Postoperative outcome in Chinese patients having primary total knee arthroplasty under general anaesthesia/intravenous patient-controlled analgesia compared to spinal-epidural anaesthesia/analgesia

OBJECTIVE

To compare postoperative outcomes in patients having primary total knee arthroplasty receiving general or regional anaesthesia.

DESIGN

Randomised prospective study.

SETTING

Regional hospital, Hong Kong.

PATIENTS

Patients having primary total knee replacement were randomised to either general anaesthesia followed by postoperative intravenous patient-controlled analgesia with morphine, or combined spinal-epidural anaesthesia followed by postoperative epidural infusion of bupivacaine 0.1% with fentanyl 2 microg/mL.

MAIN OUTCOME MEASURES

Visual analogue scale pain scores, perioperative blood loss, time to first meal and ambulation, and prevalence of postoperative complications.

RESULTS

Sixty consecutive patients were enrolled in this study. Postoperative median pain scores were consistently lower at 1 (P<0.0001), 6 (P=0.08), 12 (P=0.003), 24 (P=0.14), and 48 hours (P=0.007) in those given regional anaesthesia. Although there was a trend towards fewer complications in the latter group, there were no statistically significant differences between the two groups with respect to the incidence of postoperative blood loss, haemodynamic instability, pruritus, nausea, vomiting, urinary retention, or other surgical/medical complications. Postoperatively, patients given regional anaesthesia also resumed meals earlier (P<0.0001), and showed a trend towards earlier ambulation and hospital discharge.

CONCLUSION

Chinese patients undergoing total knee arthroplasty with regional anaesthesia/regionally delivered analgesia enjoyed better postoperative pain relief and resumed meals earlier than those receiving general anaesthesia/intravenous patient-controlled analgesia. The former also showed trends towards less adverse effects, postoperative complications, earlier ambulation, and earlier hospital discharge.

Recall of preoperative anaesthesia information in Hong Kong Chinese patients

OBJECTIVE

To evaluate the ability of patients to recall information provided during a preoperative visit.

DESIGN

Qualitative study.

SETTING

Regional hospital, Hong Kong.

PATIENTS

Sixty patients scheduled for elective surgery under general anaesthesia or central neuro-axial block.

MAIN OUTCOME MEASURES

Satisfactory recall of preoperative information, defined as the ability to remember at least 75% of adverse effects described.

RESULTS

Fifty-nine (98.3%) patients were satisfied with the preoperative information. Forty-two (70%) patients rated anaesthetic complications as important. At the interview on the day of the operation, 57 (95%) patients had satisfactory recall of the information provided. Eighty-five percent of patients remembered that the information was provided by an anaesthesiologist. After the operation, of those who experienced adverse effects, 48 (96%) patients remembered being told to anticipate the adverse anaesthetic event. Univariate analysis found that age, sex, education level, occupation, and the modality of anaesthesia did not affect patient recall of preoperative information on the day of surgery or 1 day postsurgery. CONCLUSION. There was satisfactory recall of preoperative information by the majority of patients in the study. Most patients expressed satisfaction with the information provided.

Tracheobronchial injury secondary to blunt chest trauma: diagnosis and management

Tracheobronchial injury is an uncommon complication in blunt chest trauma. The typical clinical features include haemoptysis, dyspneoa, and air leak. Tracheobronchial injury occurs after high energy impact and is commonly associated with injuries of other vital organs. If tracheobronchial injury is undetected and left untreated, it may cause persistent air leak which can render ventilation difficult and inefficient. Diagnosis of tracheobronchial injury should be made and confirmed by flexible bronchoscopy. The essence of airway management is to bypass the lesion by means of endobronchial intubation to the healthy bronchus with a single-lumen or double-lumen endotracheal tube. Such manoeuvres can also facilitate surgical access if thoracotomy is indicated. Taking into account the size of the lesion and the resulting respiratory status, surgical reconstruction of the injured airway is often necessary. More severe injury may even require lobectomy or pneumonectomy. Late complications of untreated tracheobronchial injury include bronchial stenosis, recurrent pneumonia and bronchiectasis. Prompt diagnosis and treatment generally lead to good functional recovery.