General compared with neuraxial anesthesia for total hip and knee arthroplasty

Spinal anesthesia has been used for total hip replacement (THR) since 1970s (1). In recent decades and in light of growing body of evidence supporting better outcome of THR and total knee replacement (TKR) with the use of neuraxial anesthesia, this type of anesthesia has become more popular among anesthesiologists and surgeons (2-7). A recent study by Memtsoudis et al. (7), using the Premier database and reviewing 382,236 joint arthroplasty procedures, revealed that general anesthesia was by far the most frequent type of anesthesia used for joint arthroplasty as approximately 75% of the procedures were performed under general anesthesia. So it seems that the use of neuraxial anesthesia for total joint arthroplasty (TJA) is still limited to high volume specialized centers and less frequently used in other centers. The reason for the lack of universal adoption of regional anesthesia may be many. Barriers such as patient’s fear of spinal anesthesia, the lack of adequate experience or the lack of familiarity with the regional anesthesia techniques, and administration of perioperative anticoagulation to patients that prevents the use of regional anesthesia may be some of the factors (7).