Regional forms of anesthesia — spinal or epidural (neuraxial)
anesthesia and peripheral nerve blocks, or PNB — which numb only the
area of the body that requires surgery, provide better pain control
and lead to faster rehabilitation and fewer complications than
general anesthesia, research shows. But some surgeons avoid using
them due to concerns that regional anesthesia may cause motor
weakness, making patients more likely to fall when they are walking
in the first days after knee replacement surgery.
"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, M.D., Ph.D., lead author of the article and professor of
anesthesiology and public health and director of critical care
services at the Hospital for Special Surgery, New York, N.Y. "This
work suggests that fear of in-hospital falls is not a reason to
avoid regional anesthesia for orthopedic surgery."
Researchers analyzed the types of anesthesia used in 191,570 knee
replacement surgeries in the Premier Perspective database: 76.2
percent of patients had general anesthesia, 10.9 percent had spinal
or epidural anesthesia, and 12.9 percent had a combination of
neuraxial and general anesthesia. In addition, 12.1 percent of all
patients had peripheral nerve blocks. Researchers then analyzed the
type of anesthesia used for those who suffered from an inpatient
fall, in other words, in the hospital. Of patients who had general
anesthesia, 1.62 percent fell, compared with 1.3 percent of those
who had neuraxial anesthesia and 1.5 percent who had general and
neuraxial anesthesia. Patients who also received a peripheral nerve
block had a fall rate of 1.58 percent.
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When patients fall during recovery, they are more likely to have
worse outcomes, including more heart and lung problems and higher
rates of death within 30 days of surgery. Spinal or epidural
anesthesia and peripheral nerve blocks are used far less often than
general anesthesia because of concern that regional forms of
anesthesia, particularly peripheral nerve blocks, may increase
muscle weakness and make patients more prone to falls. However,
there has never been a large study based on real-world practices to
determine if that is true.
"In this study using data from a wide range of hospital settings,
we found this concern seems unfounded, especially because hospitals
and physicians performing these procedures use fall-prevention
programs and are able to reduce the impact of other factors shown to
increase fall risk, such as higher narcotic use," said Dr.
[Text from file received from the
American Society of
The American Society of Anesthesiologists, founded in 1905, is an
educational, research and scientific society with more than 52,000
members, organized to raise and maintain the standards of the
medical practice of anesthesiology. The society is committed to
ensuring physician anesthesiologists evaluate and supervise the
medical care of patients before, during and after surgery to provide
the highest quality and safest care every patient deserves.
For more information on the field of anesthesiology, visit the
American Society of Anesthesiologists online at asahq.org. To learn
more about the role physician anesthesiologists play in ensuring
patient safety, visit
asahq.org/WhenSecondsCount. To join the social conversation,
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