General anesthesia linked to more falls after knee replacement

General anesthesia may not be necessary for many people undergoing knee-replacement surgery, according to a study in the journal Anesthesiology. It found that using more localized anesthetics did not increase the likelihood that patients would fall when using their new knees for the first time in the days following surgery.

There have been concerns that regional forms of anesthesia—which numb only the nerves in a specific part of the body—leave the leg muscles weak and the patient prone to falling down, the authors wrote. So general anesthesia has been used instead, even though regional anesthesias offer better pain control, quicker rehabilitation of the joint and fewer complications.

“We found that not only do these types of anesthesia not increase the risk of falls, but also spinal or epidural anesthesia may even decrease the risk compared to general anesthesia,” said Stavros G. Memtsoudis, MD, PhD, the study’s lead author.

“This work suggests that fear of in-hospital falls is not a reason to avoid regional anesthesia for orthopedic surgery.”

The knee is the most commonly replaced joint, according to the Arthritis Foundation, probably because it is one of the joints most commonly affected by osteoarthritis. Falls during recovery from knee replacement procedures are associated with a higher risk for heart and lung problems and even higher rates of death within 30 days of surgery, according to the study.

About the study

Researchers analyzed the types of anesthesia used in 191,570 knee replacement surgeries in hundreds of hospitals. In all:

  • About 76 percent of patients had general anesthesia, of whom 1.62 percent fell.
  • About 13 percent of patients had a combination of neuraxial (a type of regional anesthesia) and general anesthesia, and 1.5 percent of these people fell.
  • About 12 percent of patients had a peripheral nerve block (also a type of regional anesthesia), of whom 1.58 percent fell.
  • About 11 percent had neuraxial anesthesia alone, of whom 1.3 percent fell.

Based on these findings, surgeons do not need to avoid using regional anesthesia, especially where effective fall-prevention programs are in place, noted Dr. Memtsoudis.

The take-home message
If you’re having knee-replacement surgery, talk with your surgeon about the type of anesthesia planned for your procedure. Also ask him or her how you can reduce your risk of falls during recovery.

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