Adverse Effects Associated With Spinal Versus General Anaesthesia for Hip and Knee Arthroplasties: Protocol for a Systematic Review

BACKGROUND: Spinal and general anaesthesia are the most common anaesthetic methods for hip and knee arthroplasties. Differences in their effects on short- and long-term postoperative outcomes, including mortality morbidity, and adverse events, remain uncertain. Identifying the anesthetic method that provides the best recovery could help optimise patient care. Previous reviews have reported conflicting results and have methodological limitations, highlighting the need for an updated systematic review. METHODS: This protocol describes a Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) compliant systematic review and meta-analysis of randomised clinical trials, incorporating Trial sequential analysis. The review aims to evaluate the beneficial and harmful effects of spinal versus general anaesthesia in adult patients undergoing hip or knee arthroplasty. To identify relevant trials, we will search major medical databases (e.g., MEDLINE, EMBASE, CENTRAL) and clinical trial registries and include all trials directly comparing spinal versus general anaesthesia. Two review authors will independently screen the literature, extract data and conduct risk of bias assessment (Cochrane Risk of Bias tool-version 2 (RoB-2)). The primary outcome will be the proportion of participants with one or more serious adverse events. Secondary outcomes will be pain, postoperative opioid consumption, time to first mobilisation, hospital length of stay, non-serious adverse events, and quality of recovery. The certainty of evidence will be assessed by Grading of Recommendations, Assessment, Development and Evaluations (GRADE) and presented in a 'Summary of Findings' table. DISCUSSION: To guide clinicians in choosing between spinal and general anaesthesia for hip and knee arthroplasties, a systematic review of the existing evidence is needed. This review will support clinicians and patients in weighing the benefits against the harms of the two anaesthetic methods and in making evidence-based, informed decisions.