Limited evidence for anesthesia and analgesia for outpatient primary knee and hip arthroplasty: A scoping review.
Review
Overview
abstract
INTRODUCTION: The prevalence of outpatient lower extremity arthroplasty is growing. This review was conducted to summarize literature for anesthesia and analgesia in this population. In this scoping review, we assess the evidence regarding the use of spinal anesthesia, periarticular and/or local infiltration analgesia, and peripheral nerve blocks for knee and hip arthroplasty with a focus on patient centered outcomes to identify knowledge gaps in practice that may influence future research. METHODS: PICO (population, intervention, comparison, outcome) questions were engineered to address the use of spinal anesthesia, periarticular injection, and peripheral nerve blocks on time to discharge, time to first ambulation, and mean/median pain scores in the first 24 h after surgery. A standardized systematic approach was used in the literature review. The National Library of Medicine's MEDLINE, Embase, and Cochrane (Cochrane Central Register of Controlled Trials and Database of Systematic Reviews) databases were queried up to August 2024. RESULTS: The literature search yielded 5905 studies, 3552 abstracts were screened, 549 full texts were reviewed, and 277 articles were included in the scoping review; only 3 studies assessed outcomes in the outpatient setting. Spinal anesthesia may be associated with decreased length of stay but data is conflicting. The use of surgeon periarticular and local infiltration is supported in both knee and hip arthroplasty. For knee arthroplasty, peripheral nerve blocks may decrease pain even in the presence of periarticular infiltration. Time to discharge and time to first ambulation were not well studied in the literature. CONCLUSION: Overall, while evidence exists to support the use of spinal anesthesia, periarticular infiltration, and/or peripheral nerve blocks for knee and hip arthroplasty, it is primarily focused on inpatient rather than ambulatory populations. Our review presents the current literature and emphasizes the need for research on the potential impact of these techniques on patient-centered outcomes in an outpatient arthroplasty setting. LEVEL OF EVIDENCE: III.
