BACKGROUND: The mean blood loss is about 500-1,700 ml by general anesthesia technique in total hip replacement (THR) and the amount of blood loss is dependent on the degree of induced hypotension. We performed this study to evaluate the differences on the amount of blood loss and the number of transfused patients according to different anesthetic technique under the similar hypotension level. METHODS: Forty-seven patients of ASA physical status class 1, 2 and 3, scheduled for THR, were randomly assigned into epidural anesthesia group (E group), combined general epidural anesthesia group (GE group) and general anesthesia group (G group). G group was maintained with sevoflurane anesthesia and the monitoring of central and arterial blood pressure was performed. The remifentanil (0.1microgram/kg/min) was infused continuously for the target mean arterial pressure of 60 +/- 5 mmHg. GE group received general anesthesia with the same technique of G group and epidural anestheia was combined after general anesthesia. The remifentanil (0.1microgram/kg/min) was infused continuously for the target mean arterial blood pressure of 60 +/- 5 mmHg. E group received epidural anesthesia with 0.75% ropivacaine and additional bolus dose of local anesthetics was injected if the mean arterial blood pressure did not reach 60 +/- 5 mmHg. RESULTS: The mean volume of blood loss and the number of transfused patients was significantly less in E or GE group at 24 hour after surgery (P < 0.05), however we could not find any significant differences during intraoperative period. CONCLUSIONS: Epidural or combined general epidural anesthesia technique is a good method to reduce bleeding and the number of transfused patients.