Işılay Gizem ÖNDAĞ, Mustafa Kemal ARSLANTAŞ, Gülbin Töre ALTUN, Pelin Çorman DİNÇER, Hilmi Ömer AYANOĞLU
Journal of Cardio-Vascular-Thoracic Anaesthesia and Intensive Care Society - 2026;32(2):81-90
Objectives: To compare perioperative lung aeration loss after elective lower extremity orthopaedic surgery under regional versus general anaesthesia using a standardised 12-zone lung ultrasound (LUS) score and to evaluate its relationship with spirometry and arterial blood gas (ABG) outcomes. Methods: In this prospective, single-centre observational study conducted at a tertiary care university hospital, 60 adults (ASA I-III) without pulmonary disease undergoing elective lower extremity orthopaedic surgery were allocated by clinical decision to receive combined spinal-epidural anaesthesia (n=30) or general anaesthesia (n=30). LUS, spirometry, and ABG on room air were performed preoperatively and within 2 hours postoperatively. Results: Baseline characteristics and preoperative LUS scores were comparable between the groups (13.03+/-3.60 vs. 12.70+/-3.29). Postoperative aeration loss was significantly greater after general anaesthesia (DeltaLUS 6.53+/-2.90) than after regional anaesthesia (DeltaLUS 1.90+/-3.26), with a mean difference of 4.63 (95% CI 3.03-6.24; p<0.001; Cohen's d=1.50). Clinically significant atelectasis (DeltaLUS>=4) occurred more frequently in the general anaesthesia group (76.7% vs. 36.7%; absolute risk reduction, 40.0%; NNT, 2.5). Adjusted analysis confirmed an independent group effect (beta=4.79; p<0.001; R²=0.513). Oxygenation did not differ between the groups and showed no correlation with DeltaLUS. Small airway function declined more after general anaesthesia. Conclusions: These findings suggest that regional anaesthesia may be associated with reduced perioperative lung aeration loss and support the potential role of LUS in perioperative monitoring. Further randomised controlled trials are warranted.
