Comparison of postoperative deep vein thrombosis incidence between regional anesthesia with monitored anesthesia care and general anesthesia alone in total knee arthroplasty patients.

BACKGROUND

Total knee arthroplasty (TKA) is associated with a risk of postoperative deep vein thrombosis (DVT). While regional anesthesia is integral to multimodal analgesia protocols, its specific impact on DVT risk compared to general anesthesia remains unclear.

METHODS

This retrospective cohort study included 250 patients undergoing unilateral TKA. Based on anesthetic records, patients were categorized into a regional anesthesia with monitored anesthesia care group (RA group, n = 78) or a general anesthesia alone group (GA group, n = 172). The RA protocol comprised spinal anesthesia and peripheral nerve blocks, with propofol titrated to maintain mild sedation and spontaneous ventilation Propensity score matching created 78 balanced pairs. The primary outcome was the incidence of in-hospital DVT, assessed via venous ultrasound. Secondary outcomes included pulmonary embolism, readmissions, ambulation time, length of stay, pain scores, opioid consumption, D-dimer levels, and complications.

RESULTS

After matching, no significant difference was found in the overall incidence of postoperative DVT or symptomatic pulmonary embolism between groups (p > 0.05). However, the RA group demonstrated superior secondary outcomes: significantly lower 30-day readmission rates, earlier time to first ambulation, and shorter hospital stay (p < 0.05). Postoperative pain scores and 24-h intravenous morphine consumption were significantly reduced in the RA group3. Plasma D-dimer levels on postoperative days 1 and 3 were also lower in the RA group (p < 0.05). The incidences of postoperative nausea and vomiting and pulmonary complications were significantly reduced with RA. Multivariate analysis confirmed that anesthesia type was not an independent predictor for DVT (p > 0.05), whereas advanced age and higher BMI were significant risk factors.

CONCLUSION

With standardized pharmacologic prophylaxis, combined regional-general anesthesia did not further reduce the incidence of DVT after TKA compared to general anesthesia alone. Nonetheless, it provided significantly better analgesia, facilitated earlier functional recovery, shortened hospitalization, and lowered the risks of nausea, vomiting, and pulmonary complications. These findings support the inclusion of regional anesthesia as a key component for optimizing perioperative management in TKA patients.