Effect Of General Anesthesia And Combined Spinal And Epidural Analgesia On Early Postoperative Functional Recovery In Patients With Lower Extremity Fracture

Objective: To analyze the effect of general anesthesia and combined spinal and epidural anesthesia on early postoperative functional recovery,pain control,and complications of patients with lower limb fracture undergoing open reduction and internal fixation,and to provide some reference for the selection of more favorable anesthesia which facilitates early postoperative activity.Method: The clinical data of patients who underwent elective open reduction and internal fixation for lower limb fractures in the First Affiliated Hospital of Dali University from April2021 to January 2022 were collected,and all the patients were followed up.Patients were divided into two groups according to their received anesthetic as follows: the general anesthesia group（GA group）and the combined spinal and epidural anesthesia group（CSEA group）.Outcome parameters focused on the evaluation of the recovery time of contralateral limb movement,the activity level of the injured limb at 24 h and 48 h,overall mobilization at48 h,downtime,pain scores in terms of numeric rating scores（NRS）at the instant,6h,24 h,48h,and postoperative length of hospital stay.The number of cases of remedial analgesia,postoperative complications were also analyzed.Results: According to inclusion and exclusion criteria,a total of 81 patients were included,42 received regional anesthesia and 39 received general anesthesia.The analysis showed no significant difference in gender,age,body mass index,ASA,operation duration by anesthesia type（P>0.05）.Patients in the GA group were significantly faster in the contralateral limb recovery（2h νs 8h,Z=-7.618,P<0.001）,higher in injured limb movement level at 24h（Z=-2.080,P=0.038<0.05）and earlier in downtime after surgery（11.0 ± 3.0h 22.7 ± 6.7h,t=6.087,P<0.001）than CSEA group.No significant differences were found with regard to the activity level of the affected limb at 48 h and overall mobilization（P>0.05）.The NRS score of the CSEA group was 0 immediately after surgery,lower than the GA group（P<0.001）.Then,it increased at 6h,higher than the GA group（P<0.001）.There was no difference in NRS scores between the two groups at other times（P>0.05）.Bleeding volume was less with the CSEA group（20ml νs 50 ml,Z=-3.421,P=0.001）,but the length of postoperative hospital stay was longer（9day νs 7day,Z=-4.139,P=0.021）.We also did not find a difference in postoperative complications including Nausea and vomiting,urinary retention,postoperative infection,deep venous thromboembolic events,reoperation,limb weakness,falls,and so on,between these two anesthetic techniques（P>0.05）.Conclusion: The two anesthetic techniques,general anesthesia and combined spinal and epidural analgesia,provide feasible anesthesia choices for patients undergoing open reduction and internal fixation of lower extremity fractures,but general anesthesia has some advantages in early postoperative activity and postoperative hospital stay compared with combined spinal and epidural analgesia,which seems to be associated with a shorter postoperative hospital stay.