtsoudis.
• Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, NY, USA.
• Br J Anaesth. 2018 Oct 1; 121 (4): 842-849.

BackgroundNeuraxial anaesthesia is frequently used for lower limb arthroplasty but it is unclear whether benefits vary among patients receiving different subtypes of neuraxial anaesthesia. We evaluated whether differences in risk for adverse postoperative outcomes exist between patients receiving combined spinal and epidural (CSE), epidural, or spinal anaesthesia.MethodsIn this retrospective cohort study, we identified 40 852 patients who underwent total hip and knee arthroplasty (THA and TKA) procedures under neuraxial anaesthesia (34 301 CSE, 2464 epidural, 4087 spinal) between 2005 and 2014 at a single institution. We used multivariable logistic regression to evaluate the following outcomes: cardiac, pulmonary, gastrointestinal, renal/genitourinary, and thromboembolic complications, and prolonged length of stay.ResultsCompared with CSE, spinal anaesthesia was associated with reduced adjusted odds for cardiac [odds ratio (OR), 0.68; 95% confidence interval (CI), 0.52-0.89], pulmonary (OR: 0.51; 95% CI: 0.38-0.68), gastrointestinal (OR: 0.50; 95% CI: 0.32-0.78), and thromboembolic complications (OR: 0.40; 95% CI: 0.23-0.73), and prolonged length of stay (OR: 0.72; 95% CI: 0.66-0.80). Patients who received epidural anaesthesia did not have significantly different odds for any outcomes compared with CSE patients.ConclusionsWe identified clear differences in risk for certain postoperative events by subtype of neuraxial anaesthesia, suggesting that spinal anaesthesia is associated with the most favourable outcomes profile.Copyright © 2018 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.

This article appears in the collection: Regional blocks.

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