Insights into spinal vs general anesthesia: Which comes out on top for same-day outpatient surgery?

Editor’s Note

A growing body of research is shedding new light on the long-running debate about spinal anesthesia (SA) and general anesthesia (GA) in outpatient surgical settings, Outpatient Surgery Magazine March 12 reports. Recent studies suggest both approaches can be considered safe and effective, with the “best” choice often hinging on the patient’s risk profile, procedure type, and provider preference.

Research published last November found SA and GA equally viable for primary total knee arthroplasty (TKA) when comparing long-term functional recovery and morbidity. However, the same study revealed a higher rate of deep venous thrombosis (DVT) among GA patients in total joint arthroplasty (TJA), and increased risk of pulmonary embolism (PE) in total hip arthroplasty (THA). Notably, 1-year mortality for GA patients after THA stood at 1.8%—three times higher than the 0.6% observed in the SA group. TKA patients, meanwhile, showed no significant difference in mortality based on anesthesia choice.

When it comes to hip fractures, a large 2021 randomized study by the Perelman School of Medicine at the University of Pennsylvania reported no significant outcome differences in survival or postoperative delirium between SA and GA, the article noted. Yet, the popularity of SA is on the rise: spinals for hip fractures have grown by 50% since 2007, helped in part by next-generation anesthetics and nerve blocks like the pericapsular nerve group (PENG) block. These techniques enhance pain control and can accelerate patient mobility after surgery.

SA continues to earn praise from many anesthesia providers for its superior pain management, reduced opioid use, and potential to lower the risk of complications such as DVT. It also speeds postoperative recovery and can aid outpatient surgery centers focused on efficiency. Nevertheless, GA still has strong advocates and is often preferred by some surgeons, with no clear evidence that it dramatically increases risk for most patient populations.

Ultimately, the “right” anesthesia choice—spinal or general—depends on procedure type, patient health status, and clinician judgment, the article concluded. For both approaches, studies consistently show that patient outcomes can be excellent when best practices in pain management and careful patient selection are employed.