The impact of spinal versus general anaesthesia on postoperative outcomes following total knee arthroplasty: A systematic review

Objective: The choice of anaesthetic technique for total knee arthroplasty (TKA) significantly influences perioperative and postoperative recovery. This systematic review aims to compare the effects of spinal anaesthesia (SA) and general anaesthesia (GA) on key postoperative outcomes in patients undergoing TKA.Methods: A systematic literature search was conducted using the electronic databases PubMed, Embase, and Google Scholar for studies published between January 2011 and December 2022. The review included comparative studies (randomized controlled trials and cohort studies) that evaluated postoperative outcomes such as pain, blood loss, transfusion requirements, and length of hospital stay in adults undergoing TKA. Of the 288 records initially identified, seven studies met the pre-defined inclusion criteria.Results: The synthesized evidence indicates that spinal anaesthesia is associated with superior postoperative outcomes compared to general anaesthesia. Specifically, SA was linked to a significant reduction in postoperative pain scores, decreased intraoperative blood loss, and a lower risk of blood transfusions. However, a critical limitation noted across several studies was the inconsistent use of standardized, validated pain assessment tools.Conclusion: For patients undergoing total knee arthroplasty, spinal anaesthesia appears to offer distinct advantages over general anaesthesia by improving several critical postoperative outcome measures. To strengthen the evidence base, future research should prioritize the use of standardized, validated pain scoring systems. Further high-quality, randomized controlled trials are needed to establish robust clinical guidelines for anaesthetic management in TKA.