Comparison of Performance and Pain Intensity after Total Knee Arthroplasty Using General or Regional Anesthesia

This study aimed to compare postoperative outcomes in patients having primary total knee arthroplasty receiving general or regional anesthesia. This randomized prospective trial study was performed in Kashani Hospital (Isfahan, Iran). Sixty patients undergoing primary total knee replacement were randomized to either general anesthesia followed by postoperative intravenous patient-controlled analgesia with morphine, or combined spinal-epidural anesthesia. Pain intensity was evaluated using a verbal rating scale (VRS) at the 30th and 60th minutes in the recovery room, 6, 12, 24, and 48 hours after surgery, at discharge, and two and four weeks after the operation. Pain was also measured at discharge and two and four weeks after the operation. The amount of morphine was also determined during the first 48 postoperative hours. Range of motion was assessed according to the Knee Society Score at discharge and two and four weeks after surgery. All information was recorded in a questionnaire and analyzed by t-test and Mann-Whitney test. Median pain scores in patients who had received regional anesthesia were consistently lower at 1 (P < 0.001), 6 (P = 0.080), 12 (P = 0.003), 24 (P = 0.140), and 48 hours (P = 0.007) after the operation. Although there was a trend towards fewer complications in the mentioned group, there were no statistically significant differences between the two groups with respect to the incidence of postoperative blood loss, hemodynamic instability, pruritus, nausea, vomiting, urinary retention, or other surgical/medical complications. Patients who had been under regional anesthesia resumed meals earlier (P < 0.001) and showed a trend towards earlier ambulation and hospital discharge. Patients undergoing total knee arthroplasty with regional anesthesia enjoyed better postoperative pain relief and resumed meals earlier than those who received general anesthesia with intravenous patient-controlled analgesia. The former also showed trends towards less adverse effects and postoperative complications.