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Incidence and related factors for intraoperative failed spinal anaesthesia for lower limb arthroplasty
Author(s) -
Aasvang E. K.,
Laursen M. B.,
Madsen J.,
Krøigaard M.,
Solgaard S.,
KjærsgaardAndersen P.,
Mandøe H.,
Hansen T. B.,
Nielsen J. U.,
Krarup N.,
Skøtt A. E.,
Kehlet H.
Publication year - 2018
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/aas.13118
Subject(s) - medicine , anesthesia , perioperative , general anaesthesia , spinal anesthesia , incidence (geometry) , bupivacaine , airway , airway management , surgery , prospective cohort study , arthroplasty , physics , optics
Background Spinal anaesthesia is the preferred choice for total hip‐ and knee arthroplasty (THA/TKA), due to the claimed superior outcome profile, relative simple technique and without the need for advanced airway support. However, choosing and informing about spinal anaesthesia should also include the risk for intraoperative failed spinal anaesthesia with associated pain, discomfort and suboptimal settings for airway management. Small‐scale studies suggest incidences from 1 to 17%; however, no multi‐institutional large data exists on failed spinal incidence and related factors during THA/TKA, hindering evidence‐based information and potential anaesthesia stratification. Methods In a sub‐analysis, data from a prospective study on spinal anaesthesia for THA/TKA were examined for incidence of intraoperative conversion to general anaesthesia. Potential perioperative factors (age, gender, American Society of Anaesthesiologist (ASA) score, height, weight, BMI, procedure, bupivacaine dosage and duration of time from spinal administration until end of surgery) were analysed with logistic regression for relation to failed spinal anaesthesia. Results In all, 1451 patients were included for analysis, whereof 57 (3.9%) had failed spinal anaesthesia. Spinal failure patients were significantly younger (61 vs. 67 years, P = 0.003), and operation time longer in the failed spinal group vs no‐failure, respectively (133 vs. 89 min, P < 0.001). No significant differences were found with regard to bupivacaine volume, gender, ASA‐score, height, weight, BMI or THA vs. TKA. Conclusion Failed spinal anaesthesia for THA and TKA is a relatively frequent occurrence and identification of risk patients is not feasible. These results should be considered when choosing anaesthesia and included in the information to patients.