Abstract: AIM: To systematically evaluate the effects of epidural anesthesia (EA) and combined spinal epidural anesthesia (CSEA) in femoral head replacement in elderly persons using meta-analysis. METHODS: Literature was retrieved in electronic databases covering PubMed, EMbase, CNKI and WanFang Data from established dates to July, 2013. Two reviewers independently screened studies according to the inclusion and exclusion criteria, extracted data and evaluated the methodological quality of the included studies. Then meta-analysis was performed using the software RevMan 5.2.RESULTS: Eighteen published randomized controlled trials involving a total of 1653 patients were suitable for inclusion in the review. The results of meta-analysis revealed that, the onset, duration time of motor-block time, and the sensory regressive time of CSEA were significantly shorter in femoral head replacement than that of EA. As the duration of anesthesia of CSEA was longer than that of EA, the number of patients needed extra anesthesia of CSEA was less. Moreover, the incidence rate of hypotension, bradycardia, shivering and an episode of oxygen desaturation in femoral head replacement with CSEA was lower than that with EA. CONCLUSION: The current evidence shows that, compared with EA, CSEA in elderly is superior in anesthetic efficacy, and is good at femoral head replacement.

Key words: elderly, femoral head replacement, epidural anesthesia, combined spinal epidural anesthesia, systematic review