General vs Neuraxial Anesthesia in Direct Anterior Approach Total Hip Arthroplasty: Effect on Length of Stay and Early Pain Control

Background: Recent literature has suggested some benefits for neuraxial anesthesia (NA) as an alternative for general anesthesia (GA) for primary total hip arthroplasty patients. We examined the impact of NA vs GA on outcomes for patients undergoing direct anterior (DA) approach total hip arthroplasty (THA) in an institution with established rapid recovery protocols. Methods: A retrospective review was conducted for 500 consecutive THA patients from a single institution. Univariate analysis and multivariate linear regression were used to compare outcomes for THA patients receiving NA and GA. Results: There was a significant difference in length of stay with NA patients having a shorter length of stay (NA 32.7 hours vs GA 38.1 hours, P = .003). Patients receiving NA had significantly lower PACU morphine milligram equivalents (MME) (NA 10.2 MME vs GA 15.6 MME, P <.001) and reported a lower score on the PACU pain numeric rating scale (NA 2.1 vs GA 3.7, P <.001). Conclusion: Neuraxial anesthesia is associated with decreased LOS, decreased PACU MME, and a lower PACU pain score for patients undergoing primary DA THA. These trends remained consistent when controlling for age, gender, BMI, and ASA. (C) 2020 Elsevier Inc. All rights reserved.

Automated summary

In patients undergoing direct anterior total hip arthroplasty, neuraxial anesthesia was associated with decreased length of stay, lower post-anesthesia care unit morphine usage, and lower post-anesthesia care unit pain scores compared to general anesthesia. These benefits remained consistent after controlling for age, gender, BMI, and ASA status.