THE USE OF ANAESTHETIC METHODS IN ATHLETES' ORTHOPEDIC SURGERY: A LITERATURE REVIEW OF THE IMPACT ON REHABILITATION AND QUALITY OF CARE
Abstract
Background: Athletes aim for rapid, pain-free return to activity after injury, but many of them require surgery. As the choice of anesthesia for surgery affects postoperative recovery and patient satisfaction it is crucial to analyze which type of anesthesia is adequate.
Aim: This literature review was created to analyze the latest information on general versus regional anaesthesia on postoperative rehabilitation, pain management, length of hospital stay, and perceived quality of care in the context of orthopedic procedures in physically active patients.
Materials and methods: The review analyzed current literature from Pubmed and other medical databases published between 2000 and 2025.
Conclusion: A large number of factors must be taken into account when choosing what type of anaesthesia must be used. Patient collaboration, a holistic approach to the patient and understanding his needs influences the rehabilitation process and thus a faster return to health and physical activity.
References
Prieto-González, P., Martínez-Castillo, J. L., Fernández-Galván, L. M., Casado, A., Soporki, S., & Sánchez-Infante, J. (2021). Epidemiology of Sports-Related Injuries and Associated Risk Factors in adolescent Athletes: An Injury Surveillance. International Journal of Environmental Research and Public Health, 18(9), 4857. https://doi.org/10.3390/ijerph18094857
Gimigliano, F., Resmini, G., Moretti, A., Aulicino, M., Gargiulo, F., Gimigliano, A., Liguori, S., Paoletta, M., & Iolascon, G. (2021). Epidemiology of Musculoskeletal Injuries in Adult Athletes: A scoping review. Medicina, 57(10), 1118. https://doi.org/10.3390/medicina57101118
Franco, M. F., Madaleno, F. O., De Paula, T. M., Ferreira, T. V., Pinto, R. Z., & Resende, R. A. (2021). Prevalence of overuse injuries in athletes from individual and team sports: A systematic review with meta-analysis and GRADE recommendations. Brazilian Journal of Physical Therapy, 25(5), 500–513. https://doi.org/10.1016/j.bjpt.2021.04.013
Swindell, H. W., Coury, J. R., Dantzker, N., Lopez, C. D., Saltzman, B. M., Trofa, D. P., & Ahmad, C. S. (2021). A systematic review of the orthopaedic literature on truncal and lower extremity injuries in major league baseball players. JAAOS Global Research and Reviews, 5(8). https://doi.org/10.5435/jaaosglobal-d-21-00030
Minkara, A. A., Westermann, R. W., Rosneck, J., & Lynch, T. S. (2018). Systematic review and meta-analysis of outcomes after hip arthroscopy in femoroacetabular impingement. The American Journal of Sports Medicine, 47(2), 488–500. https://doi.org/10.1177/0363546517749475
Valsamis, E., Sadler, J., Kennedy, T., Thornhill, C., Carey, C., & Ricketts, D. (2018). Anaesthesia: what a surgeon needs to know. British Journal of Hospital Medicine, 79(5), 270–278. https://doi.org/10.12968/hmed.2018.79.5.270
Witjes, S., Gouttebarge, V., Kuijer, P. P. F. M., Van Geenen, R. C. I., Poolman, R. W., & Kerkhoffs, G. M. M. J. (2016). Return to sports and Physical Activity after Total and Unicondylar Knee Arthroplasty: A Systematic Review and Meta-Analysis. Sports Medicine, 46(2), 269–292. https://doi.org/10.1007/s40279-015-0421-9
Grauman, S., Boethius, J., & Johansson, J. (2016). Regional Anaesthesia Is Associated with Shorter Postanaesthetic Care and Less Pain Than General Anaesthesia after Upper Extremity Surgery. Anesthesiology Research and Practice, 2016, 1–5. https://doi.org/10.1155/2016/6308371
Cunningham, D. J., LaRose, M., Zhang, G., Patel, P., Paniagua, A., Gadsden, J., & Gage, M. J. (2022). Regional anesthesia associated with decreased inpatient and outpatient opioid demand in tibial plateau fracture surgery. Anesthesia & Analgesia. https://doi.org/10.1213/ane.0000000000005980
Helwani, M. A., Avidan, M. S., Abdallah, A. B., Kaiser, D. J., Clohisy, J. C., Hall, B. L., & Kaiser, H. A. (2015). Effects of regional versus general anesthesia on outcomes after total hip arthroplasty. Journal of Bone and Joint Surgery, 97(3), 186–193. https://doi.org/10.2106/jbjs.n.00612
Wang, X., Li, H., Yuan, C., & Zhao, H. (2021). Association between type of anesthesia and length of hospital stay in primary unilateral total knee arthroplasty patients: a single-center retrospective study. Journal of Orthopaedic Surgery and Research, 16(1). https://doi.org/10.1186/s13018-021-02817-4
Čižmáriková, R., Habala, L., & Valentová, J. (2025). General Anesthetics: Aspects of chirality, pharmacodynamics, and pharmacokinetics. Pharmaceuticals, 18(2), 250. https://doi.org/10.3390/ph18020250
Son, Y. (2010). Molecular mechanisms of general anesthesia. Korean Journal of Anesthesiology, 59(1), 3. https://doi.org/10.4097/kjae.2010.59.1.3
Doo, A. R., Kang, S., Kim, Y. S., Lee, T., Lee, J., & Kim, D. (2019). The effect of the type of anesthesia on the quality of postoperative recovery after orthopedic forearm surgery. Korean Journal of Anesthesiology, 73(1), 58–66. https://doi.org/10.4097/kja.19352
Pu, X., & Sun, J. (2019). General anesthesia vs spinal anesthesia for patients undergoing total-hip arthroplasty. Medicine, 98(16), e14925. https://doi.org/10.1097/md.0000000000014925
Sansonnens, J., Taffé, P., & Burnand, B. (2015). Higher occurrence of nausea and vomiting after total hip arthroplasty using general versus spinal anesthesia: an observational study. BMC Anesthesiology, 16(1). https://doi.org/10.1186/s12871-016-0207-0
Koutp, A., Hauer, G., Leitner, L., Kaltenegger, L., Fischerauer, S., Clar, C., Reinbacher, P., Schittek, G., Leithner, A., & Sadoghi, P. (2023). Less induction time and postoperative pain using spinal anesthesia versus general anesthesia with or without the use of peripheral nerve blocks in total knee arthroplasty. The Journal of Arthroplasty, 39(4), 904–909. https://doi.org/10.1016/j.arth.2023.10.018
Sponheuer, K., Becker-Rux, D., Scheike, S., Barsch, L., Pempe, C., Pfrepper, C., Roth, A., & Werdehausen, R. (2025). Impact of anesthesia type on postoperative pain and outcomes in primary hip and knee arthroplasty: a retrospective register analysis. BMC Anesthesiology, 25(1). https://doi.org/10.1186/s12871-025-03127-6
De Cassai, A., Geraldini, F., Boscolo, A., Pasin, L., Pettenuzzo, T., Persona, P., Munari, M., & Navalesi, P. (2020). General anesthesia compared to spinal anesthesia for patients undergoing lumbar vertebral surgery: A Meta-Analysis of Randomized Controlled Trials. Journal of Clinical Medicine, 10(1), 102. https://doi.org/10.3390/jcm10010102
Huang, Y., & Chang, K. (2021). Sensory block level prediction of spinal anaesthesia with 0.5% hyperbaric bupivacaine: a retrospective study. Scientific Reports, 11(1). https://doi.org/10.1038/s41598-021-88726-2
Roh, Y. H., Park, S. G., & Lee, S. H. (2023b). Regional versus General Anesthesia in Postoperative Pain Management after Distal Radius Fracture Surgery: Meta-Analysis of Randomized Controlled Trials. Journal of Personalized Medicine, 13(11), 1543. https://doi.org/10.3390/jpm13111543
Donauer, K., Bomberg, H., Wagenpfeil, S., Volk, T., Meissner, W., & Wolf, A. (2018). Regional vs. General Anesthesia for Total Knee and Hip Replacement: An Analysis of Postoperative Pain Perception from the International PAIN OUT Registry. Pain Practice, 18(8), 1036–1047. https://doi.org/10.1111/papr.12708
Bose, J. N., Rajavel, K., Munusamy, R., & Ramesh, P. (2024). Postoperative pain control in orthopedic surgery: A randomized trial comparing regional anaesthesia and systemic opioids. Bioinformation, 20(12), 1931–1934. https://doi.org/10.6026/9732063002001931
Ilfeld, B. M., Said, E. T., Finneran, J. J., Sztain, J. F., Abramson, W. B., Gabriel, R. A., Khatibi, B., Swisher, M. W., Jaeger, P., Covey, D. C., & Robertson, C. M. (2018). Ultrasound-Guided percutaneous peripheral nerve stimulation: Neuromodulation of the femoral nerve for postoperative analgesia following ambulatory anterior cruciate ligament reconstruction: a proof of concept study. Neuromodulation Technology at the Neural Interface, 22(5), 621–629. https://doi.org/10.1111/ner.12851
Hussain, N., Brull, R., Vannabouathong, C., Speer, J., Lagnese, C., McCartney, C. J. L., & Abdallah, F. W. (2022). Network meta‐analysis of the analgesic effectiveness of regional anaesthesia techniques for anterior cruciate ligament reconstruction. Anaesthesia, 78(2), 207–224. https://doi.org/10.1111/anae.15873
Zuo, W., Guo, W., Ma, J., & Cui, W. (2019). Dose adductor canal block combined with local infiltration analgesia has a synergistic effect than adductor canal block alone in total knee arthroplasty: a meta-analysis and systematic review. Journal of Orthopaedic Surgery and Research, 14(1). https://doi.org/10.1186/s13018-019-1138-5
Stundner, O., Ortmaier, R., & Memtsoudis, S. G. (2014). Which outcomes related to regional anesthesia are most important for orthopedic surgery patients? Anesthesiology Clinics, 32(4), 809–821. https://doi.org/10.1016/j.anclin.2014.08.003
Epstein, N. (2014b). A review article on the benefits of early mobilization following spinal surgery and other medical/surgical procedures. Surgical Neurology International, 5(4), 66. https://doi.org/10.4103/2152-7806.130674
De Biase, G., Gruenbaum, S. E., West, J. L., Chen, S., Bojaxhi, E., Kryzanski, J., Quiñones-Hinojosa, A., & Abode-Iyamah, K. (2021). Spinal versus general anesthesia for minimally invasive transforaminal lumbar interbody fusion: implications on operating room time, pain, and ambulation. Neurosurgical FOCUS, 51(6), E3. https://doi.org/10.3171/2021.9.focus21265
Bourget-Murray, J., Halpenny, D., Mahdavi, S., Piroozfar, S., & Sharma, R. (2022). Perioperative outcomes associated with general and spinal anesthesia after total joint arthroplasty for osteoarthritis: a large, Canadian, retrospective cohort study. Canadian Journal of Surgery, 65(4), E460–E467. https://doi.org/10.1503/cjs.008821
Knio, Z. O., Clancy, P. W., & Zuo, Z. (2023). Effect of spinal versus general anesthesia on thirty-day outcomes following total hip arthroplasty: A matched-pair cohort analysis. Journal of Clinical Anesthesia, 87, 111083. https://doi.org/10.1016/j.jclinane.2023.111083
Pirie, K., Traer, E., Finniss, D., Myles, P. S., & Riedel, B. (2022). Current approaches to acute postoperative pain management after major abdominal surgery: a narrative review and future directions. British Journal of Anaesthesia, 129(3), 378–393. https://doi.org/10.1016/j.bja.2022.05.029
Swank, K. R., DiBartola, A. C., Everhart, J. S., Kaeding, C. C., Magnussen, R. A., & Flanigan, D. C. (2017). The effect of femoral nerve block on quadriceps strength in anterior cruciate ligament reconstruction: a systematic review. Arthroscopy the Journal of Arthroscopic and Related Surgery, 33(5), 1082-1091.e1. https://doi.org/10.1016/j.arthro.2017.01.034
Sharma, S., Iorio, R., Specht, L. M., Davies-Lepie, S., & Healy, W. L. (2009). Complications of femoral nerve block for total knee arthroplasty. Clinical Orthopaedics and Related Research, 468(1), 135–140. https://doi.org/10.1007/s11999-009-1025-1
Turbitt, L. R., McHardy, P. G., Casanova, M., Shapiro, J., Li, L., & Choi, S. (2017). Analysis of inpatient falls after total knee arthroplasty in patients with continuous femoral nerve block. Anesthesia & Analgesia, 127(1), 224–227. https://doi.org/10.1213/ane.0000000000002703
Wang, D., Yang, Y., Li, Q., Tang, S., Zeng, W., Xu, J., Xie, T., Pei, F., Yang, L., Li, L., & Zhou, Z. (2017). Adductor canal block versus femoral nerve block for total knee arthroplasty: a meta-analysis of randomized controlled trials. Scientific Reports, 7(1). https://doi.org/10.1038/srep40721
Hasabo, E. A., Assar, A., Mahmoud, M. M., Abdalrahman, H. A., Ibrahim, E. A., Hasanin, M. A., Emam, A. K., AbdelQadir, Y. H., AbdelAzim, A. A., & Ali, A. S. (2022). Adductor canal block versus femoral nerve block for pain control after total knee arthroplasty: A systematic review and Meta-analysis. Medicine, 101(34), e30110. https://doi.org/10.1097/md.0000000000030110
Borchard, S. M., VanTienderen, R. J., Pitcher, N. J., McCormick, E. M., & Westermann, R. W. (2025). Block or No-Block? Regional Anesthesia and Return-to-Sport Outcomes in Quadriceps Tendon Autograft ACL Reconstruction. The Journal of Knee Surgery. https://doi.org/10.1055/a-2542-2526
Rousseau-Saine, N., Williams, S. R., Girard, F., Hébert, L. J., Robin, F., Duchesne, L., Lavoie, F., & Ruel, M. (2017). The effect of adductor canal block on knee extensor muscle strength 6 weeks after total knee arthroplasty: a randomized, controlled trial. Anesthesia & Analgesia, 126(3), 1019–1027. https://doi.org/10.1213/ane.0000000000002338
Fu, G., Xu, L., Chen, H., & Lin, J. (2025). State-of-the-art anesthesia practices: a comprehensive review on optimizing patient safety and recovery. BMC Surgery, 25(1). https://doi.org/10.1186/s12893-025-02763-6
Arvinen-Barrow, M., Clement, D., Hamson-Utley, J. J., Kamphoff, C., Zakrajsek, R., Lee, S., Hemmings, B., Lintunen, T., & Martin, S. B. (2015b). Athletes’ Expectations About Sport-Injury Rehabilitation: A Cross-Cultural Study. Journal of Sport Rehabilitation, 25(4), 338–347. https://doi.org/10.1123/jsr.2015-0018
Todd, M. M. (2004). Anesthetic Neurotoxicity: The Collision between Laboratory Neuroscience and Clinical Medicine. Anesthesiology, 101(2), 272–273. https://doi.org/10.1097/00000542-200408000-00003
Horlocker, T. T. (2011). Complications of regional anesthesia and acute pain management. Anesthesiology Clinics, 29(2), 257–278. https://doi.org/10.1016/j.anclin.2011.04.006
Çalışkan, F., Seller, A., & Gerçek, M. (2024). The effect of patient education on pain level and fear of pain in orthopedic surgery: a randomized controlled trial. Journal of PeriAnesthesia Nursing. https://doi.org/10.1016/j.jopan.2024.07.015
Chan, D. K., Lonsdale, C., Ho, P. Y., Yung, P. S., & Chan, K. M. (2009). Patient Motivation and Adherence to Postsurgery Rehabilitation Exercise Recommendations: The Influence of Physiotherapists’ Autonomy-Supportive Behaviors. Archives of Physical Medicine and Rehabilitation, 90(12), 1977–1982. https://doi.org/10.1016/j.apmr.2009.05.024
Han, F., Banerjee, A., Shen, L., & Krishna, L. (2015). Increased compliance with supervised rehabilitation improves functional outcome and return to sport after anterior cruciate ligament reconstruction in recreational athletes. Orthopaedic Journal of Sports Medicine, 3(12). https://doi.org/10.1177/2325967115620770
McDonald, S., Page, M. J., Beringer, K., Wasiak, J., & Sprowson, A. (2014). Preoperative education for hip or knee replacement. Cochrane Library, 2015(9). https://doi.org/10.1002/14651858.cd003526.pub3
Ho, C., Chen, Y., Wu, H., Huang, H., & Lin, S. (2022). The Effects of a Patient-Specific Integrated Education Program on Pain, Perioperative Anxiety, and Functional Recovery following Total Knee Replacement. Journal of Personalized Medicine, 12(5), 719. https://doi.org/10.3390/jpm12050719
Johansson, K., Nuutila, L., Virtanen, H., Katajisto, J., & Salanterä, S. (2005). Preoperative education for orthopaedic patients: systematic review. Journal of Advanced Nursing, 50(2), 212–223. https://doi.org/10.1111/j.1365-2648.2005.03381.x
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Copyright (c) 2025 Zuzanna Kudlińska, Honorata Juniewicz, Patryk Heryć, Karolina Kananowicz, Ryszard Łagowski, Julia Kosęda, Anna Jędrasiak, Jakub Piotrowski, Zofia Laska, Marianna Latour
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