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Hip and knee replacement: spinal anesthesia and nerve blocks

What large studies found about spinal versus general anesthesia for joint replacement, and why nerve blocks are recommended.

2 minute read7 sources, each checked word for wordLibrary checked October 18, 2026

In short

  • In a national study of joint replacement, spinal or epidural anesthesia was linked with better outcomes than general anesthesia alone.E2Good1
  • An international consensus recommends peripheral nerve blocks for hip and knee replacement unless they are contraindicated.E2Good2
  • For hip fracture, nerve blocks reduce pain on movement and acute confusion.E1Strong3

How sure each claim is:E1StrongE2GoodOfficial textReviewWhat the grades mean

Spinal or general anesthesia?

In a large US database of hip and knee replacements, neuraxial (spinal or epidural) anesthesia was associated with better outcomes than general anesthesia. The authors called for research into why.E2Good1

Association is not proof of cause. A randomized trial studied older adults having hip fracture surgery. Spinal anesthesia was not superior to general anesthesia for survival and walking at 60 days.E1Strong4

Serious complications of spinal and epidural anesthesia are rare.E2Good5

Nerve blocks

The International Consensus on Anesthesia-Related Outcomes after Surgery group recommends peripheral nerve blocks in hip and knee replacement for improved outcomes.E2Good2

It recommends them unless contraindications prevent their use, and says the team's skills and the hospital's resources need to match.E2Good2

A review estimated nerve symptoms after peripheral nerve blocks at under 3%, with permanent injury rare.Review6

In adults with hip fracture, a Cochrane review found that nerve blocks reduce pain on movement and acute confusion. They probably also reduce chest infections and time to first getting up.E1Strong3

Blood thinners and the block

Bleeding complications with regional anesthesia are extremely rare, and a regional anesthesia society proposes conservative times for pausing blood thinners before these blocks.E2Good7

Questions you might bring to your anesthesia team

  1. Will I have spinal anesthesia, general anesthesia, or both?
  2. Will I have a nerve block, and how long will the numbness last?
  3. What is the plan for my blood thinner around the spinal or block?
  4. How will pain be managed at home, with and without opioids?

Every claim in this guide was written from its sources and checked against them word for word. Its clinical review by Dr. Recio, a practicing nurse anesthesiologist (CRNA), is pending. This line changes when the review is done.

Sources

Each source opens on PubMed, DailyMed or the publisher's page. Under each one are the exact words from it that this page relies on, copied word for word and checked against the original.

  1. Perioperative comparative effectiveness of anesthetic technique in orthopedic patients. Memtsoudis SG, Anesthesiology, 2013. E2Good Observational study
    The words this page rests on
    The utilization of neuraxial versus general anesthesia for primary joint arthroplasty is associated with superior perioperative outcomes. More research is needed to study potential mechanisms for these findings.
  2. Peripheral nerve block anesthesia/analgesia for patients undergoing primary hip and knee arthroplasty: recommendations from the International Consensus on Anesthesia-Related Outcomes after Surgery (ICAROS) group based on a systematic review and meta-analysis of current literature. Memtsoudis SG, Reg Anesth Pain Med, 2021. E2Good Consensus statement
    The words this page rests on
    PNB use is recommended for patients undergoing THA and TKA except when contraindications preclude their use. Furthermore, the alignment of provider skills and practice location resources needs to be ensured.
    Based on the current body of evidence, the consensus group recommends PNB use in THA/TKA for improved outcomes.
  3. Peripheral nerve blocks for hip fractures in adults. Guay J, Cochrane Database Syst Rev, 2020. E1Strong Systematic review
    The words this page rests on
    PNBs reduce pain on movement within 30 minutes after block placement, risk of acute confusional state, and probably also reduce the risk of chest infection and time to first mobilization.
  4. Spinal Anesthesia or General Anesthesia for Hip Surgery in Older Adults. Neuman MD, N Engl J Med, 2021. E1Strong Randomized trial
    The words this page rests on
    Spinal anesthesia for hip-fracture surgery in older adults was not superior to general anesthesia with respect to survival and recovery of ambulation at 60 days. The incidence of postoperative delirium was similar with the two types of anesthesia.
  5. Major complications of central neuraxial block: report on the Third National Audit Project of the Royal College of Anaesthetists. Cook TM, Br J Anaesth, 2009. E2Good Observational study
    The words this page rests on
    Serious complications of central neuraxial block (CNB) are rare.
  6. Neurological complications after regional anesthesia: contemporary estimates of risk. Brull R, Anesth Analg, 2007. Review Expert review
    The words this page rests on
    Our review suggests that the rate of neurological complications after central nerve blockade is <4:10,000, or 0.04%. The rate of neuropathy after PNB is <3:100, or 3%. However, permanent neurological injury after RA is rare in contemporary anesthetic practice.
  7. Regional anesthesia in the patient receiving antithrombotic or thrombolytic therapy: American Society of Regional Anesthesia and Pain Medicine Evidence-Based Guidelines (fifth edition). Kopp SL, Reg Anesth Pain Med, 2025. E2Good Guideline
    The words this page rests on
    Hemorrhagic complications associated with regional anesthesia are extremely rare.
    It is impossible to perform large, randomized controlled trials evaluating a complication this rare; therefore, where the evidence is limited, the authors continue to maintain an 'antihemorrhagic' approach focused on patient safety and have proposed conservative times for the interruption of therapy prior to neural blockade.