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Hip Surgery and Venous Thrombosis: Effect of Anesthesia-Reply

Russell D. Hull, MBBS, MSc; Gary E. Raskob, MSc
JAMA. 1990;264(16):2072. doi:10.1001/jama.1990.03450160040013.
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In Reply.—  The patients in our randomized trial received general anesthesia. Spinal anesthesia was not in use for patients undergoing hip replacement at our center during the period of study (1978 to 1986).We agree with Dr Schultheis that the effect of anesthetic management on recovery from hip surgery remains controversial. Randomized clinical trials suggest that the frequency of deep-vein thrombosis may be reduced by the use of spinal anesthesia, but the absolute rate of thrombosis remains relatively high (29%).1 In the study by Davis et al,2 spinal anesthesia was associated with an apparently low rate of deep-vein thrombosis (13%). However, this latter trial underestimated the frequency of deepvein thrombosis because venography was not performed in patients with negative findings by fibrinogen leg scanning and impedance plethysmography; we and others3,4 have reported that these noninvasive tests fail to identify 30% to 54% of patients with deep-vein


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