Application for ESRA Abstract Prizes: I apply as an Anesthesiologist (Aged 35 years old or less)

Background and Aims This study compares perioperative complications of patients undergoing general anaesthesia (GA), spinal anaesthesia (SA) or isolated peripheral triple nerve blocks (NB) for total knee replacement surgery in high risk patients.

Methods In this retrospective single center study, 329 patients (ASA≥III), scheduled for elective total knee replacement between 2014 and 2020 were included. All patients received a femoral catheter and a proximal sciatica nerve block for perioperative analgesia. Patients in the NB group received an additional obturator nerve block. Due to failure resulting from insufficient block or patients expressing their wish for a general anaesthesia, patients were assigned according to the definitive anaesthesia method. There were 22 individuals in the NB-, 171 patients in the SA – and 136 patients in the GA group. Perioperative parameters, events and costs were compared. Differences between groups were compared using the chi- square test.

Results The NB group showed a significantly better haemodynamic stability intraoperatively with less vasopressor consumption, respectively less relevant hypotension. In 73% of patients in the NB group a PACU-Bypass was achieved (vs 34% in SA group vs 13%in GA group). This influenced the overall costs positively. Remarkably, during the initial 24 hours, no episodes with severe pain (visual analog scale score > 30) were observed in the NB group. Regarding other postoperative complications we could not observe a statistically significant difference.

Conclusions In summary, the use of triple block as an isolated technique for total knee replacement surgery in specific high-risk patients appears to be a safe option with less haemodynamic complications.