{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T20:47:00Z","timestamp":1783111620866,"version":"3.54.6"},"reference-count":30,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,9,24]],"date-time":"2025-09-24T00:00:00Z","timestamp":1758672000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>To investigate the effect of general anesthesia with spontaneous breathing laryngeal mask airway (LMA) intubation combined with a peripheral nerve block (PNB) in orthopedic surgery through a retrospective study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Data from 160 adult patients (American Society of Anesthesiologists grade 1\u20133) who underwent elective orthopedic surgery under general anesthesia with LMA intubation combined with PNB were retrospectively analyzed. All patients received ultrasound-guided PNB before general anesthesia. Among them, 78 patients were assigned to the spontaneous breathing group and 82 patients to the pressure-controlled ventilation group. The parameters compared included baseline characteristics, perioperative anesthetic drug dosages, anesthesia recovery time, adverse events during recovery, numerical rating scale score at 2\u202fh postoperatively, postoperative pulmonary complications, hospitalization costs, and length of stay.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Both groups successfully completed the surgeries. Compared to the pressure-controlled ventilation group, the spontaneous breathing group exhibited significantly lower doses of fentanyl and rocuronium bromide (<jats:italic>p<\/jats:italic>\u202f&amp;lt;\u202f0.001), shorter length of stay (<jats:italic>p<\/jats:italic>\u202f=\u202f0.047), reduced incidence of postoperative hypertension in the post-anesthesia care unit (<jats:italic>p<\/jats:italic>\u202f&amp;lt;\u202f0.001), and lower anesthesia costs (<jats:italic>p<\/jats:italic>\u202f&amp;lt;\u202f0.001) and total hospitalization costs (<jats:italic>p<\/jats:italic>\u202f=\u202f0.001). No statistically significant differences were observed between the two groups in baseline characteristics, anesthesia recovery time, incidence of postoperative hypoxemia or hypotension in the post-anesthesia care unit, numerical rating score at 2\u202fh postoperatively, incidence of postoperative pulmonary complications, or surgical costs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>General anesthesia with spontaneous breathing LMA intubation combined with PNB is safe and feasible for elective orthopedic surgeries in adults. This approach is beneficial in shortening the length of stay and reducing hospitalization costs.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fmed.2025.1584437","type":"journal-article","created":{"date-parts":[[2025,9,24]],"date-time":"2025-09-24T05:40:51Z","timestamp":1758692451000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["General anesthesia with spontaneous breathing and laryngeal mask airway intubation combined with peripheral nerve block in orthopedic surgery: a retrospective 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Care"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"243","DOI":"10.1016\/j.bpa.2010.02.008","article-title":"Role of spontaneous and assisted ventilation during general anaesthesia","volume":"24","author":"Magnusson","year":"2010","journal-title":"Best Pract Res Clin Anaesthesiol"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"50","DOI":"10.1001\/jama.2021.22647","article-title":"Effect of regional vs general anesthesia on incidence of postoperative delirium in older patients undergoing hip fracture surgery: the RAGA randomized trial","volume":"327","author":"Li","year":"2022","journal-title":"JAMA"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"103135","DOI":"10.1016\/j.otsr.2021.103135","article-title":"Comparison of pericapsular nerve group (PENG) block with fascia iliaca compartment block (FICB) for pain control in hip fractures: A double-blind prospective randomized controlled clinical 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breathing","volume":"6","author":"Kitajima","year":"1992","journal-title":"J Anesth"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"e2416797","DOI":"10.1001\/jamanetworkopen.2024.16797","article-title":"Semirecumbent Positioning During Anesthesia Recovery and Postoperative Hypoxemia: A Randomized Clinical Trial","volume":"7","author":"Wang","year":"2024","journal-title":"JAMA Netw Open"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"1338","DOI":"10.1097\/ALN.0b013e3181fc6e0a","article-title":"Prediction of postoperative pulmonary complications in a population-based surgical cohort","volume":"113","author":"Canet","year":"2010","journal-title":"Anesthesiology"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"864","DOI":"10.1093\/bja\/aes017","article-title":"Ventilatory responses after major surgery and high dependency care","volume":"108","author":"Nieuwenhuijs","year":"2012","journal-title":"Br J 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Limitations","volume":"25","author":"Hawkins","year":"2019","journal-title":"Curr Pharm Des"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3310\/hta14390","article-title":"Sugammadex for the reversal of muscle relaxation in general anaesthesia: a systematic review and economic assessment","volume":"14","author":"Chambers","year":"2010","journal-title":"Health Technol Assess"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"340","DOI":"10.1177\/0310057X1204000219","article-title":"Unrestricted access to sugammadex: impact on neuromuscular blocking agent choice, reversal practice and associated healthcare costs","volume":"40","author":"Ledowski","year":"2012","journal-title":"Anaesth Intensive Care"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"43","DOI":"10.2147\/CEOR.S100921","article-title":"Sugammadex for reversal of neuromuscular blockade: a retrospective analysis of clinical outcomes and cost-effectiveness in a single 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