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BJA Advance Access originally published online on July 23, 2009
British Journal of Anaesthesia 2009 103(3):335-345; doi:10.1093/bja/aep208
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 BJA: September 2009
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© The Author [2009]. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournal.org

Does regional anaesthesia improve outcome after total hip arthroplasty? A systematic review

A. J. R. Macfarlane1,2, G. A. Prasad1, V. W. S. Chan1 and R. Brull1,*

1 Department of Anaesthesia and Pain Management, Toronto Western Hospital, University Health Network, 399 Bathurst Street, Toronto, ON, Canada M5T 2S8

* Corresponding author. E-mail: richard.brull{at}uhn.on.ca

Total hip arthroplasty (THA) is amenable to a variety of regional anaesthesia (RA) techniques that may improve patient outcome. We sought to answer whether RA decreased mortality, cardiovascular morbidity, deep venous thrombosis (DVT) and pulmonary embolism (PE), blood loss, duration of surgery, pain, opioid-related adverse effects, cognitive defects, and length of stay. We also questioned whether RA improved rehabilitation. To do so, we performed a systematic review of the contemporary literature to compare general anaesthesia (GA) and RA and also systemic and regional analgesia for THA. To reflect contemporary surgical and anaesthetic practice, only randomized controlled trials (RCTs) from 1990 onward were included. We identified 18 studies involving 1239 patients. Only two of the 18 trials were of Level I quality. There is insufficient evidence from RCTs alone to conclude if anaesthetic technique influenced mortality, cardiovascular morbidity, or the incidence of DVT and PE when using thromboprophylaxis. Blood loss may be reduced in patients receiving RA rather than GA for THA. Our review suggests that there is no difference in duration of surgery in patients who receive GA or RA. Compared with systemic analgesia, regional analgesia can reduce postoperative pain, morphine consumption, and nausea and vomiting. Length of stay is not reduced and rehabilitation does not appear to be facilitated by RA or analgesia for THA.

Keywords: anaesthesia, general; anaesthetic techniques, regional; analgesia, postoperative; analgesic techniques, regional; surgery, orthopaedic

2 Present address: Department of Anaesthesia, Glasgow Royal Infirmary, 84 Castle Street, Glasgow G4 0SF, UK


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E-letters:

Read all E-letters

The role of regional anesthesia in the length of stay in the hospital and the rehabilitation center following total hip replacement
Jacques E. Chelly, MD, PhD, MBA, et al.
British Journal of Anaesthesia, 12 Aug 2009 [Full text]
In response to Dr Chelly
Richard Brull, et al.
British Journal of Anaesthesia, 14 Aug 2009 [Full text]
Regional anaesthesia and reduction of theatres efficiency, a myth or a reality?
Hany Shawkat, et al.
British Journal of Anaesthesia, 28 Sep 2009 [Full text]

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