OBJECTIVE: To compare the effectiveness of general (GA) Vs epidural (EA) Vs Spinal (SA) Vs a combination (GEA) anesthetic technique in terms of pain relief for patients undergoing hip arthroplasty. METHOD: In a prospective cohort open label multi-center study in three major general hospitals in Athens, Greece, all 210 patients undergoing hip arthroplasty during a period of one calendar year ending 25/12/1998 underwent face to face interviews after surgery and for four consecutive postoperative days. A Visual Analogue Scale (VAS) was used to measure intensity of pain on a continuous scale with the ends marked as “no pain” (0mm) and “worst pain ever” (100mm) twice daily. After controlling for demographics and ASA status, the study arms were compared on the basis of physician-suggested clinically meaningful pain intervals of: 0-30VAS (excellent analgesia), 31-50VAS (good analgesia), 51-70VAS (bad analgesia) and 71-100VAS (insufficient analgesia). Ordinary least square regressions were run with pain intensity as dependent variable and clinical, organizational, physician and patient characteristics as independent ones. RESULTS: Immediately after surgery, EA and GEA present statistically significant higher numbers of patients in the 0-30VAS interval than the rest two anesthesia techniques (p.005). EA and GEA also show lower numbers of patients at the “bad” and “insufficient” analgesia intervals at a statistically significant level during the study period, except for the third postoperative day. In regression analysis, locus of postoperative pain management responsibility, analgesia technique, and hospital practice variations significantly accounted for clinically meaningful differences in postoperative pain levels. CONCLUSIONS: Epidural and general/epidural anesthetic techniques result in more patients with excellent analgesia immediately after hip arthroplasty. The use of continuous postoperative epidural analgesia (CEPA) technique together with assigning anesthesiologists responsibility for post operative pain management result in better pain relief during a period of four postoperative days.