Total intravenous anaesthesia versus subarachnoid block in unilateral total knee arthroplasty: A comparison of recovery profile and time to readiness for discharge

The ideal anaesthetic technique for total knee arthroplasty(TKA) remains controversial with previous studies showing varied results. Though the superiority of neuraxial anaesthesia over general anaesthesia in terms of postoperative recovery, morbidity and mortality has been demonstrated in several earlier studies, recent studies evaluating modern general anaesthetic techniques like target controlled infusion have shown faster and better recovery with GA, especially when used in conjunction with multi-modal analgesia and accelerated rehabilitative regimens. While neuraxial blockade is largely considered safe, it is not without risks – it is invasive and although rare, does have the potential for spinal haematoma, infection, abscess, and nerve damage. Neuraxial blockade has also been reported to be associated with adverse cardiovascular outcomes in patients who are already at high risk for increased cardiovascular morbidity. Patients’ preference for general anaesthesia when compared to regional techniques has been shown in a few studies. A systematic review by Macfarlane et al evaluating contemporary studies comparing regional and general anaesthesia failed to demonstrate clear cut benefits of neuraxial anaesthesia over general anaesthesia for the intraoperative management of TKA.

Thus, there is a lack of consensus regarding the best method of anaesthesia for patients undergoing TKA and further studies are required to investigate the different anaesthetic techniques, including total intravenous anaesthesia, for patients undergoing TKA. This study was initiated to compare the time to readiness for discharge and the postoperative recovery profile after total intravenous general anaesthesia or subarachnoid block for unilateral total knee arthroplasty.