So far , the evidence available from the studies included is insufficient to prove that neuraxial anesthesia is more effective and safer than general anesthesia for orthopedic surgery .
However , this systematic review does not rule out clinical ly important differences with regard to mortality , stroke , myocardial infa rct ion , length of hospitalization , postoperative cognitive dysfunction or pneumonia
CONTEXT AND OBJECTIVE Taking the outcome of mortality into consideration , there is controversy about the beneficial effects of neuraxial anesthesia for orthopedic surgery .
The aim of this study was to compare the effectiveness and safety of neuraxial anesthesia versus general anesthesia for  orthopedic surgery .
Comparison of general anesthesia with and without lumbar epidural for total hip arthroplasty: effects of epidural block on hip arthroplasty.
STUDY OBJECTIVES To determine whether lumbar epidural anesthesia , when combined with general anesthesia , decreases perioperative blood loss , the incidence of postoperative deep vein thrombosis ( DVT ) , cardiac dysrhythmias , and ischemia in patients undergoing total hip arthroplasty ( THA ) . DESIGN R and omized , controlled study . SETTING A university hospital . PATIENTS 37 ASA physical status I , II , and III patients , undergoing elective THA . INTERVENTION Patients were divided into two statistically comparable groups : Group GA = general anesthesia ; Group CEGA = general anesthesia plus lumbar epidural anesthesia . All patients had 48-hour perioperative Holter monitoring , applied on admission , the day prior to surgery . In both groups , general anesthesia was induced with thiopental sodium and muscle relaxant , and maintained with oxygen , nitrous oxide , isoflurane , opioid , and muscle relaxant . Group B received lumbar epidural anesthesia with 10 ml 0.5 % bupivacaine with 1:200,000 epinephrine prior to anesthesia induction . Blood loss was measured by suction bottle contents , sponge weights , and collection drainage . DVT was assessed with postoperative leg scanning , plethysmography , and venogram . MEASUREMENTS AND MAIN RESULTS Intraoperative blood loss was less after combined epidural-general anesthesia ( 663.8 ml + /- 299.0 ml ) than after general anesthesia alone ( 1,259.2 ml + /- 366.0 ml ) . The difference was found to be statistically significant ( p < 0.00005 ) . No difference was found between the two groups in postoperative blood loss , incidence of DVT , cardiac dysrhythmias , or ischemia . CONCLUSION Combined regional-general anesthesia decreases intraoperative blood loss in THA , and thereby offers an advantage over general anesthesia alone
So far , the evidence available from the studies included is insufficient to prove that neuraxial anesthesia is more effective and safer than general anesthesia for orthopedic surgery .
However , this systematic review does not rule out clinical ly important differences with regard to mortality , stroke , myocardial infa rct ion , length of hospitalization , postoperative cognitive dysfunction or pneumonia
CONTEXT AND OBJECTIVE Taking the outcome of mortality into consideration , there is controversy about the beneficial effects of neuraxial anesthesia for orthopedic surgery .
The aim of this study was to compare the effectiveness and safety of neuraxial anesthesia versus general anesthesia for  orthopedic surgery .