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Total intravenous general anaesthesia vs. spinal anaesthesia for total hip arthroplasty

change in the method of anaesthesia less often. However, patients in the spinal anaesthesia group fulfilled discharge criteria earlier. We were astonished about the conclusion. General anaesthesia resulted in a more favourable recovery, but the outcome after surgery was not mentioned. Morbidity and mortality were not studied in a controlled manner; there was only one interview via phone 6 months after surgery. This interview consisted of two questions, one about the experience of the anaesthesia and one about the type of anaesthesia if a total hip replacement surgery would be necessary again. Rodgers et al. analysed 141 trials with 9559 patients in their meta-analysis. They recommended a more widespread use of neuraxial blockade because mortality and morbidity were significantly reduced. Mortality was reduced by one third in patients with epidural or spinal anaesthesia. Moreover, serious complications like deep vein thrombosis and pulmonary embolism were reduced. The recovery profile in the first 24 h is important for the patient′s satisfaction. However, serious complications and mortality are more important. We know, that orthopaedic patients have a high risk to suffer from deep vein thrombosis; therefore, spinal or epidural anaesthesia are the preferable techniques. We think that the article should mention the potential benefit of neuraxial blockades. Especially patients with comorbidities may benefit from a neuraxial blockade concerning outcome after operation. Anaesthetists might change their recommendation concerning the type of anaesthesia (general anaesthesia vs. spinal anaesthesia) for the patients after reading the article. The results of the study are interesting because they show a shift towards better tolerance of general anaesthesia if performed as a total intravenous anaesthesia. We conducted a very similar study nearly 15 years ago. We performed general anaesthesia as a balanced anaesthesia. Many complications after surgery were similar in both groups, nausea, too; in the study by Harsten et al. nausea was reduced.