November 29, 2010 By - Randy Dotinga
WEDNESDAY, July 28 — Patients are less likely to develop infections at the sites of total hip or knee replacements if they undergo epidural or spinal anesthesia instead of general anesthesia, a new study reports.
And while the risk of infection is small, the potential for problems is significant. “However, these infections are extremely serious and difficult to treat because of the implanted hardware. Sometimes the entire joint needs to be removed,” said Dr. Daniel Sessler, of the department of outcomes research at the Anesthesiology Institute at The Cleveland Clinic, who wrote a commentary accompanying the study published in the August issue of the journal Anesthesiology.
In the study, lead author Dr. Chuen-Chau Chang and colleagues at Taipei Medical University examined a database of 3,081 patients in Taiwan who’d had total hip or knee replacement between 2002 and 2006. They found that 56 patients — 1.8 percent — developed an infection at the surgery site within 30 days of the procedure. Of that group, 2.8 percent had had general anesthesia, while 1.2 percent had had epidural or spinal anesthesia.
After adjusting their statistics so they wouldn’t be thrown off by factors such as the age and sex of the patients, the researchers found that those who had general anesthesia instead of epidural or spinal anesthesia were more than twice as likely to have developed a surgical site infection.
“Many anesthetics used in general anesthesia have been shown to compromise immunity responses,” Chang said in a news release from the American Society of Anesthesiologists.
Sessler, in an interview, said the major message of the study is that “spinal or epidural anesthesia reduces the risk of a very serious complication. It would thus be a mistake for patients to insist on general anesthesia if their anesthesiologist suggests a regional approach.”
Patients who receive regional anesthesia are often sedated so they’re not awake during the procedure, he added.