Comparison of conventional and robotic knee arthroplasty results: A retrospective observational study.

OBJECTIVE: This study aimed to determine whether a standard anesthetic protocol consisting of combined spinal epidural anesthesia (CSEA) in conjunction with controlled hypotensive anesthesia (CHA), which was used for conventional total knee arthroplasty (cTKA), could provide equally effective anesthetic conditions for robotic total knee arthroplasty (rTKA). METHODS: Data were collected from the medical records of 113 patients (median age=67 years; age range=55-84) who underwent elective unilateral cTKA (n=52) or rTKA (n=61) without a tourniquet from 2021 to 2023. The primary outcome measure was the rate of patients whose anesthetic method did not provide adequate motor and sensory block during the surgery and had to be converted to general anesthesia. The secondary outcome measure was to compare perioperative variables, including pain scores, analgesic consumption, blood loss, transfusions, and complications. RESULTS: In 6 patients (11.5%) in group rTKA, it was required to convert CSEA to general anesthesia at 160-180 minutes due to the pain at the operative knee and/or to the movement of the operative leg during surgery compared to none / zero in group cTKA (P=.008). Motor and sensory blocks terminated earlier than the total surgery time in those patients. Mean total surgery time was significantly higher in group rTKA than in group cTKA (151.25 ± 24.51 (120-240) minutes vs. 116.72 ± 4.99 (105-125) minutes, P < .001). Total surgery times tended to decrease gradually in group rTKA after the 11th case, indicating a learning curve for surgical performance. Conversion to general anesthesia was required only in 1 patient after the 11th case compared to the previous 5 patients. Mean pain scores and rescue analgesic consumption were higher in group rTKA at postoperative 0 hour and between 0 and 4 hours (P < .05) but similar at the following time points (P > .05). Blood loss, transfusion, and complication rates were similar (P > .05). Hospital discharge times were higher in group rTKA (P < .05). CONCLUSION: Although our standard CSEA protocol failed due to the regression of motor and sensory block during surgery in 11.5% of patients in rTKA, the CSEA technique combined with controlled hypotensive anesthesia provided similar anesthetic conditions in the remaining patients in group rTKA as in group cTKA. The CSEA may be considered an effective and safe anesthetic method for rTKA if interventions are applied to extend the duration of the CSEA for this novel surgical technique. LEVEL OF EVIDENCE: Level III, Therapeutic Study.

Linguistic validation of a widely used recovery score: quality of recovery-15 (QoR-15).

BACKGROUND: The quality of recovery-15 (QoR-15) is a patient reported outcome questionnaire that measures the quality of recovery after surgery and anesthesia. The QoR-15 has been validated in many languages; Turkish version of the QoR-15 has not yet been established. The aims of this study were to translate the QoR-15 questionnaire into Turkish and to perform a full psychometric evaluation of the Turkish version. METHODS: After translating the original English version of the QoR-15 scale into Turkish, the QoR-15T scale was psychometrically validated. This process included validity, reliability, responsiveness, feasibility. The QoR-15T was evaluated before the surgery and 24 h after surgery. RESULTS: A total of 210 patients completed the pre- and postoperative questionnaires, providing a completion rate of 93.75%. The correlation coefficient between QoR-15T score and VAS score was 0.644 on postoperative day 1 (p < 0.001). Inter item Cronbach's alpha was 0.863. Global test-retest concordance coefficient was 0.98 (95% CI: 0.94-1.00). DISCUSSION: The QoR-15T scale is a reliable and valid instrument for evaluating postoperative quality of recovery in Turkish speaking patients. The psychometric characteristics used to assess postoperative quality of recovery were similar to those in the English version.

Preoperative ankle block for postoperative analgesia in foot surgery.

BACKGROUND: The use of a tourniquet and patients' preference for general anesthesia (GA) limit performing ankle blocks (AB) as a sole anesthetic technique for orthopedic foot surgery. The aim of this prospective and randomized study was to test the hypothesis that administration of an AB before GA could be effective for postoperative pain relief in patients undergoing outpatient hallux valgus surgery. Primary outcome measure was mean pain score and secondary outcome measures were time to mobilization of patients, time to hospital discharge, and complications. METHODS: A total of 110 adult patients were randomly assigned into two groups: group GA (n = 55) and group GA + AB (n = 55). Group GA + AB received an AB using 100 mg lidocaine 2% and 75 mg bupivacaine 0.5% before the induction of GA. Pain intensity was evaluated using a visual analogue scale (VAS). RESULTS: Mean VAS scores were higher and times to first rescue analgesic were shorter in group GA compared to group GA + AB (p = 0.001). More patients required rescue analgesic in group GA and pethidine consumption was higher (p = 0.001). Time to mobilization was shorter in GA + AB group (p = 0.001) but hospital discharge time was similar between groups (p = 0.269). The incidence of nausea and vomiting was higher in group GA (p = 0.002). CONCLUSION: Ankle block is an effective and simple technique for reducing postoperative pain and opioid consumption. It reduced the time to mobilization without a delay in hospital discharge. It is concluded that the routine administration of AB before GA may be an effective and simple method for pain relief after foot surgery.

Fast-track anesthesia in patients undergoing outpatient laparoscopic cholecystectomy: comparison of sevoflurane with total intravenous anesthesia.

BACKGROUND: The use of short-acting anesthetics has introduced a "fast-track anesthesia" concept in outpatient surgery which provides discharge of the patients from operation room directly to the phase II recovery area without entering into postanesthesia care unit. The aim of this prospective and randomized study was to compare general anesthesia using sevoflurane with propofol-remifentanil-based total intravenous anesthesia (TIVA) for fast-track eligibility in patients undergoing outpatient laparoscopic cholecystectomy. The secondary aim was to compare 2 discharge scoring systems: White's Fast-Tracking Scoring System (WFTSS) and Modified Aldrete Scoring Systems (MASS) with regard to postanesthesia care unit bypass rate and postoperative problems. METHODS: After obtaining ethical approval and written informed patient consent, 80 patients were randomly assigned into 2 groups: group sevoflurane (n=40) and group TIVA (n=40). Anesthesia was induced with propofol, fentanyl, and rocuronium in both groups and maintained with sevoflurane in group sevoflurane and with remifentanil-propofol in group TIVA. Fast-track eligibility was evaluated using both WFTSS and MASS while patients were discharged from operation room according to WFTSS. Recovery times, number of fast-track eligible patients, factors related to fast-track ineligibility, and perioperative complications were evaluated. RESULTS: The ratio of fast-track eligible patients was higher and times to fast-track eligibility were shorter in group TIVA compared with group sevoflurane (82.1% vs 57.5% and 8 minutes vs 12 minutes; P<.05). The primary factors that have inhibited fast-tracking were desaturation, hemodynamic instability, pain, and postoperative nausea and vomiting, respectively. Postoperative nausea and vomiting presented a major difference in the rate of fast-track ineligibility between groups (4 patients in group sevoflurane, whereas none in group TIVA; P<.05). The fast-track ratio was lower with the WFTSS compared with MASS in group sevoflurane (57.5% vs 77.5%, P<.05), but similar in group TIVA.