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SURVEY OF ANAESTHESIA PRACTICES FOR KNEE REPLACEMENT SURGERIES AMONGST CONSULTANT ANAESTHETISTS IN A TERTIARY REFERRAL ORTHOPAEDIC CENTRE IN UK
ESRA Academy. Galitzine S. Sep 8, 2016; 138465
Topic: Knee Surgery
Dr. Svetlana Galitzine
Dr. Svetlana Galitzine

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Abstract
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Background and Aims:

In our centre approximately 1000 unilateral and total knee replacements (UKR, TKR) are performed yearly which constitutes 10% of all orthopaedic surgeries.

Recent research shows positive impact of central neuraxial anaesthesia and motor-sparing peripheral nerve blocks (MS PNBs) on patient outcomes.

Therefore we set out to analyse anaesthetic practices in our centre.

Methods:

35 consultants with regular orthopaedic commitments were invited to complete an anonymous survey stating three preferred choices for KRs. 

Results:

25/35 (71%) respondents stated:
• For primary TKR 60.9% preferred GA + femoral PNB + high volume local infiltration analgesia ((LA “cocktail”) and 34.8% chose spinal anaesthesia (SA) without opiates+/-sedation + LA ‘cocktail’.
GA + MS PNB and GA + LA “cocktail” were preferred by 21.7% (Table1).
• For revision TKR, GA + epidural (47.8%) or GA + femoral and sciatic PNBs (43.5%) were the preferred techniques (Table2).
• For UKR, preferred options were: SA without opiates+/-sedation + LA “cocktail” (52.2%) and GA + femoral PNB + LA “cocktail” (47.8%).




Conclusions:

Our survey showed diverse practice for KRs, with the only clear preference being GA + femoral PNB + LA ‘cocktail’ for primary TKR. 
This diversity can be explained by various factors: anaesthetists’, patients’ and surgeons’ preferences, recent research and local guidelines.
 Enlightened with our results we plan to develop sustainable local guidelines for TKR anaesthesia as part of multimodal pathway, to benefit patients’ outcomes.

References: 
1. Memtsoudis S et al. Perioperative comparative effectiveness of anesthetic technique in orthopaedic patients. Anesthesiology 2013; 118: 1046-1058.

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