title: Neuraxial anesthesia for orthopedic surgery: systematic review and meta-analysis of randomized clinical trials.
abstract: 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.
  
  
  METHODS
  Systematic review at Universidade Federal de Alagoas.
  
  
  METHODS
  We searched the Cochrane Central Register of Controlled Trials (Issue 10, 2012), PubMed (1966 to November 2012), Lilacs (1982 to November 2012), SciELO, EMBASE (1974 to November 2012) and reference lists of the studies included. Only randomized controlled trials were included.
  
  
  RESULTS
  Out of 5,032 titles and abstracts, 17 studies were included. There were no statistically significant differences in mortality (risk difference, RD: -0.01; 95% confidence interval, CI: -0.04 to 0.01; n = 1903), stroke (RD: 0.02; 95% CI: -0.04 to 0.08; n = 259), myocardial infarction (RD: -0.01; 95% CI: -0.04 to 0.02; n = 291), length of hospitalization (mean difference, -0.05; 95% CI: -0.69 to 0.58; n = 870), postoperative cognitive dysfunction (RD: 0.00; 95% CI: -0.04 to 0.05; n = 479) or pneumonia (odds ratio, 0.61; 95% CI: 0.25 to 1.49; n = 167).
  
  
  CONCLUSIONS
  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 clinically important differences with regard to mortality, stroke, myocardial infarction, length of hospitalization, postoperative cognitive dysfunction or pneumonia.
authors.affiliation: Department of Anesthesiology, Universidade Federal de Alagoas, MaceióAlagoas, Brazil.
authors.forename: Fabiano Timbó
authors.initials: FT
authors.lastname: Barbosa
authors.affiliation: Department of Surgery, Universidade Estadual de Ciências da Saúde de Alagoas, MaceióAlagoas, Brazil.
authors.forename: Aldemar Araújo
authors.initials: AA
authors.lastname: Castro
authors.affiliation: Department of Anatomy, Universidade Estadual de Ciências da Saúde de Alagoas, MaceióAlagoas, Brazil.
authors.forename: Célio Fernando de
authors.initials: CF
authors.lastname: Sousa-Rodrigues
mesh_terms: D000767:Anesthesia, Epidural / Q000401:mortality* / Q000592:standards; D000768:Anesthesia, General / Q000401:mortality / Q000592:standards; D000775:Anesthesia, Spinal / Q000401:mortality* / Q000592:standards; D003072:Cognition Disorders / Q000209:etiology; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D009203:Myocardial Infarction / Q000209:etiology; D019637:Orthopedic Procedures; D011014:Pneumonia / Q000209:etiology; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D020521:Stroke / Q000209:etiology