Epidural analgesia with a local anaesthetic minimizes the catabolic response to surgery. To determine whether this could enhance the rate of recovery following orthopedic surgery, 51 patients undergoing bilateral one-stage total knee arthroplasty were randomized to receive continuous epidural bupivacaine/fentanyl or continuous intravenous fentanyl to compare the efficacy of these modes of pain relief on postoperative clinical outcomes and rates of rehabilitation. Infusions were maintained for 36 to 48 hours in a postanesthesia care unit. Postoperatively, pain relief (visual analogue scale), attainment of physical therapy goals, and cardiopulmonary complications were measured daily for 7 days. Epidural analgesia with a combination of bupivacaine and fentanyl did not result in any measurable improvement in rehabilitation milestones or reduction in postoperative complications following bilateral total knee arthroplasty than with fentanyl infusions alone.