title: Comparison of general anesthesia with and without lumbar epidural for total hip arthroplasty: effects of epidural block on hip arthroplasty.
abstract: OBJECTIVE
  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).
  
  
  METHODS
  Randomized, controlled study.
  
  
  METHODS
  A university hospital.
  
  
  METHODS
  37 ASA physical status I, II, and III patients, undergoing elective THA.
  
  
  METHODS
  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.
  
  
  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.
  
  
  CONCLUSIONS
  Combined regional-general anesthesia decreases intraoperative blood loss in THA, and thereby offers an advantage over general anesthesia alone.
authors.affiliation: Department of Anaesthesia, St. Joseph's Hospital, Hamilton, Ontario, Canada.
authors.forename: A
authors.initials: A
authors.lastname: Dauphin
authors.forename: K E
authors.initials: KE
authors.lastname: Raymer
authors.forename: E B
authors.initials: EB
authors.lastname: Stanton
authors.forename: H D
authors.initials: HD
authors.lastname: Fuller
mesh_terms: D000368:Aged; D000767:Anesthesia, Epidural; D000768:Anesthesia, General; D016063:Blood Loss, Surgical; D004311:Double-Blind Method; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006622:Hip Prosthesis; D006801:Humans; D008297:Male; D016343:Monitoring, Intraoperative; D011183:Postoperative Complications / Q000517:prevention & control