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 .
Randomized Trial of Epidural Versus General Anesthesia: Outcomes After Primary Total Knee Replacement
To compare the effects of epidural anesthesia and general anesthesia on early postoperative outcomes after unilateral primary total knee replacement , 262 patients were r and omly assigned to receive either epidural or general anesthesia . All patients received a common rehabilitation protocol including a st and ardized assessment of progress . One hundred eighty-eight patients received a common thromboembolic prophylaxis protocol with postoperative aspirin , and had a st and ardized surveillance protocol to detect thromboembolic complications . Deep vein thrombosis was determined by venography on the operative limb , and pulmonary embolism was determined by comparison of preoperative and postoperative lung perfusion scans . The epidural anesthesia group reached all rehabilitative milestones earlier postoperatively than did the general anesthesia group , with a statistically significant earlier attainment of stair climbing . The incidence of deep vein thrombosis was 40 % with epidural anesthesia , and 48 % with general anesthesia . There were no clots proximal to the popliteal veins . The incidence of pulmonary embolism on lung scan was 12 % with epidural anesthesia and 9 % with general anesthesia . Epidural anesthesia is associated with more rapid achievement of postoperative in hospital rehabilitation goals after total knee replacement . A minor reduction in postoperative deep vein thrombosis rate was observed with epidural anesthesia , but this did not reach statistical significance . No difference in early postoperative pulmonary embolism was observed between the 2 types of anesthesia
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 .