Peripheral Nerve Block Versus Spinal Anesthesia for Total Knee Replacement in Elderly Patients

Spinal anesthesia and peripheral nerve block anesthesia are used in total knee replacement. The aim of the study was to examine whether peripheral nerve block anesthesia would provide a more stable hemodynamic profile and analgesic effect in elderly patients undergoing total knee replacement, as compared to spinal anesthesia. This is a single-center case-control trial, with patients from our prospectively followed registry. The patients were divided into two groups, those with peripheral nerve block anesthesia and spinal anesthesia. Propensity score analysis was performed in 1:1 ratio. The primary outcome was analgesia with total analgesic effect and the secondary outcome was intraoperative hemodynamic status. The patients in peripheral nerve block anesthesia group had a longer length of analgesia (606.19±219.35 vs 359.48±106.82, P<0.01) and pain scores during 24h and 48h after the surgery were lower in the same group of patients (3.21±1.74 vs 5.02±2.23, P=0.037; 3.03±1.57 vs 5.67±2.51, P=0.028). Spinal anesthesia group had a larger number of patients with significant hypotension (3.84% vs 15.38%, P=0.01), as well as a larger number of patients who received vasopressors (0% vs 9.61%, P<0.01). Both anesthesia methods demonstrated sufficient analgesic efficacy in total knee replacement, although there was less pain severity and longer analgesic effect of peripheral nerve block anesthesia in patients who were 60 years old or older. Spinal anesthesia showed a significantly higher degree of hypotension than in those patients receivingperipheral nerve block anesthesia.