Two articles in this months Journal of Arthroplasty looked at the benefits of spinal versus general anesthesia when undergoing total joint replacement. The first by Turcotte et al, demonstrated that with rapid recovery protocols, spinal anesthesia led to shorter length of hospital stay, less blood loss, lower complication rates and fewer postoperative emergency room visits. The second by Paziuk et al, also showed a lower complication rate and superior outcomes for patients undergoing spinal versus general anesthesia. The mechanism for this benefit may relate to the effect of spinal anesthesia in reducing activation of the sympathetic nervous system and reducing the surgical stress response which leads to inflammation.
Our AVATAR program uses spinal anesthesia for all patients unless there is a contraindication. These can include previous spine surgery, severe spine arthritis or use of blood thinner in close proximity to the procedure. We use a short-acting spinal with sedation that allows patients to sleep comfortably through the surgery without having to be placed under a deep general anesthesia. This allows patients to awaken quickly after surgery, and it eliminates the side of effects of general anesthesia which can include nausea, somnolence, and disorientation. With our AVATAR recovery, patients can mobilize within an hour of surgery, and this by itself has benefits including improved blood flow, improved pulmonary function and improved bowel function. This protocol along with out use of long-acting local anesthetics around the joint, allows more than half of our patients to recovery in the comfort of their own home the same day as their surgery.
To read about the benefits of same-day joint replacement and the more about our AVATAR program, see our other blog posts on these topics.