EP3.15 Anesthetic Technique in Hip Arthroscopy: A Systematic Review of General versus Neuraxial Approaches

Abstract Background Hip arthroscopy is increasingly performed for femoroacetabular impingement syndrome (FAIS). While general anesthesia (GA) is most commonly used, neuraxial anesthesia (NA) has been proposed as an alternative. Evidence specific to hip arthroscopy remains limited and heterogeneous. Purpose To compare general and neuraxial anesthesia for hip arthroscopy with respect to perioperative outcomes, complications, and efficiency metrics. Methods A systematic review was conducted in accordance with PRISMA guidelines. MEDLINE, Embase, Cochrane CENTRAL, and Scopus were searched from January 2016 to March 2026. Comparative studies evaluating GA versus NA in adult patients undergoing hip arthroscopy were included. Data were extracted using a standardized form and risk of bias was assessed using the ROBINS-I tool. Findings were synthesized qualitatively given anticipated clinical and methodological heterogeneity. Results Five retrospective comparative studies were included, with sample sizes ranging from 58 to 240 patients. Neuraxial anesthesia was associated with lower immediate postoperative pain scores (median 5.2 vs 6.2); and reduced opioid consumption in the PACU (6.0 vs 8.1 mg), although one study reported no statistically significant differences. Findings related to perioperative efficiency were heterogeneous. Some studies demonstrated shorter early recovery times with neuraxial anesthesia, while others reported no difference or longer total perioperative time related to anesthesia preparation. No consistent differences were reported between anesthesia types in longer-term functional outcomes, complication rates, or need for subsequent surgery. Urinary retention was more frequently reported with neuraxial anesthesia in one study. Conclusion Neuraxial anesthesia may provide improved immediate postoperative analgesia and reduced opioid requirements following hip arthroscopy, without compromising longer-term outcomes. Its impact on perioperative efficiency is variable, and the existing evidence base is limited to small retrospective studies at moderate-to-high risk of bias. Neuraxial anesthesia represents a reasonable alternative to general anesthesia where early analgesia and opioid-sparing are prioritized, though prospective comparative trials are needed to define its role.