NEURAXIAL VS. GENERAL ANAESTHESIA

One high moderate quality (Liang 2017) and four low-quality (Basques 2015, Bourget 2022, Hunt 2013, Matharu 2020) were included. The moderate quality prospective randomized study by Liang 2017 showed shorter operative time, shorter duration of anesthesia, lower Visual Analogue Score for pain and high Minimum Metal State Examination Score (MME) with reginal anesthesia as compared to general anesthesia. Patients were followed for up to five days after surgery. There was no statistically significant difference in postoperative adverse effects, including pulmonary embolism, pneumonia, hypertension, renal failure, cardiac infarction, blood transfusion and mechanical ventilation. However, cardiac infarction, blood transfusion and mechanical ventilation numbers were twice in the general anesthesia group.

Two low-quality studies (Basques 2015, Matharu 2020) showed that there are lower blood transfusion rates with regional anesthesia. Another two low quality studies (Matharu 2020, Bourget 2022) reported shorter length of stay with reginal anesthesia. Three low-quality studies (Matharu 2020, Hunt 2013, Basques 2015) have reported lower overall complications.
Matharu (2020) showed lower 90-days any complication, readmission, renal failure, surgical site infection (SSI), deep vein thrombosis / pulmonary embolism (DVT/PE), blood transfusion and length of stay with regional anesthesia. Hunt (2013) reported lower 3-month mortality with regional anesthesia. Bourget (2022) had lower blood transfusion with reginal anesthesia but shorter length of stay with general anesthesia. Basques (2015) article favored reginal anesthesia for overall any complication, cardiac arrest, blood transfusion and operative time.
Benefits/Harms of Implementation

Both general and neuraxial anesthesia in total hip arthroplasty is associated with specific risks and benefits. While neuraxial anesthesia is associated with lower rates of adverse events in most patients, the choice of anesthesia should be individualized to each patient based on their medical comorbidities. The decision to proceed with a particular type of anesthesia should be made by each individual patient and anesthesiologist after an informed decision-making process where the risks and benefits of each anesthetic for that individual patient are discussed.

Outcome Importance
As the incidence and prevalence of osteoarthritis of the hip continues to rise, the number of total hip arthroplasty procedures performed is increasing as well.

Cost Effectiveness/Resource Utilization
No studies specifically addressed associated costs and resource utilization in a cost comparative approach between neuraxial and general anesthesia. Neuraxial anesthesia is performed by most anesthesiologists, but specialized training is required.

Acceptability
This option should be readily implemented as it does not influence a major change in clinical practice. Both neuraxial and general anesthesia are widely utilized in total hip arthroplasty.

Feasibility
General anesthesia and neuraxial anesthesia is available to most patients. Thus, this option should be easily implemented with no apparent barriers to adoption.

Future Research
Future studies level I prospective randomized controlled trials are needed to compare general versus neuraxial anesthesia. Future studies should focus on the patient reported outcomes, functional outcomes, opioid consumption, recovery, as well as adverse events and costs. Future studies are also needed to establish differences in adverse events or clinical outcomes within certain subgroups and populations.