Abstract

There is a crucial need to understand the advantages and disadvantages of comparing two common anesthesia types, general and spinal anesthesia, to make informed perioperative decisions regarding total knee arthroplasty (TKA). This systematic review aimed to examine all relevant studies published to date that compare general vs. spinal anesthesia for TKA in the perioperative period, focusing specifically on the incidence of thromboembolic events and recovery time. A total of 13 studies that reported on more than 320,000 arthroplasty surgeries were identified. The overall findings from these studies indicated that spinal anesthesia was associated with improved outcomes compared to general anesthesia in relation to thromboembolic events, as spinal anesthesia was associated with significantly lower odds of developing deep vein thrombosis (odds ratio = 1.9 - 3.1) when compared to general anesthesia, as well as significantly lower levels of postoperative opioid consumption and pain, and shorter length of stay (by approximately half a day). SA was also associated with fewer complications, such as low rates of altered mental status, decreased ICU admissions, and fewer 90-day readmissions. This review of the systematic literature provided strong evidence that SA had better clinical outcomes than GA in TKA procedures. SA reduced the chance of developing a thromboembolic event, leads to quicker recovery with less dependence on opioids, shorter hospitalization, and lower rates of major systemic complications. These data lend considerable support to the use of SA as part of a comprehensive enhanced recovery program for all patients undergoing TKA.

Key words: Total knee arthroplasty, general anesthesia, spinal anesthesia, postoperative recovery, length of stay, systematic review.