title: Long-term cognitive and social sequelae of general versus regional anesthesia during arthroplasty in the elderly. A Prospective Randomized Study Comparing Short- and Intermediate-Term Perioperative Outcome Variables After Spinal or General Anesthesia for Lumbar Disk and Laminectomy Surgery Anaesthesia and blood loss in total hip replacement Comparison of the effects of spinal anaesthesia and general anaesthesia on postoperative oxygenation and perioperative mortality. Spinal anesthesia versus general anesthesia for elective lumbar spine surgery: A randomized clinical trial Cognitive and functional competence after anaesthesia in patients aged over 60: controlled trial of general and regional anaesthesia for elective hip or knee replacement. Prevention of thromboembolic disease following total knee arthroplasty. Epidural versus general anesthesia. Randomized Trial of Epidural Versus General Anesthesia: Outcomes After Primary Total Knee Replacement Mental function and morbidity after acute hip surgery during spinal and general anaesthesia Postoperative outcome in Chinese patients having primary total knee arthroplasty under general anaesthesia/intravenous patient-controlled analgesia compared to spinal-epidural anaesthesia/analgesia. Anaesthesia for lower limb amputation Randomized comparison between sevoflurane anaesthesia and unilateral spinal anaesthesia in elderly patients undergoing orthopaedic surgery Spinal or General Anesthesia for Surgery of the Fractured Hip? A Prospective Study of Mortality in 578 Patients [Epidural vs general anaesthesia]. Cognitive effects after epidural vs general anesthesia in older adults. A randomized trial. Mortality after spinal and general anaesthesia for surgical fixation of hip fractures Immediate and long-term mental recovery from general versus epidural anesthesia in elderly patients. Anaesthesia for surgical correction of fractured femoral neck A comparison of three techniques Prospective, multi-centre trial of mortality following general or spinal anaesthesia for hip fracture surgery in the elderly. Postoperative Confusion after Anesthesia in Elderly Patients with Femoral Neck Fractures Comparison of general anesthesia with and without lumbar epidural for total hip arthroplasty: effects of epidural block on hip arthroplasty. Spinal Versus General Anesthesia for Orthopedic Surgery: Anesthesia Drug and Supply Costs Perioperative myocardial ischaemia in patients undergoing surgery for fractured hip randomized to incremental spinal, single-dose spinal or general anaesthesia.
abstract: This study compared the effects of general and regional anesthesia on cognitive and psychosocial functioning in elderly persons . Sixty-four patients between 60 and 86 yr of age undergoing knee arthroplasty were r and omly assigned to receive either general or regional anesthesia . A battery of psychometric tests , including the Satz-Mogel form of the Wechsler Adult Intelligence Scale-Revised , the Wechsler Memory Scale-Revised and the Sickness Impact Profile , and various neuropsychological measures were administered by a blinded observer just before surgery and again 3 months later . Analyses of covariance revealed improvements in most measures that were equivalent between groups . The results indicated that there were no cognitive or psychosocial effects of general or regional anesthesia after 3 months in elderly persons undergoing knee arthroplasty . In this patient population , general anesthesia poses no more risk to long-term mental function than regional anesthesia General or regional anesthesia may be used for lumbar laminectomy . To determine whether one method is superior , 122 patients were r and omly assigned to receive either a  st and ard general anesthetic ( GA ) or spinal anesthesia ( SA ) supplemented with intravenous ( IV ) propofol sedation . Data from the intraoperative period through hospital discharge were collected and compared . Demographically , both groups were similar .  Total anesthesia ( 131.0 + /- 4.3 vs 106.6 + /- 3.2 min ) and surgical times ( 81.5 + /- 3.6 vs 67.1 + /- 2.8 min ) were longer in the GA group . Intraoperative hemodynamics were similar between groups except that the incidence of increased blood pressure was more frequent with GA ( 26.2 % vs 3.3 % ) . Blood loss was less during SA ( 133 + /- 18 mL vs 221 + /- 32 mL ) . Postanesthesia care unit ( PACU ) heart rates and mean arterial pressures were higher in the GA group . Peak pain scores in the PACU were higher after GA compared with SA ( 58 + /- 4 vs 22 + /- 3 ) as were the number of patients who required analgesics . Severe nausea was more common in the GA group both in the PACU and during the 24 h after surgery . Analgesic requirements after discharge from the PACU , urinary retention , and days in the hospital did not differ between groups . This study suggests that SA may be superior to GA both intraoperatively and postoperatively for lumbar spine procedures lasting less than 2 h. ( Anesth Analg 1996;83:559 - 64 Twenty-seven consecutive patients scheduled for total hip replacement were r and omly divided into three groups . The first group had their operations under epidural analgesia , the second whilst breathing halothane spontaneously and patients in the third group were anaesthetised using a modified neuroleptoanaesthetic ( NLA ) technique .  Blood lost during the operation was measured by a colorimetric technique . Closed suction drains were used and all blood lost after the operation collected for measurement . Deliberate hypotensive techniques were not employed . The mean operative blood loss of patients who had their operations under epidural anaesthesia  was significantly less than that of patients in the other two groups , being 341 - 6 + /- 59 - 1 ml ( s.e.m . ) for the epidural group , 648 - 4 + /- 58 - 3 ml ( s.e.m . ) for the halothane group and 744 + /- 98 - 9 ml ( s.e.m . ) for the NLA group . There was no significant difference in the amounts of blood collected by closed suction drainage in any of the three groups and the mean values for total overall blood loss incurred by procedure were 734 - 1 + /- 40 - 7 ml ( s.e.m . ) for the epidural group , 986 - 3 + /- 94 - 9 ml ( s.e.m . ) for the halothane group and 1168 - 4 + /- 126 ml ( s.e.m . ) for the NLA group . In this series only 3 of 10 patients ( 30 % ) who had their operation under epidural anaesthesia required transfusion with whole blood , compared with 7 of 9 ( 78 % ) in the halothane group , and 7 of 8 ( 87 - 5 % ) in the neuroleptoanalgesia group . From this series it is evident that the need for transfusion of whole blood in total hip replacement can be significantly reduced by the use of epidural analgesia One hundred patients presenting for surgical treatment of fractured neck of femur were allocated to receive either spinal ( SAB ) or general ( GA ) anaesthesia . Before operation , the mean PaO2 was 9.04 kPa . There was a significant decrease in PaO2 of 0.68 kPa in GA group at 1 h after operation , while blood-gas values were unchanged in SAB group . Eight patients ( 15.7 % ) in GA group and five patients ( 10.2 % ) in SAB group died within 4 weeks of surgery . The difference was not statistically significant BACKGROUND : Either general or regional anesthesia can be used for lumbar disk surgery . The common anesthetic technique is general anesthesia ( GA ) . The aim of this study was to compare the intra and postoperative outcomes of spinal anesthesia ( SA ) with GA in these patients . METHODS : Seventy-two patients were enrolled in the study . They were r and omized into two groups with 37 patients in GA Group and 35 ones in SA Group . The heart rate ( HR ) , mean arterial pressure ( MAP ) , blood loss , surgeons satisfaction with the operating conditions , the severity of postoperative pain based on visual analogue scale ( VAS ) and analgesic use were recorded . RESULTS : The mean blood loss was significantly less in the SA Group compared to GA Group ( p < 0.05 ) . Intraoperative maximum blood pressure and heart rate changes were significantly less in SA Group ( p < 0.05 ) . The surgeons satisfaction was significantly more in the SA Group ( p < 0.05 ) . The number of patients who used postoperative analgesic as well as postoperative mean VAS was significantly less in SA Group in comparison with GA group ( p < 0.05 for both ) . CONCLUSIONS : Our study showed that SA was superior to GA in providing postoperative analgesia and decreasing blood loss while maintained better perioperative hemodynamic stability without increasing adverse side effects OBJECTIVE --To determine the influence of general or regional anaesthesia on long term mental function in elderly patients . DESIGN -- Prospect i ve study of patients r and omly allocated to receive general or regional anaesthesia .  SETTING --The patients ' homes and a large teaching hospital in Cardiff . SUBJECTS--146 Patients aged 60 and over scheduled for elective hip or knee replacement .  MAIN OUTCOME MEASURES --Scores achieved in tests of cognitive function and functional competence . RESULTS --72 Patients were allocated to receive general anaesthesia and 74 regional anaesthesia . Anaesthetic technique did not influence the duration of the operation , time to mobilisation postoperatively , requirements for analgesia after the operation , or duration of stay in hospital . Three months after the operation there was an improvement in the score for the recognition component ( 76 ms , 95 % confidence interval 9 to 144 ) and the response component ( 82 ms , 5 to 158 ) of the choice reaction time in the group receiving general anaesthesia compared with the group receiving regional anaesthesia . This was the only significant difference between the two groups in the assessment s of cognitive and functional competence . Eleven patients receiving regional anaesthesia and 12 receiving general anaesthesia reported that their memory and concentration were worse than before the operation , but this was not confirmed by testing . CONCLUSION --Cognitive and functional competence in elderly patients was not detectably impaired after either general or regional anaesthesia when attention was paid to the known perioperative influences on mental function Seventy-two patients were r and omized into a prospect i ve clinical trial to evaluate the effects of epidural ( EA ) versus general anesthesia ( GA ) on the incidence of thromboembolic disease ( TED )  following total knee arthroplasty ( TKA ) . Males received aspirin 650 mg po bid and females low-dose warfarin daily to maintain the prothrombin time at 15 to 16 seconds for pharmacologic prophylaxis against TED . Thirty-four patients had EA and 38 GA for their primary TKA .  Contrast venography and ventilation-perfusion scanning were performed on the sixth , seventh , and eighth postoperative days , and these were interpreted in a blinded fashion . The mean age of the 45 males and 27 females was 64 years ( range , 42 - 84 years ) . There were no significant differences between the two groups with respect to hematocrit , operative time , blood loss , number of units transfused , or hospital stay . Twelve of the 34 patients ( 35 % ) receiving an EA and 10 of the 38 patients ( 26 % ) receiving GA developed TED , an overall incidence of 31 % ( p greater than 0.05 ) Fifty-three percent of the clots were located in the popliteal vein above the trifurcation or more proximal . However , the incidence of proximal vein thrombosis was significantly less in patients receiving an EA ( 46 % ) rather than a GA ( 64 % ) . The incidence and distribution of clots was not affected by the type of pharmacologic prophylaxis , gender , or use of methylmethacrylate . Ten percent of the patients had a positive scan by strict criteria and were thought to have a pulmonary embolism ( PE ) . In patients with a femoral vein clot , the incidence of PE was 67 % . One bleeding complication occurred in a patient who took double the appropriate warfarin dose . ( ABSTRACT TRUNCATED AT 250 WORDS To compare the effects of epidural anesthesia and general anesthesia on early postoperative outcomes after unilateral primary total knee replacement , 262 patients were r and omly assigned to receive either epidural or general anesthesia . All patients received a common rehabilitation protocol including a st and ardized assessment of progress . One hundred eighty-eight patients received a common thromboembolic prophylaxis protocol with postoperative aspirin , and had a st and ardized surveillance protocol to detect thromboembolic complications . Deep vein thrombosis was determined by venography on the operative limb , and pulmonary embolism was determined by comparison of preoperative and postoperative lung perfusion scans . The epidural anesthesia group reached all rehabilitative milestones earlier postoperatively than did the general anesthesia group , with a statistically significant earlier attainment of stair climbing . The incidence of deep vein thrombosis was 40 % with epidural anesthesia , and 48 % with general anesthesia . There were no clots proximal to the popliteal veins . The incidence of pulmonary embolism on lung scan was 12 % with epidural anesthesia and 9 % with general anesthesia . Epidural anesthesia is associated with more rapid achievement of postoperative in hospital rehabilitation goals after total knee replacement . A minor reduction in postoperative deep vein thrombosis rate was observed with epidural anesthesia , but this did not reach statistical significance . No difference in early postoperative pulmonary embolism was observed between the 2 types of anesthesia Forty elderly patients ( mean age 78.9 years ) undergoing acute surgery for hip fracture were given at r and om either spinal analgesia with bupivacaine 0.75 % or general anaesthesia with diazepam , fentanly and N2O/O2 . Mental function was studied pre‐operatively with an abbreviated mental test and 1 week and 3 months postoperatively in both groups . Mortality and number of complications was similar in the two groups , but a shorter time of ambulation was seen in the spinal group compared to the general anaesthetic group . No persistent impairment in mental function was found after acute hip surgery under spinal or general anaesthesia and the only advantage of regional technique was a shorter time of ambulation OBJECTIVE To compare postoperative outcomes in patients having primary total knee arthroplasty receiving general or regional anaesthesia .  DESIGN R and omised prospect i ve study . SETTING Regional hospital , Hong Kong . PATIENTS Patients having primary total knee replacement were r and omised to either general anaesthesia followed by postoperative intravenous patient-controlled analgesia with morphine , or combined spinal-epidural anaesthesia followed by postoperative epidural infusion of bupivacaine 0.1 % with fentanyl 2 microg/mL. MAIN OUTCOME MEASURES Visual analogue scale pain scores , perioperative blood loss , time to first meal and ambulation , and prevalence of postoperative complications . RESULTS Sixty consecutive patients were enrolled in this study . Postoperative median pain scores were consistently lower at 1 ( P<0.0001 ) , 6 ( P=0.08 ) , 12 ( P=0.003 ) , 24 ( P=0.14 ) , and 48 hours ( P=0.007 ) in those given regional anaesthesia . Although there was a trend towards fewer complications in the latter group , there were no statistically significant differences between the two groups with respect to the incidence of postoperative blood loss , haemodynamic instability , pruritus , nausea , vomiting , urinary retention , or other surgical/medical complications . Postoperatively , patients given regional anaesthesia also resumed meals earlier ( P<0.0001 ) , and showed a trend towards earlier ambulation and hospital discharge . CONCLUSION Chinese patients undergoing total knee arthroplasty with  regional anaesthesia/regionally delivered analgesia enjoyed better postoperative pain relief and resumed meals earlier than those receiving general anaesthesia/intravenous patient-controlled analgesia . The former also showed trends towards less adverse effects , postoperative complications , earlier ambulation , and earlier hospital discharge Amputation of the lower limb for vascular disease has a high morbidity and mortality . A comparative study in 60 patients was carried out between spinal analgesia with sedation and general anaesthesia with controlled ventilation which maintained end expiratory carbon dioxide between 4–4.5 kPa . The spinal technique had advantages over general anaesthesia during surgery and in the first 24 hours , but no long term benefits Background and objective : This prospect i ve , r and omized study was conducted to compare unilateral spinal block using small doses of hyperbaric bupivacaine and single-agent anaesthesia with sevoflurane in elderly patients undergoing hip surgery . Methods : Thirty patients ( > 65 yr ) undergoing hip fracture repair were r and omly allocated to receive unilateral spinal anaesthesia with hyperbaric bupivacaine 7.5 mg 0.5 % ( Group Spinal , n = 15 ) or volatile induction and maintenance anaesthesia with sevoflurane ( Group SEVO , n = 15 ) . General anaesthesia was induced by increasing the inspired concentration to 5 % . A laryngeal mask airway was placed without muscle relaxants , and the end-tidal concentrations of sevoflurane were adjusted to maintain cardiovascular stability . Hypotension ( decrease in systolic arterial pressure > 20 % from baseline ) , hypertension or bradycardia ( heart rate < 50 beats min−1 ) requiring treatment , and the length of stay in the postanaesthesia care unit was recorded . Cognitive functions were evaluated the previous day , and 1 and 7 days after surgery with the Mini Mental State Examination test . Results : Hypotension occurred in seven patients of Group Spinal ( 46 % ) and in 12 patients of Group SEVO ( 80 % ) ( P = 0.05 ) . Phenylephrine was required to control hypotension in three spinal patients ( 21 % ) and four SEVO patients ( 26 % ) ( n.s . ) . SEVO patients had lower heart rates than spinal patients from 15 to 60 min after anaesthesia induction ( P = 0.01 ) . Bradycardia was observed in three SEVO patients ( 22 % ) . Discharge from the postanaesthesia care unit required 15 ( range 5 - 30 ) min in Group Spinal and 55 ( 15 - 80 ) min in Group SEVO ( P = 0.0005 ) . Eight patients in Group Spinal ( 53 % ) and nine patients in Group SEVO ( 60 % ) showed cognitive decline ( Mini Mental State Examination test decreased ⩾ 2 points from baseline ) 24 h after surgery ( n.s . ) . Seven days after surgery , confusion was still present in one patient of Group Spinal ( 6 % ) and in three patients of Group SEVO ( 20 % ) ( n.s . ) . Conclusions : In elderly patients undergoing hemiarthroplasty of the hip , induction and maintenance with sevoflurane provide a rapid emergence from anaesthesia without more depression of postoperative cognitive function compared with unilateral spinal anaesthesia . This technique represents an attractive option when patient refusal , lack of adequate co-operation or concomitant anticoagulant therapy contraindicate the use of spinal anaesthesia The mortality following surgical correction of upper femoral fractures was investigated in 578 patients , over the age of 50 yr , r and omly allocated to receive spinal ( bupivacaine ) or general ( enflurane or neurolept ) anaesthesia .  Thirty days after surgery the mortality was 6 % after spinal and 8 % after general anaesthesia ( ns ) . Six months to 2 years after surgery the mortality was identical in the two groups . There were no differences with respect to ambulation and discharge . The estimated blood loss was smaller ( P less than 0.05 ) in patients receiving spinal anaesthesia .  Regardless of the anaesthetic technique , a high short-term mortality was related to age , male sex , and trochanteric fracture , whereas excess long-term mortality was related to male sex and high ASA scores BACKGROUND Aim of this study is to determine if and how the anaesthesia technique can significantly influence the outcome in patients after major orthopaedic surgery in terms of : patrimony of red blood cells ( blood loss and erythropoiesis ) , incidence of intra and postoperative complications , postoperative pain control and hospital stay . METHODS 210 patients , ASA physical status I-III , undergoing elective primary total hip replacement were r and omly allocated in three groups of 70 patients to receive either epidural anaesthesia ( Group EA ) , general anaesthesia ( GA ) , or epidural anaesthesia integrated with mild general anaesthesia ( IA ) . RESULTS Data show a significant difference between the amount of pain measured by VRS immediately after surgery : prevalently absent in groups IA ( 84.3 % ) and EA ( 85.7 % ) and prevalently severe and moderate in group AG ( 34.3 % ) . The measurement of the basic circulating erythrocyte mass in the first , third and fifth postoperative day , calculated by the Mercuriali formula , which considers blood loss , autologous and homologous transfusions and erythropoiesis , showed that general anaesthesia leads to a significant delay in the resumption of haemopoiesis . This result was attenuated by its combination with epidural anaesthesia . CONCLUSIONS On the basis of the literature and the results of our study , epidural anaesthesia seems to be the most appropriate technique for patients scheduled for total hip replacement : due to its simpler analgesic cover , its tendency to be associated with a lower incidence of complications in the first 24 hours after surgery . The incidence of relevant hypotension is minor compared to integrated anaesthesia . General anaesthesia produced a significant decrease in postoperative erythropoiesis OBJECTIVE To compare the effect of epidural vs general anesthesia on the incidence of long-term cognitive dysfunction after total knee replacement surgery in older adults . DESIGN R and omized controlled clinical trial . SETTING Orthopedic specialty academic hospital . PATIENTS A total of 262 patients undergoing elective primary total knee replacement with a median age of 69 years ; 70 % women . INTERVENTION R and om assignment to either epidural or general anesthesia . MAIN OUTCOME MEASURES A thorough neuropsychological assessment was performed preoperatively and repeated at 1 week and 6 months postoperatively . Cognitive outcome was assessed by within-patient change on 10 tests of memory , psychomotor , and language skills . Prospect i ve st and ardized surveillance for cardiovascular complications was performed to allow simultaneous assessment of anesthetic effects on cognitive and cardiovascular outcomes . RESULTS The two groups were similar at baseline in terms of age , sex , comorbidity , and cognitive function . There were no significant differences between the epidural and general anesthesia groups in within-subject change from baseline on any of the 10 cognitive test results at either 1 week or 6 months . Overall , 5 % of patients showed a long-term clinical ly significant deterioration in cognitive function . There was no difference between the anesthesia groups in the incidence of major cardiovascular complications ( 3 % overall ) . CONCLUSIONS The type of anesthesia , general or epidural , does not affect the magnitude or pattern of postoperative cognitive dysfunction or the incidence of major cardiovascular complications in older adults undergoing elective total knee replacement . This is the largest trial of the effects of general vs regional anesthesia on cerebral function reported to date , with more than 99 % power to detect a clinical ly significant difference on any of the neuropsychological tests One thous and , three hundred and thirty three patients who underwent anaesthesia for surgical fixation of a hip fracture were studied prospect ively to assess the effects on outcome of general and spinal anaesthesia . There were no significant differences between the groups in risk factors , length of hospital stay or mortality rates after 30 days or one year . The data presented may be useful for those wishing to audit anaesthetic services provided to patients with hip fracture The postoperative course of mental performance during the first week and at 3 months after operation was studied in 30 patients above the age of 60 , undergoing total hip replacement arthroplasty . The patients were r and omly allocated to receive either general anesthesia , epidural analgesia , or general anesthesia plus epidural analgesia . The surgically induced increase in plasma cortisol and glucose was inhibited in the two groups receiving epidural analgesia . Mental performance was studied with psychological methods . An equal degree of postoperative impairment of mental performance of 3 - 4 days ' duration was found in all groups . Three months after surgery , mental function had improved slightly and to the same extent in all groups . We conclude that the after surgery , mental function had improved slightly and to the same extent in all groups . We conclude that the transient mental impairment occurring within the first postoperative week is caused by factors other than general anesthetic agents and the endocrine-metabolic response to surgery Sixty patients with fractured neck of femur and scheduled for surgical correction were r and omly allocated to receive one of three anaesthetic techniques : general anaesthesia ; spinal analgesia ; psoas compartment block . The patients in the local anaesthetic groups also received a light general anaesthetic . There was little difference in the pre‐ , intra‐ and postoperative events , and no difference in postoperative mortality In a prospect i ve r and omized multi-centre study , the mortality following internal fixation surgery for fracture of the upper femur was investigated in 538 elderly patients allocated to receive subarachnoid blockade or general ( narcotic-relaxant ) anaesthesia .  The 28-day mortality was 6.6 % with subarachnoid , and 5.9 % with general , anaesthesia . The difference was not significant ( 95 % confidence limits : -3.5 to + 4.8 ) . At 1 year following surgery , the mortality was 20.4 % . Increasing age , ischaemic heart disease , cardiac failure , preoperative arrhythmias and poor ASA status were all associated with increases in early and long term mortality . A delay to surgery of more than 24 h from admission was also associated with an increased 28-day mortality . Senile dementia and admission other than from the patient 's own home , were factors associated with a poorer long term outcome . From the point of view of mortality , subarachnoid anaesthesia did not appear to confer any advantages over general anaesthesia in non-prosthetic surgery for hip fracture in the elderly Fifty-seven patients , all over the age of 64 , with femoral neck fracture were r and omized to receive epidural or halothane anesthesia  to see if the anesthetic technique influenced the incidence of postoperative confusion . All patients were lucid on admission . Using the American Psychiatric Association 's Diagnostic and Statistical Manual of Mental Disorders ( DSM-III ) as criteria for confusion , we found that 44 % of the patients developed confusion that correlated closely to a history of mental depression ( P < 0.01 ) and to the use of drugs with anticholinergic effect ( P < 0.005 ) . There was no difference in the incidence of confusion between the two anesthetic groups . In patients given halothane , however , early postoperative hypoxemia was associated with confusion ( P < 0.05 ) . Patients with confusion had significantly more postoperative complications and almost four times longer hospitalization times . It is concluded that anticholinergic medication and a history of mental depression are predominant risk factors for development of postoperative confusion and in this respect are more important than the anesthetic technique STUDY OBJECTIVES To determine whether lumbar epidural anesthesia , when combined with general anesthesia , decreases perioperative blood loss , the incidence of postoperative deep vein thrombosis ( DVT ) , cardiac dysrhythmias , and ischemia in patients undergoing total hip arthroplasty ( THA ) . DESIGN R and omized , controlled study . SETTING A university hospital . PATIENTS 37 ASA physical status I , II , and III patients , undergoing elective THA . INTERVENTION Patients were divided into two statistically comparable groups : Group GA = general anesthesia ; Group CEGA = general anesthesia plus lumbar epidural anesthesia . All patients had 48-hour perioperative Holter monitoring , applied on admission , the day prior to surgery . In both groups , general anesthesia was induced with thiopental sodium and muscle relaxant , and maintained with oxygen , nitrous oxide , isoflurane , opioid , and muscle relaxant . Group B received lumbar epidural anesthesia with 10 ml 0.5 % bupivacaine with 1:200,000 epinephrine prior to anesthesia induction . Blood loss was measured by suction bottle contents , sponge weights , and collection drainage . DVT was assessed with postoperative leg scanning , plethysmography , and venogram . MEASUREMENTS AND MAIN RESULTS Intraoperative blood loss was less after combined epidural-general anesthesia ( 663.8 ml + /- 299.0 ml ) than after general anesthesia alone ( 1,259.2 ml + /- 366.0 ml ) . The difference was found to be statistically significant ( p < 0.00005 ) . No difference was found between the two groups in postoperative blood loss , incidence of DVT , cardiac dysrhythmias , or ischemia . CONCLUSION Combined regional-general anesthesia decreases intraoperative blood loss in THA , and thereby offers an advantage over general anesthesia alone Total hip or knee replacement surgeries are common orthopedic interventions that can be performed with spinal anesthesia ( SA ) or general anesthesia ( GA ) . No study has investigated the economic aspects associated with the two anesthetic techniques for this common surgery . We r and omized 40 patients to receive either SA or GA  and analyzed the drug and supply costs for anesthesia und recovery . Anesthesia-related times , hemodynamic variables , and pain scores were also recorded . Total costs per case without personnel costs were almost half in the SA group compared with the GA group ; this was a result of less cost for anesthesia ( P < 0.01 ) and for recovery ( P < 0.05 ) . This finding was supported by a sensitivity analysis . There were no relevant differences regarding anesthesia-related times . Patients in the GA group were admitted to the postanesthesia care unit with a higher pain score and needed more analgesics than patients in the SA group ( both P < 0.01 ) . We conclude that SA is a more cost-effective alternative to GA in patients undergoing hip or knee replacement , as it is associated with lower fixed and variable costs . Moreover , SA seems to be more effective , as patients in the SA group showed lower postoperative pain scores during their stay in the postanesthesia care unit Quantitative assessment of myocardial ischaemia during incremental spinal , single-dose spinal and general anaesthesia may provide guidelines for the choice of anaesthetic technique for osteo synthesis of hip fractures in the elderly atherosclerotic individual . Forty-three patients with coronary artery disease were allocated to receive either incremental spinal anaesthesia ( bupivacaine 0.5 % plain ) ( A ) , single-dose spinal anaesthesia ( 2.5 mL of bupivacaine 0.5 % plain ) ( B ) or general anaesthesia ( fentanyl , thiopentone , atracurium , enflurane , N2O/O2 ) ( C ) for hip surgery .  ST segment monitoring was performed from the induction of anaesthesia and for the following 48 h , and perioperative hypotension , blood loss and fluid therapy were recorded . ST depression developed in two out of 14 ( A ) , seven out of 15 ( B ) and six out of 14 ( C ) patients ( P = 0.14 ) . In ( A ) , a total of seven ST depressions occurred in the observation period as opposed to 125 in ( B ) and 16 in ( C ) ( P < 0.05 ) . Intra-operative ST depression only occurred in ( B ) . Three ( A ) , 33 ( B ) and 40 ( C ) hypotensive events were recorded ( P < 0.002 ) . Altogether , 56 % of hypotensive patients developed ST depression compared with 10 % of normotensive patients ( P < 0.003 ) . In ( A ) , 1.6 mL of 0.5 % bupivacaine were used as opposed to the fixed 2.5 mL dose in ( B ) ( P < 0.001 ) . In the first post-operative week , mortality was higher in ( B ) ( P < 0.05 ) but , after 1 month , there was no significant difference in mortality between the three groups . The incidence of hypotension and myocardial ischaemia was lowest in the group receiving incremental spinal anaesthesia
target: So far , the evidence available from the studies included is insufficient to prove that neuraxial anesthesia is more effective and safer than general anesthesia for orthopedic surgery .
  However , this systematic review does not rule out clinical ly important differences with regard to mortality , stroke , myocardial infa rct ion , length of hospitalization , postoperative cognitive dysfunction or pneumonia
background: CONTEXT AND OBJECTIVE Taking the outcome of mortality into consideration , there is controversy about the beneficial effects of neuraxial anesthesia for orthopedic surgery .
  The aim of this study was to compare the effectiveness and safety of neuraxial anesthesia versus general anesthesia for  orthopedic surgery .