Outcome After Total Knee Arthroplasty Under General or Spinal Anesthesia
Condition: Knee Osteoarthritis; Arthropathy of Knee Joint; Knee Pain Chronic; Rheumatoid Arthritis; Anesthesia
MeSH terms: Osteoarthritis; Osteoarthritis, Knee; Joint Diseases
Study type: Interventional

Summary: 
      Previous retrospective database studies suggest that total knee arthroplasty (TKA) surgery
      under spinal anesthesia has less complications than when performed under general anesthesia.
      In general, complications are rare and both anesthesia types are widely accepted. In Finland,
      total knee arthroplasty has typically been performed under spinal anesthesia.

      In a recent prospective randomized controlled study, total knee arthroplasty under general
      anesthesia resulted in less acute postoperative pain (opioid-need measured by
      patient-controlled anesthesia), less nausea, and faster hospital discharge than that
      performed under spinal anesthesia. Also the use of surgical tourniquet can affect surgical
      outcome: it may reduce bleeding and surgery time, but it may also cause weakness of thigh
      muscles and thus hinder mobilization. In a recent study, both techniques with and without
      surgical tourniquet appeared equal.

      The aims of this study are to compare total knee arthroplasty under spinal or general
      anesthesia, with or without surgical tourniquet, in relation to acute and chronic
      postoperative pain, nausea, knee function, patient reported quality of life and satisfaction
      on care, complications, length of stay, and need of surgical unit resources. This randomized
      controlled study includes 400 patients with informed consent, 18-75-years-of-age, standard
      primary total knee arthroplasty operation, American Society of Anesthesiologist (ASA)
      physical status classification I-III, body mass index under 40, and no contraindications for
      medications or treatments used.

      The hypothesis of this study are used to reassess best practices of primary total knee
      arthroplasty operation to enhance quality of care, patient outcomes and satisfaction, and
      availability of surgery due to better patient flow at surgical unit.
    


Intervention name(s): Spinal anesthesia with tourniquet; Spinal anesthesia without tourniquet; General anesthesia with tourniquet; General anesthesia without tourniquet; Oxycodone by patient-controlled analgesia (PCA)
Intervention type(s): Procedure; Procedure; Procedure; Procedure; Drug
Intervention description(s): Operation is done under spinal anesthesia and surgical tourniquet is used.; Operation is done under spinal anesthesia and without the use of surgical tourniquet.; Operation is done under general anesthesia and surgical tourniquet is used.; Operation is done under general anesthesia and without the use of surgical tourniquet.; PCA device (CADD Legacy PCA Pump, Smiths Medical, Kent, UK) is programmed to give intravenous oxycodone in doses of 0.04 mg/kg (ideal body weight). The minimum time between doses is set to 10 minutes and no more than 4 doses per hour are allowed.
Intervention MeSH terms: Oxycodone; Anesthetics
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Total knee arthroplasty; Anesthesia; Surgical tourniquet; Pain; Postoperative nausea and vomiting; Quality of life; Length of stay; Knee function; Bioelectrical impedance; Knee endoprosthesis