Title : Effectiveness of regional vs general anaesthesia in total knee replacement outcomes: A systematic review and meta analysis
Abstract:
Background: Total knee replacement (TKR) is a common procedure for advanced knee osteoarthritis. The choice of anaesthesia—regional anaesthesia (RA) versus general anaesthesia (GA)—can influence perioperative outcomes. This systematic review and meta-analysis aimed to compare the effectiveness of RA and GA in TKR.
Methods: We systematically searched PubMed, Embase, Scopus, Web of Science, and Cochrane Library from inception to May 2025 for studies comparing RA and GA in TKR. Eligible studies included adult patients and reported at least one of the following outcomes: blood transfusion, complication rates, or hospital length of stay. A random-effects meta-analysis was performed to pool data.
Results: Nine retrospective cohort studies encompassing 522,080 TKR procedures were included. RA significantly reduced the odds of perioperative blood transfusion (OR = 0.58, 95% CI 0.44–0.77, p = 0.0001), 30-day postoperative complications (OR = 0.59, 95% CI 0.39–0.88, p = 0.01), and hospital length of stay (SMD = -0.09, 95% CI –0.14 to –0.04, p = 0.0009). No study found RA to be inferior to GA. Heterogeneity was high across outcomes, but the direction of effect consistently favored RA.
Conclusion: Regional anaesthesia is associated with better short-term outcomes than general anaesthesia in total knee replacement, including fewer complications, lower transfusion rates, and shorter hospital stays. These findings support the preferential use of RA, particularly in high-risk patients, while considering individual patient factors.
Keywords: Total knee replacement, regional anaesthesia, general anaesthesia, blood transfusion, postoperative complications, length of stay, meta-analysis.
