Limited evidence supports the use of neuraxial anesthesia compared to general anesthesia to reduce complications in patients with symptomatic osteoarthritis of the hip undergoing total hip arthroplasty.

Rationale

Two studies (Hunt et al and Basques et al) examined the use of spinal compared with general anesthesia in total hip arthroplasty and met the criteria for the guideline. Both were retrospective analyses of large cohort databases, and both noted fewer adverse events when spinal anesthesia was used when compared with general anesthesia. Hunt et al examined outcomes of 409,096 total hip arthroplasties recorded in the National Joint Registry for England and Wales, and reported a 0.85 hazard ratio of death within 90 days when spinal anesthesia was used instead of general. Basques et al examined 20,936 total hip arthroplasty patients in the National Surgical Quality Improvement Program (NSQIP) database, of which 12,752 had general and 8184 had spinal anesthesia. General anesthesia was associated with a 1.31 odds ratio of having any adverse event, 5.81 odds ratio of prolonged ventilator use, 2.17 odds ratio of unplanned intubation, 2.51 odds ratio of stroke, 5.04 odds ratio of cardiac arrest, 1.34 odds ratio of blood transfusion, and 1.35 odds ratio of a minor adverse event after surgery.

  1. Hunt,L.P.; Ben-Shlomo,Y.; Clark,E.M.; Dieppe,P.; Judge,A.; MacGregor,A.J.; Tobias,J.H.; Vernon,K.; Blom,A.W. 90-day mortality after 409,096 total hip replacements for osteoarthritis, from the National Joint Registry for England and Wales: a retrospective analysis. 2013/9/28: 9898
  2. Basques,B.A.; Toy,J.O.; Bohl,D.D.; Golinvaux,N.S.; Grauer,J.N. General compared with spinal anesthesia for total hip arthroplasty. J Bone Joint Surg Am; 2015/3/18: 6