Limited evidence for anesthesia and analgesia for outpatient primary knee and hip arthroplasty: A scoping review - 22/06/25

Doi : 10.1016/j.otsr.2025.104318

Jinlei Li ^a,^{^{1
Jinlei Li and Alberto E Ardon contributed equally to this manuscript.},}⁎ , Alberto E. Ardon ^b,^{^{1
Jinlei Li and Alberto E Ardon contributed equally to this manuscript.}}, Rebecca L. Johnson ^c, Nigel Gillespie ^a, Yan Lai ^d, Jean-Pierre Phillip Ouanes ^e, Ashley M. Shilling ^f, Hanae K. Tokita ^g, Cameron K. Ledford ^h, Sylvia H. Wilson ⁱ
^a Department of Anesthesiology, Yale School of Medicine, New Haven, CT, United States of America
^b Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL, United States of America
^c Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, United States of America
^d Department of Anesthesiology & Critical Care Medicine, Memorial Sloan Kettering Cancer Center NY, NY, United States of America
^e Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, West Palm Beach, FL, United States of America
^f Department of Anesthesiology, University of Virginia Health System, Charlottesville, VA, United States of America
^g Department of Anesthesiology and Critical Care Medicine, Josie Robertson Surgery Center, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
^h Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL, United States of America
ⁱ Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, SC, United States of America

^⁎Corresponding author.

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Abstract

Introduction

The prevalence of outpatient lower extremity arthroplasty is growing. This review was conducted to summarize literature for anesthesia and analgesia in this population. In this scoping review, we assess the evidence regarding the use of spinal anesthesia, periarticular and/or local infiltration analgesia, and peripheral nerve blocks for knee and hip arthroplasty with a focus on patient centered outcomes to identify knowledge gaps in practice that may influence future research.

Methods

PICO (population, intervention, comparison, outcome) questions were engineered to address the use of spinal anesthesia, periarticular injection, and peripheral nerve blocks on time to discharge, time to first ambulation, and mean/median pain scores in the first 24 h after surgery. A standardized systematic approach was used in the literature review. The National Library of Medicine’s MEDLINE, Embase, and Cochrane (Cochrane Central Register of Controlled Trials and Database of Systematic Reviews) databases were queried up to August 2024.

Results

The literature search yielded 5905 studies, 3552 abstracts were screened, 549 full texts were reviewed, and 277 articles were included in the scoping review; only 3 studies assessed outcomes in the outpatient setting. Spinal anesthesia may be associated with decreased length of stay but data is conflicting. The use of surgeon periarticular and local infiltration is supported in both knee and hip arthroplasty. For knee arthroplasty, peripheral nerve blocks may decrease pain even in the presence of periarticular infiltration. Time to discharge and time to first ambulation were not well studied in the literature.

Conclusion

Overall, while evidence exists to support the use of spinal anesthesia, periarticular infiltration, and/or peripheral nerve blocks for knee and hip arthroplasty, it is primarily focused on inpatient rather than ambulatory populations. Our review presents the current literature and emphasizes the need for research on the potential impact of these techniques on patient-centered outcomes in an outpatient arthroplasty setting.