A Comparison of Neuraxial Block Versus General Anesthesia for Elective Total Hip Replacement: A Meta-analysis
William J. Mauermann, Ashley M. Shilling, Zhiyi Zuo
(Anesth Analg, 103:1018-1025, 2006)
Department of Anesthesiology, University of Virginia Health System, Charlottesville, VA.
A recent meta-analysis revealed that compared with general anesthesia (GA), neuraxial block lessened many serious complications in patients undergoing various types of surgeries. It is unknown whether this finding from the study of heterogeneous patients applies to a particular surgical patient population. This meta-analysis was performed to ascertain whether anesthesia choice affected the outcome after elective total hip replacement (THR). Databases for MEDLINE (1966 to August 2005), MD Consult (1969 to August 2005), and EMBASE (1969 to August 2005) were searched in an analysis that included randomized and quasi-randomized studies that compared GA and neuraxial (spinal or epidural) block for elective THR. Ten independent trials involving 330 patients under GA and 348 patients under neuraxial block were identified and analyzed. Pooled results from 5 trials showed that neuraxial block markedly decreased the incidence of radiographically diagnosed deep venous thrombosis or pulmonary embolism. The odds ratio (OR) for deep venous thrombosis was 0.27 with a 95% confidence interval (CI) of 0.17 to 0.42. The OR for pulmonary embolism was 0.26 with a 95% CI of 0.12 to 0.56. Neuraxial block also lessened the operative time by 7.1 minutes per case (95% CI, 2.3-11.9 minutes). Data from 3 trials showed that patients under neuraxial block for THR were less likely to require blood transfusion than were patients under GA (21/177 [12%] vs 62/188 [33%] of patients transfused). The OR for this comparison was 0.26. However, the CIs were wide and compatible with both no effect and a nine-tenths reduction (95% CI, 0.06-1.05). Outcomes appear to be better in patients undergoing elective THR under neuraxial anesthesia than in those undergoing the procedure under GA.