General Anaesthesia Versus Spinal Anaesthesia for Outpatient Total Hip and Knee Arthroplasty: A Randomised Trial Protocol
Abstract
Introduction: Same-day discharge after primary total hip arthroplasty (THA) and total knee arthroplasty (TKA) is increasing, but the optimal anaesthetic technique for outpatient pathways remains uncertain. Neuraxial anaesthesia is widely recommended based on observational evidence, whereas fast-track programmes using short-acting total intravenous anaesthesia may facilitate early mobilisation and discharge. No randomised controlled trial has compared general anaesthesia (GA) with spinal anaesthesia (SA) specifically in outpatient primary THA/TKA using a same-day discharge target.
Methods and analysis: GASPS is a pragmatic, multicentre, parallel-group superiority randomised controlled trial. Adults scheduled for outpatient primary THA or TKA will be randomised 1:1 to GA or SA, with stratification by site and procedure (THA/TKA). The primary outcome is successful same-day discharge (discharge on the day of surgery) without readmission within 48 h after discharge. The five key secondary outcomes are time to fulfilment of hospital discharge indicators, quality-of-recovery (QoR-15) trajectories over postoperative Days 1-35, patients' qualitative experiences of anaesthesia and recovery, cost per quality-adjusted life-year and safety (adverse events); all remaining outcomes-including pain, postoperative nausea and vomiting, opioid consumption, mobilisation and patient-reported outcomes (EQ-5D-5L and HOOS/KOOS)-are exploratory. An embedded qualitative study will explore patient…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design. Reported size: 35 participants or records.
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