Aim: Supine lateral bending radiographs are the standard methods of evaluating curve flexibility before surgery in idiopathic scoliosis. Supine traction radiographs have also been used at the authors’ institution in addition to the supine lateral bending radiographs before surgery, believing that it is usually more helpful to analyze the response of the main and compensatory curves to corrective forces. The purpose of this prospective study was to use and evaluate the results of traction radiographs taken before general anesthesia (BGA) and under general anesthesia (UGA). Material and Method: 25 patients required surgical treatment with idiopathic scoliosis were evaluated prospectively. Thirteen were female. The average age was 12.87 years. We designed a new electronic traction table in order to take the longitudinal traction and three-points lateral pressure radiographs. We situated the patient on the table and measured the patient’s weight. Then we made a longitudinal and lateral traction while asking the possible neurologic symptoms. If there was not any symptom we stopped at the seventy percent of the patient’s weight for the longitudinal and at the fifty percent for the lateral pressure. These radiographs had been taken before and under general anesthesia (UGA). The influence of the traction radiographies on the decision for surgery and its correlation with postoperative result was examined. Results: Longitudinal traction radiographs taken consciously provided the best amount of flexibility, with no significant difference from traction with the patient UGA (p = 0.17) but with significant difference from bending radiographs (p < 0.002). No significant difference was demonstrated between the traction radiographies taken before and under general anesthesia and postoperative correction (P = 0.14). Conclusion: The curve flexibility in supine traction films taken with the patient BGA was nearly equal to the curve flexibility in supine traction films taken with the patient UGA in all patients and all types of curves. Thus, there is no need to obtain a normal supine traction film for flexibility analysis under general anesthesia. By this way; the surgeons will be able to give the patient a definitive plan before surgery because the decision can be finalized after seeing the traction radiographs with the patient before the general anesthesia and operation time will be shorter

Background: Traditionally, lumbar discectomy is performed under general anaesthesia because of ability to perform operations of long duration in prone position with a secure airway. Some recent reports suggest better outcomes with regional anaesthesia. Aim: The aim of this study was to compare the intra-operative and short-term post-operative outcome variables in patients undergoing primary single-level lumbar discectomy with epidural and general anaesthesia. Methods: This was a prospective randomized trial involving sixty patients over a two-year period in a tertiary hospital in India. Patients were allocated into two groups: Group A (n=30) patients received general anaesthesia and Group B (n=30) patients received epidural anaesthesia. Baseline and intra-operative haemodynamic parameters, surgical duration, surgical onset time, intra-operative blood loss, cost incurred by patient, nausea and vomiting and post-operative pain score were also recorded. Results: The groups were comparable for demographic data and baseline hemodynamic observations. Patients in the epidural anaesthesia group had significantly lower blood loss (p< 0.001), lower peak pain scores (p< 0.001), lesser surgical time (p< 0.001),and significantly reduced post-operative nausea and vomiting (p< 0.01) as compared to the general anaesthesia group. The cost incurred for epidural anaesthesia was two third of that incurred in general anaesthesia (p< 0.001). Epidural group had significantly more surgical onset time (p< 0.001). Conclusion: Lumbar discectomy can be safely performed using epidural anaesthesia. The intra-operative blood loss, surgical duration, cost incurred by the patient, postoperative nausea, vomiting and pain are significantly reduced in patients receiving epidural anaesthesia, thereby leading to a significantly higher patient satisfaction. In the present climate of NHS, where any initiative to cut down the cost of resources consumed is welcomed as long as the patient safety is not compromised, epidural anaesthetic may provide an effective alternative to general anaesthetic for lumbar discectomy

Purpose: To determine if it is necessary to assess instability of the chronic anterior cruciate ligament deficient knee under general anaesthesia. Materials and methods: 27 anterior cruciate ligament deficient knees in 27 patients were evaluated both subjectively using the Lachmanns and pivot shift test and objectively using the KT 1000 arthometer. This was done in the preoperative clinic (without the patient anaesthetised) and subsequently in the anaesthetic room with the patient anaesthetised (under general anaesthesia) prior to anterior cruciate ligament reconstruction. The data was prospectively collected. Only data on 21 knees was available for analysis. There were 20 females and one male with an average age of 29 years. Results: There was no statistical significant difference (using students T test) between the data collected using the KT 1000 arthometer with and without the patient anaesthetised. A significant difference was noted both for the Lachmanns (p< 0.01) and pivot shift test (p< 0.001) between the results obtained with and without anaesthesia. This however did not change the management. Conclusion: Assessing the chronic anterior cruciate ligament deficient knee using the KT 1000 arthrometer, Lachmann and pivot shift test under general anaesthesia is not necessary if these assessments have been carried out in clinic

The purpose of this study is to determine whether the mode of anaesthesia chosen for patients undergoing lumbar microdiscectomy surgery has any significant influence on the immediate outcome in terms of safety, efficacy or patient satisfaction. This prospective randomised study compared safety, efficacy and satisfaction levels in patients having spinal versus general anaesthesia for single level lumbar micro-discectomy. Fifty consecutive healthy and cooperative patients were recruited and prospectively randomised into two equal groups; half the patients received a spinal anaesthetic (SA), the remainder a general anaesthetic (GA). Each specific mode of anaesthesia was standardised. Comprehensive postoperative evaluation concentrated on documenting any complications specific to the particular mode of anaesthesia, recording the pace at which the various milestones of physiological and functional recovery were reached, and the level of patient satisfaction with the type of anaesthesia used. The results showed no serious complication specific to their particular mode of anaesthesia in either group. Thirteen out of 25 SA patients required temporary urinary catheterisation (9 males, 4 females) while among the GA group 4 patients required urinary catheterisation (4 males and 1 female). Post-operative pain perception was significantly lower in the SA group. The SA patients achieved the milestones of physiological and functional recovery more rapidly. While both groups were satisfied with their procedure, the level of satisfaction was significantly higher in the SA group. In conclusion, lumbar spinal microdiscectomy can be carried out with equal safety, employing either spinal or general anaesthesia. While they require more temporary urinary catheterisation associated with the previous use of intrathecal morphine, patients undergoing SA suffer less pain in association with their procedure and recover more rapidly. Blinded to an extent by not having experienced the alternative, both groups appeared satisfied with their anaesthetic. However, the level of satisfaction was significantly higher in the SA group

Purpose. The purposes of this study are as follows; 1) to compare postoperative blood loss between general anesthesia(GA) and spinal anesthesia(SA) and 2) to analyze the affecting factors of postoperative blood loss through the subgroup analysis. METHODS. A retrospective analysis was made on the clinical data of 122 patients with osteoarthritis undergoing primary TKA between January 2012 and December 2013. According to different anesthetic method, the patients were divided into the General Anesthesia group (73 cases) and the Spinal Anesthesia group (49 cases). Each group was divided subgroup as age, BMI, Preoperative blood pressure, Surgery time, Torniquet time, INR. The total blood loss, Post Operation 1 day blood loss, hidden blood loss, and the percentage of hidden blood loss were compared between 2 groups. For the analysis of postoperative blood loss, each group was compared postoperative blood loss using hemovac drainage per day and total blood loss. In preoperative blood pressure, Higher than 140 mmHg in systolic blood pressure and higher than 90 mmHg in diastolic blood pressure were employed as a cut-off value to group the well-controlled hypertension group(n=42) and uncontrolled hypertension group(n=29). RESULTS. One day after the surgery blood loss(p=0.322) and total blood loss(p=0.560) showed no significant differences between two group. But in the uncontrolled hypertension group showed a large amount of bleeding one day after the surgery(p=0.003) and total blood loss(p=0.004) in the spinal anesthesia. CONCLUSION. It seems that, general anesthesia is effective method to reduce postoperative blood loss. Preoperative blood pressure control is one of the important affecting factor of postoperative blood loss

Introduction and Aims: Patients with proximal femoral fracture are frail with multiple comorbidities and the anaesthesia often proves a greater challenge than the surgery itself. The aim was firstly, to determine whether general, compared to regional anaesthesia, caused a decrease in the mental test score (MTS) of patients with proximal femoral fracture. Secondly, what effect does a reduced MTS have on the general outcome for such patients. Method: A prospective observational study was conducted in a regional trauma centre. One hundred and seventy consecutive patients over 60 years of age (mean age 82.6 years) were included. Age under 60 years was the only exclusion criterion. Pre- and post-operative (day five) MTS values were recorded by the same clinician. Results: The MTS decreased by 2.43 points when general anaesthesia was administered compared to 1.5 for regional anaesthesia (p< 0.01 Mann Whitney). Lower post-operative MTS values were associated with increased mortality (p< 0.001 Mann Whitney). The greater the decrease in MTS (between pre- and postoperative values) the more likely it is that the patient will be institutionalised (p< 0.01 Mann Whitney). Conclusion: Reduced mental function as observed after general anaesthesia is associated with increased mortality and institutionalisation. Thus the increased use of regional anaesthesia is advocated

The purpose of this study is to determine whether the mode of anaesthesia chosen for patients undergoing lumbar microdiscectomy surgery has any significant influence on the immediate outcome in terms of safety, efficacy or patient satisfaction. This prospective randomised study compared safety, efficacy and satisfaction levels in patients having spinal versus general anaesthesia for single level lumbar microdiscectomy. Fifty consecutive healthy and cooperative patients were recruited and prospectively randomised into two equal groups; half the patients received a spinal anaesthetic (SA), the remainder a general anaesthetic (GA). Each specific mode of anaesthesia was standardised. Comprehensive post-operative evaluation concentrated on documenting any complications specific to the particular mode of anaesthesia, recording the pace at which the various milestones of physiological and functional recovery were reached, and the level of patient satisfaction with the type of anaesthesia used. The results showed no serious complication specific to their particular mode of anaesthesia in either group. Thirteen out of 25 SA patients required temporary urinary catheterisation (9 males, 4 females) while among the GA group 4 patients required urinary catheterisation (4 males and 1 female). Post-operative pain perception was significantly lower in the SA group. The SA patients achieved the milestones of physiological and functional recovery more rapidly. While both groups were satisfied with their procedure, the level of satisfaction was significantly higher in the SA group. In conclusion, lumbar spinal microdiscectomy can be carried out with equal safety, employing either spinal or general anaesthesia. While they require more temporary urinary catheterisation associated with the previous use of intrathecal morphine, patients undergoing SA suffer less pain in association with their procedure and recover more rapidly. Blinded to an extent by not having experienced the alternative, both groups appeared satisfied with their anaesthetic. However, the level of satisfaction was significantly higher in the SA group

Purpose. The pros and cons of general anesthesia versus spinal anesthesia in total hip arthroplasty has been a long debated topic. The purpose of this study was to compare the surgical times, blood loss and transfusion requirements between anesthetic types in patients undergoing primary total hip arthroplasty. Method. A consecutive series of 1600 THA procedures with complete preoperative and postoperative data were evaluated. Twenty eight percent of procedures were performed with a general anesthetic (GA), 67% with a spinal anesthetic (SP) and 5% with a combination of the two. Outcomes were compared and tested for significance using the Independent Samples Kruskal Wallis or Pearson Chi-Square analysis. Results. Comparing GA and SP respectively, there was a statistically significant difference in patient age between the groups (age 63.73 14.5 vs 66.6 12.8, p<0.05), but not in ASA scores and distribution, or preoperative hemoglobin levels (131.74 32.5 vs 133.21 28.9). There was a statistically significant difference in length of time proceeding surgical procedure favoring Generals (SP: 35 mins (10 72) vs GA: 30 mins (8 65), p<0.05), however overall time in room was longer in Generals (GA: 132.83 29.0 vs SP: 127.15 22.5). There was a statistically significant difference in discharge hemoglobin favoring Spinals (SP: 97.9 14.2 vs GA: 94.9 16.4, p<0.05), lower transfusion rates (SP: 8.4% vs GA: 14.0%, p<0.05) and shorter length of stay (SP: 4.9 days vs GA: 5.3 days, p<0.05). The patients receiving a combination of anesthetic had a significantly greater length of time prior to proceeding the surgical procedure (43 mins (20 145)) and overall time in room (142.85 27.2) compared to both GA and SP, however were similar in all other outcomes. Conclusion. In this consecutive series of patients undergoing general anesthesia, spinal anesthesia and a combination for total hip arthroplasty, the general anesthesia cohort demonstrated advantages in statistically significantly shorter time proceeding the surgical procedure, however the overall procedure time was significantly longer. The spinal group had less blood loss and lower transfusion rates and the combination group had statistically longer procedure times compared to both GA and SP

The aim was to compare the efficacy and outcomes of reduction of closed forearm fractures in a paediatric population using Ketamine in the Emergency Department (ED) setting versus reduction under general anaesthesia (GA) in the operating theatre (OT). A prospective audit of children presenting to our institution with closed fractures of the radius and/or ulna was conducted. Patients presenting to ED were offered manipulation under GA or Ketamine, and then grouped accordingly. Children were followed up until full range of motion had recovered. Outcomes measured at follow up were 1) need for remanipulation, 2) position at union, 3) total hospital stay and 4) functional outcome. Forearm fractures account for 22% of acute paediatric orthopaedic admissions to our institution. 70% require manipulation and splintage. 221 forearm fractures required manipulation during the study period. 90 patients (41%) were manipulated under Ketamine in the ED, 131 patients (59%) were manipulated in the OT. There was no significant difference in mean angulation of fractures treated by either method (p=0.20). There was no significant difference between the two methods with respect to rates of remanipulation (p=0.73) or poor position at union (p=0.55). There was a significantly shorter hospital stay for those treated in the ED. Treatment of paediatric forearm fractures in the ED under Ketamine sedation offers an effective alternative for selected fractures. It also offers considerable financial savings and is less of a drain on valuable theatre and staff resources

Objective. Compare the safety and effectiveness of different anesthetic technique used in the simultaneous bilateral total knee arthroplasty (BTKA). Methods. Medical records of patients admitted for simultaneous BTKA between January 1, 2014 and September 1, 2015 in ‘The safety and effect evaluation of joint arthroplasty’ database were analyzed. The general anesthesia (GA) and neuraxial anesthesia (NA) group were identified. Patient preoperative characteristics were compared. Perioperative outcomes measured included operating time, blood loss, transfusion requirement, length of hospitalization, joint range of motion at discharge, complications. Results. A total of 1191 patients from 25 hospitals were identified, 802 (67.34%) patients were performed under GA, and 389 (32.66%) patients were performed under NA. Patients characteristics were similar between the two groups (P<0.05), except that patients operated under NA were older than those under GA (P<0.01). NA was associated with significantly less overall complications and infection complications, and reduction of length of hospitalization (P<0.05). But operating time, blood loss, transfusion requirement, joint range of motion at discharge were similar between the two groups (P<0.05). Conclusion. Patients who underwent simultaneous BTKA under NA had shorter hospitalization, lower overall complication and infection complication rate than GA. And, it could have an important medical and economic impact on health-care practice

Aims

Although periarticular injection plays an important role in multimodal pain management following total hip arthroplasty (THA), there is no consensus on the optimal composition of the injection. In particular, it is not clear whether the addition of a corticosteroid improves the pain relief achieved nor whether it is associated with more complications than are observed without corticosteroid. The aim of this study was to quantify the safety and effectiveness of cortocosteroid use in periarticular injection during THA.

Introduction

Methoxyflurane can cause hepatotoxicity and nephrotoxicity at anaesthetic doses but has excellent analgesic properties and no nephrotoxic effects in patients without preexisting disease. Approved for use in the UK and Ireland in 2015, it is currently being used in emergency departments for analgesia during fracture reduction. During the Covid emergency, with theatre access severely restricted and many patients unwilling to use inhaled Nitrous oxide, Penthrox had the potential to provide adequate pain relief to aid frame removals and minor procedures in the clinic.

Aims. We hypothesized that the wide-awake local anaesthesia with no tourniquet (WALANT) technique is cost-effective, easy to use, safe, and reproducible, with a low learning curve towards mastery, having a high patient satisfaction rate. Furthermore, WALANT would be a suitable alternative for the austere and developing nation environments where lack of funds and resources are a common issue. Methods. This was a randomized control trial of 169 patients who required surgery for closed isolated distal radius fractures. The study was performed between March 2016 and April 2019 at a public sector level 1 trauma centre. General anaesthesia was used in 56 patients, Bier’s block in 58 patients, and WALANT in 55 patients. Data were collected on pre-, peri-, and postoperative parameters, clinical outcome, hospital costs, and patient satisfaction. One-way analysis of variance (ANOVA) was used with a p-value of 0.05 being significant. Results. Operations with WALANT proceeded sooner, and patients recovered faster, resulting in mean fewer missed working days (7.8 (SD 1.67)) compared with general anaesthesia (20.1 (SD 7.37)) or Bier’s block (14.1 (SD 7.65)) (p < 0.001). The WALANT patients did not develop complications, while the other patients did (p < 0.04). Clinical outcomes did not differ, nor did surgeon qualification affect clinical outcomes. Mean hospital costs were lower for WALANT ($428.50 (SD 77.71)) than for general anaesthesia ($630.63 (SD 114.77)) or Bier’s block ($734.00 (SD 37.54)) (p < 0.001). Patient satisfaction was also higher (p < 0.001). Conclusion. WALANT for distal radius fractures results in a faster recovery, is more cost-effective, has similar clinical outcomes, and has fewer complications than general anaesthesia or Bier's block. This makes WALANT an attractive technique in any setting, but especially in middle- and low-income countries. Cite this article: Bone Joint Res 2020;9(7):429–439

Radial head fractures are among the most common fractures around the elbow. Radial head arthroplasty is one of the surgical treatment options after complex radial head fractures. This surgery is usually done under general anaesthesia. However, there is a recent anaesthetic technique - wide awake local anaesthesia no tourniquet (WALANT) - that has proven useful in different surgical settings, such as in distal radius or olecranon fractures. It allows a good haemostatic control without the use of a tourniquet and allows the patient to actively collaborate during the surgical procedure. Furthermore, there are no side effects or complications caused by the general anaesthesia and there's an earlier patient discharge. The authors present the case of a seventy-six-year-old woman who presented to the emergency department after a fall from standing height with direct trauma to the left elbow. The radiological examination revealed a complete intra-articular comminuted fracture of the radial head (Mason III). Clinical management: The patient was submitted to surgery with radial head arthroplasty, using WALANT. The surgery was successfully completed without pain. There were no intra or immediate post-operative complications and the patient was discharged on the same day. Six weeks after surgery, the patient had almost full range of motion and was very pleased with the functional outcome, with no limitations on her activities of daily living. The use of WALANT has been expanded beyond the hand and wrist surgery. It is a safe and simple option for patients at high risk of general anaesthesia, allowing similar surgical outcomes without the intraoperative and postoperative complications of general anaesthesia and permitting an earlier hospital discharge. Furthermore, it allows the patient to actively collaborate during the surgery, providing the surgeons the opportunity to evaluate active mobility and stability, permitting final corrections before closing the incision

Orthopedic device-related infection (ODRI) preclinical models are widely used in translational research. Most models require induction of general anesthesia, which frequently results in hypothermia in rodents. This study aimed to evaluate the impact of peri anesthetic hypothermia in rodents on outcomes in preclinical orthopedic device-related infection studies. A retrospective analysis of all rodents that underwent surgery under general anesthesia to induce an ODRI model with inoculation of Staphylococcus epidermidis between 2016 and 2020 was conducted. A one-way multivariate analysis of covariance was used to determine the fixed effect of peri anesthetic hypothermia (hypothermic defined as rectal temperature <35°C) on the combined harvested tissue and implant colonies forming unit counts, and having controlled for the study groups including treatments received duration of surgery and anesthesia and study period. All animal experiments were approved by relevant ethical committee. A total of 127 rodents (102 rats and 25 mice) were enrolled in an ODRI and met the inclusion criteria. The mean lowest peri-anesthetic temperature was 35.3 ± 1.5 °C. The overall incidence of peri-anesthetic hypothermia was 41% and was less frequently reported in rats (34% in rats versus 68% in mice). Statistical analysis showed a significant effect of peri anesthetic hypothermia on the post-mortem combined colonies forming unit counts from the harvested tissue and implant(s) (p=0.01) when comparing normo- versus hypothermic rodents. Using Wilks’ Λ as a criterion to determine the contribution of independent variables to the model, peri-anesthetic hypothermia was the most significant, though still a weak predictor, of increased harvested colonies forming unit counts. Altogether, the data corroborate the concept that bacterial colonization is affected by abnormal body temperature during general anesthesia at the time of bacterial inoculation in rodents, which needs to be taken into consideration to decrease infection data variability and improve experimental reproducibility

Introduction. We designed this study to compare 30-day complications and length of hospital stay between patients undergoing total knee arthroplasty (TKA) with general anesthesia, to those undergoing TKA with spinal, epidural anesthesia, or Monitored Anesthesia Care (MAC, a combination of local anesthesia with sedation and analgesia provided by an anesthesiologist) with or without regional nerve blocks. Methods. We identified patients ≥18 years undergoing TKA between the years of 2006 and 2017 from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP). We collected patient demographics, anesthesia type, 30-day complications, length of operation and hospital stay from the database. We used multivariable regression to compare complications and length of stay (LOS) between anesthesia types, while adjusting for relevant covariables. Results. We identified 265,325 TKA patients. Of these, 91 (0.03%) underwent epidural anesthesia with a nerve block, while 1,855 (0.70%) underwent epidural anesthesia with no block, 12,800 (4.82%) underwent MAC with a block, 25,643 (9.66%) underwent MAC with no block, 13,575 (5.12%) underwent spinal anesthesia with a block, 80,803 (30.45%) underwent spinal anesthesia with no block, and 130,558 (49.21%) underwent general anesthesia. The rate of complications was not associated with the presence of a block, while the unadjusted LOS was significantly lower with the use of a block in patients treated with spinal anesthesia (2.54±2.07 vs. 2.84±2.25), epidural anesthesia (2.87±1.81 vs. 3.88± 4.67), and MAC (2.51±2.14 vs. 2.68±2.11), p<0.0001. The unadjusted rate of major complications was significantly lower in patients who underwent spinal anesthesia (2.10%), and MAC (1.91%) compared to general anesthesia (2.31%), p<0.0001. Similarly, the unadjusted rate of minor complications was significantly lower for patients treated with spinal anesthesia(1.86%) and MAC (1.78%) compared to general anesthesia (2.11%), p<0.0001. The unadjusted LOS was significantly longer in patients treated with epidural (3.83±4.58), compared to general (2.94±3.64) anesthesia, p<0.0001. In contrast, the unadjusted LOS was significantly lower for patients treated with spinal anesthesia (2.80±2.23), and MAC (2.62±2.12) compared to general anesthesia, p<0.0001. Following covariable adjustment, spinal anesthesia and MAC were associated with a 0.93 (0.87–0.98), and 0.84 (0.78–0.91), odds of major complications compared to general anesthesia. Similarly, spinal anesthesia and MAC were associated with a 0.92 (0.87–0.98) and 0.89 (0.82–0.97) odds of minor complications compared to general anesthesia. Following covariable adjustment, epidural anesthesia increased the LOS by 0.25 (0.27–0.28) days compared to general, while spinal anesthesia and MAC decreased the LOS by 0.04 (95%CI 0.05–0.04), and 0.10 (0.11–0.09) days, compared to general. In patients treated with spinal anesthesia, epidural anesthesia, and MAC, the use of a block was independently associated with a decreased LOS by 0.10 (0.12–0.90), 0.24 (0.39–0.09), and 0.07 (0.08–0.05). Conclusion. Patients who undergo TKA with spinal anesthetic, and MAC appear to have superior outcomes compared to those who undergo TKA with general anesthesia. In addition, the use of a regional nerve block appears to be independently associated with a shorter LOS in patients who undergo TKA with neuraxial (spinal and epidural) anesthetic, and MAC. For figures, tables, or references, please contact authors directly

Introduction and Objective. Wide awake local anaesthetic no tourniquet (WALANT) is being used for a wide variety of hand and wrist surgery. It has recently been used in distal radius fracture fixation. The purpose of this systematic review and meta-analysis was to assess the effectiveness of the WALANT technique in open reduction internal fixation. Materials and Methods. Pubmed, Embase, and Scopus databases were searched on 02/03/21 with the following search terms: radius, WALANT, local anesthetic, wide awake surgery. The primary outcome measure was conversion to general anaesthetic and mean intra-operative visual analogue scale (VAS) pain scores. Secondary measures were operative times, mean intraoperative blood loss, post-operative functional and radiological outcomes. Results. 110 articles were identified; eight studies were deemed eligible with 212 in the WALANT group and 247 in the comparative groups of regional anaesthesia and general Anaesthesia (GA). Two patients in the WALANT group required conversion to general anaesthesia due to anxiety rather than pain. Intra-operative VAS pain scores in the WALANT and regional anaesthetic group were 1.75 and 2.86 respectively (p<0.001). There was no statistically significant difference in Q-DASH scores, range of motion or radiological outcomes. There was a slight increase in mean blood loss in the WALANT group compared with those given a GA or regional anaesthetic with tourniquet (22.5ml vs 12.15ml, p<0.001). Conclusions. The WALANT technique is a viable option for anaesthetic when performing distal radius fracture fixation. It is well tolerated, giving similar post-operative outcomes to other anaesthetic methods. It is a potentially useful technique in a centre with an underresourced anaesthetic department or for patients who may not tolerate regional and general anaesthetic methods. Adequate patient counselling prior to the procedure should be performed with appropriate patient selection

This study was designed to compare length of hospital stay, and 30-day major and minor complications between patients undergoing total knee arthroplasty (TKA) with general anesthesia, to those undergoing TKA with spinal or epidural anesthesia with or without regional nerve blocks. Patients 18 years and older undergoing TKA between the years of 2005 and 2016 were identified from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP). Patient demographics, anesthesia type, length of operation and hospital stay, as well as 30-day major and minor complications were collected from the database. Patients with “primary anesthesia technique” codes for either spinal or epidural anesthesia along with “other anesthesia technique” codes for regional anesthesia were assumed to have been given a regional nerve block. Chi square tests, and analysis of variance were utilized to evaluate unadjusted differences in demographics and outcomes between anesthesia types. Multivariable regression was utilized to compare outcomes (length of stay and complications) between anesthesia types, while adjusting for age, American Society of Anesthesiologist (ASA) class, comorbidities, sex, steroid/immunosuppressant use, body mass index (BMI), diabetes, length of operation and smoking status. A total of 214,665 TKA patients were identified (average age 67 ± 10 years). Of these, 257 (0.12%) underwent epidural anesthesia with a nerve block (EB), while 2,318 (1.08%) underwent epidural anesthesia with no block (E), 14,468 (1.08%) underwent spinal anesthesia with a block (SB), and 85,243 (39.7%) underwent spinal anesthesia with no block (S), and 112,377 (52.4%) underwent general anesthesia (G). The unadjusted length of stay (LOS) was significantly longer in the E group (3.67 ± 5 days) compared to the G group (3.1 ± 3.9 days), while the unadjusted LOS was significantly shorter in the EB group (2.6 ± 1.2), and both SB and S groups (2.6 ± 3 and 2.9 ± 3, respectively), compared to the G group p < 0 .001. Following covariable adjustment, anesthesia type remained an independent predictor of length of stay. Compared to the G group, patients in the E group stayed 0.56 days longer (95% Confidence interval [95%CI] 0.42 – 0.71 days), while patients in the SB were discharged 0.28 days (95%CI 0.21 – 0.35 days) earlier, and those in the S group were discharged 0.06 days earlier (95%CI 0.02–0.09), (p < 0 .0001). While the unadjusted rates of major complications were not significantly different between groups, the unadjusted rates of minor complications were higher in the E, EB, and G groups compared to the S and SB groups. Following covariable adjustment, there were no differences between groups in the risk of minor complications. In conclusion, these data indicate that anesthesia type following TKA is associated with length of hospital stay, but not with 30-day complications. After adjusting for relevant covariables, patients who received epidural anesthesia without a nerve block for TKA were discharged later, while patients who received spinal anesthesia, both with and without a nerve block for TKA were discharged earlier, compared to patients who received general anesthesia for TKA

Aims: To determine whether lumbar spinal injection in conjunction with general anaesthesia decreases peri-operative blood loss and thereby transfusion rates as compared to general anaesthesia alone in patients undergoing primary hip arthroplasty. Methods: This is an observational study of 47 consecutive patients who underwent unilateral primary total hip arthroplasty. These were all performed by the same surgeon using the same approach, prosthesis and postoperative care. Group I consisted of 28 patients who had combined lumbar spinal and general anaesthesia performed by the same anaesthetist. Group II consisted of 19 patients who had general anaesthesia alone. Analysis was made of intra-operative blood pressure, post-operative haemoglobin levels using Mann-Whitney test and of transfusion rates using Fischer’s exact test. Results: Group I had a mean intra-operative mean arterial pressure of 53 (range 38–72.5) compared to 65 (range 45–94) in group II. This was a statistically significant difference (p = 0.0006). There was a mean drop in haemoglobin of 29 (range 9–53) in group I and of 40 (range 22–56) in group II. This was a statistically significant difference (p = 0.0006). 2 patients ( 7.1%) in group I required blood transfusion as compared to 8 (42.1%) in group II. Again this result was significantly different (p = 0.0086). Conclusion: Some previous studies have shown transfusion rates as high as 75 %. We recommend the use of combined lumbar spinal and general anaesthesia in primary total hip arthroplasty as it significantly reduces peri-operative blood loss and transfusion rates, in our study to only 4.1%. This may reduce the risk of infection and improve the bone cement interface in a cemented hip arthroplasty

Anesthetic peripheral nerve blocks (PNB) have been shown to be more advantageous than general anesthesia in a variety of surgical operations. In comparison to conventional methods of general anesthesia, the choice of regional localized infiltration has been shown to shorten hospital stays, decrease hospital readmissions, allow early mobilization, and reduce narcotic use. Perioperative complications of PNBs have been reported at varying rates in literature. Thus, the purpose of this study was to provide a review on the clinical evidence of PNB complications associated with foot and ankle surgeries. A systematic review of the literature was completed using PubMed search terms: “lower extremity”, “foot and ankle”, “nerve block”, and “complications”. All studies reporting minor and major complications were considered along with their acute management, treatments, and postoperative follow up timelines. The range of complications was reported for Sensory Abnormalities, Motor Deficits, Skin and systemic complications (local anesthetic systemic toxicity & intravascular injections). A designation of the scientific quality (Level I-IV) of all papers was assigned then a summary evidence grade was determined. The search strategy extracted 378 studies of which 38 studies were included after criteria review. Block complications were reported in 20 studies while 18 studies had no complications to report. The quality of evidence reviewed ranged from Level I to Level IV studies with follow up ranging from twenty four hours to one-three year timelines. The range of complications for all studies reporting sensory abnormalities was 0.53 to 45.00%, motor deficits 0.05 to 16.22% and skin and systemic complications 0.05 to 6.67%. Sensory abnormalities that persisted at last follow up occurred in six studies with incidence ranging from 0.23 to 1.57%. Two studies reported motor complications of a foot drop with an incidence of 0.05% and 0.12%. When considering only the highest quality studies (Level 1) that had complications to report, the complications rate was 10.00% to 45.00% for sensory abnormalities, 7.81 to 16.22% for motor deficits, 6.67% for skin complications and 2.50% for systemic complications. High quality studies (Level I providing Summary Grade A Evidence) reporting all complications with a range of incidence from 0 to 45%. While most of these complications were not serious and permanent, some were significant including sensory abnormalities, foot drop and CRPS. Based on this systematic review of the current literature, the authors emphasize a significant rate of complications with PNB and recommend that patients are appropriately informed prior to consenting to these procedures