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 .
Postoperative outcome in Chinese patients having primary total knee arthroplasty under general anaesthesia/intravenous patient-controlled analgesia compared to spinal-epidural anaesthesia/analgesia.
OBJECTIVE To compare postoperative outcomes in patients having primary total knee arthroplasty receiving general or regional anaesthesia .  DESIGN R and omised prospect i ve study . SETTING Regional hospital , Hong Kong . PATIENTS Patients having primary total knee replacement were r and omised to either general anaesthesia followed by postoperative intravenous patient-controlled analgesia with morphine , or combined spinal-epidural anaesthesia followed by postoperative epidural infusion of bupivacaine 0.1 % with fentanyl 2 microg/mL. MAIN OUTCOME MEASURES Visual analogue scale pain scores , perioperative blood loss , time to first meal and ambulation , and prevalence of postoperative complications . RESULTS Sixty consecutive patients were enrolled in this study . Postoperative median pain scores were consistently lower at 1 ( P<0.0001 ) , 6 ( P=0.08 ) , 12 ( P=0.003 ) , 24 ( P=0.14 ) , and 48 hours ( P=0.007 ) in those given regional anaesthesia . Although there was a trend towards fewer complications in the latter group , there were no statistically significant differences between the two groups with respect to the incidence of postoperative blood loss , haemodynamic instability , pruritus , nausea , vomiting , urinary retention , or other surgical/medical complications . Postoperatively , patients given regional anaesthesia also resumed meals earlier ( P<0.0001 ) , and showed a trend towards earlier ambulation and hospital discharge . CONCLUSION Chinese patients undergoing total knee arthroplasty with  regional anaesthesia/regionally delivered analgesia enjoyed better postoperative pain relief and resumed meals earlier than those receiving general anaesthesia/intravenous patient-controlled analgesia . The former also showed trends towards less adverse effects , postoperative complications , earlier ambulation , and earlier hospital discharge
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 .