Aims: To determine whether lumbar spinal injection in conjunction with general anaesthesia decreases peri-operative blood loss and thereby transfusion rates as compared to general anaesthesia alone in patients undergoing primary hip arthroplasty.

Methods: This is an observational study of 47 consecutive patients who underwent unilateral primary total hip arthroplasty. These were all performed by the same surgeon using the same approach, prosthesis and postoperative care. Group I consisted of 28 patients who had combined lumbar spinal and general anaesthesia performed by the same anaesthetist. Group II consisted of 19 patients who had general anaesthesia alone. Analysis was made of intra-operative blood pressure, post-operative haemoglobin levels using Mann-Whitney test and of transfusion rates using Fischer’s exact test.

Results: Group I had a mean intra-operative mean arterial pressure of 53 (range 38–72.5) compared to 65 (range 45–94) in group II. This was a statistically significant difference (p = 0.0006). There was a mean drop in haemoglobin of 29 (range 9–53) in group I and of 40 (range 22–56) in group II. This was a statistically significant difference (p = 0.0006). 2 patients ( 7.1%) in group I required blood transfusion as compared to 8 (42.1%) in group II. Again this result was significantly different (p = 0.0086).

Conclusion: Some previous studies have shown transfusion rates as high as 75 %. We recommend the use of combined lumbar spinal and general anaesthesia in primary total hip arthroplasty as it significantly reduces peri-operative blood loss and transfusion rates, in our study to only 4.1%. This may reduce the risk of infection and improve the bone cement interface in a cemented hip arthroplasty.