The choice between regional (spinal or epidural) and general anesthesia has been evaluated extensively for hip fracture surgery. An older meta-analysis of 15 randomized clinical trials published in 2000 showed a reduction in 1-month mortality and incidence of postoperative DVT in the regional anesthesia group; however, these advantages did not persist beyond three months.
Data from newer randomized trials are conflicting. A more recent meta-analysis published in 2016 suggests that neuraxial and general anesthesia for total hip or total knee arthroplasty appear equally effective. There were no statistically significant differences found regarding mortality, surgical duration, surgical site or chest infections, nerve palsies, postoperative nausea and vomiting, or thromboembolic disease when antithrombotic prophylaxis was used.
Therefore, the decision to use regional vs. general anesthesia should be based on patient factors (i.e. age, comorbidities, patient preference) and surgical factors (i.e. primary hip arthroplasty vs. revision). Immediate advantages of a regional anesthetic to consider include lower incidence of postoperative delirium and cognitive dysfunction as well as postoperative pain control. Regional anesthesia is particularly desirable in hip revision surgery, as some studies have shown reduced bleeding likely due to sympathetic blockade.
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